Orthopedics
When you have joint pain, every step becomes about finding relief. That's where the musculoskeletal experts at UMass Memorial Health Care can help. We can help relieve your pain and keep you moving so you can enjoy your life.
Our experts answer your orthopedic/joint replacement-related questions below.
Physician
David Ayers, MD; Donald Hangen, MD; and Robert Jones, MD
Q:
I have to get my knees done but I’m dreading the pain and rehab. How bad is it?
A:
Everyone experiences the pain associated with the operation differently. At UMass Memorial, we've developed a complete new program for helping patients manage pain--starting before the pain even begins. Because we strongly believe that the less pain a patient has, the better their rehabilitation will be, we:
- Begin to treat the pain before the pain exists by giving medications at the time of admission, before surgery.
- Eliminate intravenous drugs, and with it the associated side-effects of nausea, vomiting, altered mental status and constipation.
- Use a multi-modal pain management approach using four different oral medications that each target a different part of the pain pathway.
- Emphasize the use of spinal anesthesia in place of general anesthesia.
- Use regional nerve blocks to supplement the spinal anesthesia. This new pain treatment pathway has changed the model of care and dramatically improved the experience for patients who are having total joint replacement.
A recent review by an outside organization on patient care took notice of our program and has begun to recommend that other hospitals adopt a similar approach.
Q:
When is it time to consider a joint replacement?
A:
When to proceed with surgery is often a difficult decision for patients. The most important consideration is the amount of pain you are experiencing.
When your pain limits your function and can’t be relieved by medications (Tylenol, Alleve, Advil) or other non-operative treatment options like injections, it’s time to talk to discuss surgical options with an orthopedic surgeon that specializes in joint replacement surgery.
Q:
Can ultrasound be used to diagnose muscle problems? Is it better for injecting joints? Can I have it done at Memorial?
A:
Ultrasound can be used to aide in a variety of orthopedic diagnoses. It can assist in diagnosing muscle problems and can be used to facilitate injections into joints.
This technology is available at the Memorial Campus in the Rheumatology Practice
Q:
What can I do for pain?
A:
This depends on where the pain is; the type of pain and many other factors. I would recommend that you contact your primary care physician and see his/her advice soon. Pain should not be ignored but investigated.
Q:
I do crossfit training. I have had bruising on both my knees after working out for past 2 months especially after running/sprinting.
My first 10 steps when I start running my right ankle gives but then adjusts and its fine and bottom of my heels hurt.
Could it be heel spurs which is throwing off my knees due to compensation?
A:
Heel pain can be caused by a number of conditions; heel spurs and plantar fasciitis are two of them. I would suggest that you have an evaluation by a sports medicine trained physician to evaluate your knees, ankles and feet all of which may or may not be contributing to your symptoms.
Q:
I have what sounds like grinding in my knee when I move it, but my other knee is ok. What does this mean?
A:
Grinding in your knee can mean many things. If you are not having pain, then it may be related to some minor cartilage wear (chondromalacia).
This is commonly felt walking up stairs and generally is mild and does not require any specific intervention. If the grinding is accompanied by pain and/or swelling, it may indicate more significant cartilage wear such as osteoarthritis, or other condition.
If you have pain and/or swelling, I would advise having a physician examine your knees and consider obtaining an x-ray as well.
Q:
When walking down stairs there is a loud "tearing" noise in my left knee but no pain. It only happens when walking down stairs. I walk on the treadmill regularly - no noise no pain. What could be happening?
A:
Both ascending and descending stairs involves significant mechanical forces across the knee especially in the patella-femoral joint (kneecap).
The noise you experience in your knee may be related to some cartilage wear (Chondromalacia) on the underside of your kneecap. If there is no associated pain, it is less likely to be of concern.
A tearing sensation may also indicate a tear in the meniscus (cushioning cartilage) in the knee, but that would usually cause some pain and swelling.
Q:
At 30 years old I was diagnosed with osteoarthritis. My rheumatologist simply started me on 1,000mg of Vitamin D a day and it helped significantly so I do not need to see her again unless the pain worsens. Is it common for someone with osteoarthritis to need just vitamin D for relief and should I be prepared for an increase of pain in the future?
A:
Vitamin D is very important in maintaining healthy bones and joints. It helps in the absorption of calcium for one thing. Vitamin D deficiency may increase the risk of osteoarthritis. A recent study showed that the converse may not be true - meaning that Vitamin D supplementation may not decrease knee pain or prevent further cartilage loss.
Vitamin D supplements have certainly been given to individuals who have osteoarthritis and I would continue your Vitamin D supplements as prescribed by your rheumatologist.
Q:
Are any surgeons doing bilateral knee replacements during the same admission?
A:
Let me answer your question with a broader discussion of simultaneous bilateral knee replacements. In certain younger and healthier patients with arthritis affecting both knees, it is possible to do both knee replacements at the same time. This allows one hospitalization and avoids having to undergo surgery twice and recover twice.
