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HOW TO AVOID A KNEE REPLACEMENT

Updated: Mar 29, 2019


What is osteoarthritis?

Osteoarthritis (OA) is a chronic condition that commonly affects the knee. It is often characterised by pain, stiffness and swelling, and most frequently occurs in people over the age of 55. Other risk factors include previous joint injury and being overweight or obese.



What do the experts say?


In July 2018, the Royal Australian College of General Practitioners (RACGP) released new guidelines for the management of knee osteoarthritis.

The guidelines “strongly recommend land-based exercise for all people with knee OA to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels”.


This includes: - Muscle strengthening - Stretching - Aerobic conditioning - Neuromuscular/balance training- Cycling - Tai Chi/Yoga - Aquatic exercise/hydrotherapy


Weight management is strongly recommended for people with knee OA. Being overweight/obese is a major risk factor for the onset and progression of OA. A relationship exists between the amount of weight lost and symptomatic benefits. Weight loss is effective because it reduces the load on the joint.


A study looking at walking in obese older adults with OA shows that for every kilo of weight lost, it reduces the force going through the knee by twice the amount. (Aaboe et al., 2011).



What does this mean for me?


Exercise is one of the most effective treatments for OA. It is important to engage in low impact activities so that there is less force or weight going through the joint. Examples of low impact exercise include walking, cycling and swimming. Strengthening exercises, water exercise, and Tai Chi are other forms of exercise that are also recommended.



How does exercise help?


Exercise plays an important role in maintaining and improving your ability to move and function. With osteoarthritis, your joints become really stiff and painful. Stretching and range of motion exercises help maintain the flexibility of your joints. Stretches stop the muscles from pulling too hard on the joint decreasing pain. Strengthening exercises help to support and reduce the load on the joint. They also help to improve the biomechanics and increase smoothness when walking because your muscles are working more efficiently.



How about