This has to be balanced with studies that show a higher complication rate with simultaneous bilateral knee replacements. These risks include higher rates of cardiac events, higher rates of needing a blood transfusion, and higher rates of having a pulmonary embolus (blood clot in the lung). It is also harder to do the rehabilitation following a bilateral procedure.
Many surgeons (myself included) prefer to do staged knee replacements starting with one side and then following with the other side 6-12 weeks later.
This minimizes risks and may lead to improved outcomes. However, in the right patient, simultaneous bilateral knee replacements are an option.
Q:
Why is there so little study being done about causes and treatments of heterotopic ossification? Once you get it, it seems little can be done to fix the problem.
A:
Heterotopic ossification is a condition where bone forms outside of the skeleton. This is primarily in the soft tissues surrounding bone.
It can happen following hip surgery, but can also happen after fractures, other trauma, and other metabolic conditions. There are definitely treatment options to both prevent heterotopic ossification and to treat it once it has happened.
These include anti-inflammatory and other drugs, as well as radiation therapy. Unfortunately none of these measures are 100% effective. Heterotopic ossification that occurs following hip surgery is usually something seen on an x-ray with little to no symptoms or clinical significance.
When it causes pain or impingement or other symptoms, it can be surgically removed, although there is a risk of recurrent bone formation. There are studies being done on the biology, causes, prevention, and treatment of heterotopic ossification. I would refer you to the American Academy of Orthopaedic Surgeons website at aaos.org.
Q:
I'm having pain when I sit and lay down. It is better when I'm standing, but it's starting to hurt a bit when I walk now. The pain has been going on for about 2 months. Been using ibuprofen and hot/cold packs but nothing works.
A:
Since you have been having hip pain for a couple of months, it is worth having it evaluated. There are many causes of hip pain from tendonitis and bursitis to arthritis or other conditions.
Anti-inflammatory medications and hot and cold packs are a good place to start, but with pain walking and the duration of the pain, I would suggest seeing a physician and likely having an x-ray.
Q:
I am loaded with arthritis. Have had both shoulders and knees replaced. (total) There is not a day, that I don't have pain.
A:
(see answer below)
Q:
In 2004 I was diagnosed with Dilated Cardiomyopathy and CHF. Since this time, I could not have any arthritis medication. If I can't take arthritis medicine, what can be done for me at this point. How can you help me?
A:
The answer to your question depends on a few additional details. Do you have osteoarthritis (degenerative wear and tear type arthritis) or inflammatory arthritis (rheumatoid arthritis, for example)?
Another question would be: is your pain in the replaced joints (indicating something mechanical or soft tissue), or in other joints (indicating ongoing arthritis)? There are many different types of arthritis medications that work by different mechanisms in your body. They include analgesics (control pain), anti-inflammatory medications, and medications that are specifically for inflammatory disease.
There are even nutritional supplements that have been shown to have some benefit in arthritis. In your case, it will likely take your health care providers (orthopedist, cardiologist, and primary care physician) working together to find the right medications and treatment options for you.
Q:
I have wrist pain on my left hand outside. It puffs out and feels hard and very painful at times and I am loosing my strength due to the pain. Not constant, movement does aggravate it. How should I proceed? Orthopedic or just an x-ray?
A:
Pain and swelling in the wrist may be due to overuse causing inflammation of the tendons or ligaments. It might also be result from early arthritis in the wrist joint.
If this continues to be a problem even after a period of rest, have it evaluated by your primary care physician or an orthopedic doc. X-rays may likely be taken to evaluate the bone structure. Physical therapy is a usual first treatment for this sort of problem.
Q:
I have severe pain in left knee. I made a visit to Memorial Joint Center. Bursitis, tendinitis, torn cartilage, water on knee. Received shot with little lessening of pain. How can I heal torn cartilage without surgery ?
A:
The names of the structures in the knee can be confusing, but "torn cartilage" usually means "torn meniscus." The cartilage is the smooth covering of the bone, and the meniscus is the wedge-shaped cushion between the bones. Studies published in the last month show that physical therapy is just as effective as surgery for the treatment of meniscus tears.
Some people also benefit from the use of a brace to help provide the knee with a bit of stability as the inflammation resolves. If there is moderate or severe arthritis associated with the meniscus tear, these treatments tend to be less effective.
Q:
Sometimes when I walk, I have to press around my upper right buttock to prevent pain. When I walk in place and start raising my knees higher and higher likewise I need to press the upper area of the right buttocks to stop this sharp pain in the buttock. Any explanation as to why this is happening and what I can do to improve?
A:
Pain in the upper buttock (gluteal region, or lower back) may be due to muscle strain, irritation of the sciatic nerve, or inflammation of the sacroiliac (SI) joint.
These problems are usually treated with specific exercises or physical therapy. Less common causes might include irritation of nerves in the lower back or hip joint inflammation. If the pain is persistent, have it evaluated by your primary care physician or an orthopedic doc.
Q:
I need help walking. I had miniscus and cartilage removed. I have full arthritis in my knee, and I'll be 40 in ten days. I have been rejected for help. I have a hard time walking and standing. I cant sleep longer than 3 hours a night. I am beyond depressed and I just want relief without being handed a prescription.
A:
Moderate or severe arthritis in a 40 year old is indeed a difficult problem. The most immediate issue is the depression – please seek help from your primary care physician, a family member or an elder at your church for this.
Depression can be treated – there is hope. For the knee, injections of steroid or HA(an artificial lubricating and cushioning agent) may be helpful.
Bracing and physical therapy can also provide relief. If these options don’t work, a variety of different surgeries may be considered.
Q:
I have joint pain on my fingers for almost one year now, I only take vitamin C and D. Please help. Thanks.
A:
Joint pain in the fingers is usually due to degenerative arthritis (smooth cartilage covering of the bone wears out, and rough surfaces rub together). Treatment frequently involves the use of anti-inflammatory medications like ibuprofen or Aleve and physical therapy.
Injections of steroids into the joints or splinting may also be helpful to help reduce swelling and pain. It is usually important to keep the joints moving as much as possible.
Q:
Hi, my Mom had a knee replacement about 6 years ago and has had no improvement at all as far as pain goes. Do you think a seminar would be helpful for her to go to? Thank you.
A:
Pain after knee replacement is a complex problem, and usually requires a variety of tests to determine the cause. These seminars are not focused on pain after surgery, so it is unlikely that the information presented will directly give you an answer to your question.
Even so, I'd be happy to answer your questions at the seminar on April 23 in Leominster where I'll be presenting. You can register at www.umassmemorial.org/ortho or call 888-358-6277.
Q:
I have had bad knees for approx. 15 years & have had knee replacement suggested, bone on bone, and I do not want an operation. Any suggestions to relieve pain?
A:
Bone on bone means that the smooth cartilage covering of the bone surface is gone. Rough bone rubs on rough bone, frequently causing swelling, pain, instability and weakness.
The first line of nonoperative treatment involves gentle exercises to maintain range of motion and strengthen muscles. Bracing is also sometimes helpful.
Oral medications like Tylenol and NSAIAs(Motrin, Aleve, Advil) frequently reduce pain. The medical literature is unclear about the usefulness of Glucosamine and Chondroitin Sulfate.
Steroid injections can help relieve the pain and decrease swelling. HA injections(a synthetic lubricant and cushioning agent) may also give temporary relief.
Q:
I have a problem with my ankles - they are painful and have a burning sensation. Also, I have severe foot and leg muscle spasms mostly when I am sleeping. Thank you for your help.
A:
A burning sensation in the ankles could be caused by arthritis or ligament strain in the ankles. Exercises and physical therapy are often helpful.
Less frequently, this sort of problem may be due to irritation of nerves from the lower back. Muscle spasms may be due to slight chemical imbalances or restless leg syndrome.
It they continue to be a problem, please contact your primary care physician.
Q:
It's been 11 wks post surgery for TKR having clicking sound and the knee sometimes buckels and goes out. Also because of a leg length discrepency having pain in right groin area which also tends to go out of place.What are the next options?
A:
Clicking after a TKA in not uncommon, and it doesn't necessarily mean that there is something wrong. The noise usually diminishes over time as the soft tissues continue to heal. This may take six month or more after the surgery. Buckling and giving way may be due to weakness of the muscles after the operation, and this frequently resolves with physical therapy and time.
Persistent instability after TKA is unusual, and the ligaments around the knee should be checked if this problem does not improve. True leg length discrepancy caused by TKA is extremely rare- if pain is present in the groin as well, an x-ray may be needed to determine if there is a problem with the hip joint.
Q:
I was born with cerebral palsy. I haven't had an orthopedic doctor since I was a child. Im 55, and now the good side is wearing out. Will elastic supports you buy at cvs help with ankle and knee pain? or they a waste of money?
A:
Elastic supports may be helpful if the underlying damage to the joints is not severe. If there is arthritis or ligament damage, braces with metal supports may be helpful, but each patient is different. Cerebral Palsy is complex; an orthopaedic doctor specially trained in rehab may be useful.
Q:
I have had both knees and hips replaced. However, I still have occasional intense pain in them. Why?
A:
A small percentage of patients have pain after joint replacement for unexplained reasons. This tends to be somewhat more frequent in knee replacements than in hips. Persistent pain can on rare occasions be caused by loosening of the replacement or infection.
Occasional pain is usually less concerning. Specialized tests, including blood work , analysis of fluid from the joint or bone scan may be done to help determine the cause of the pain.
Q:
Husband needs knee replacement at 40 yrs. what's the recovery time? Other options?
A:
Knee replacements in 40 year olds are uncommon but indicated in some circumstances. Recovery time is usually 2-4 days in the hospital after surgery, and then intensive physical therapy for 4-6 weeks.
Younger patients can often return to desk jobs in 3-6 weeks, and more demanding jobs between 1 and three months. Options include physical therapy, injections, anti-inflammatory medication, bracing and sometimes specialized arthroscopic surgeries that restore or regrow cartilage.
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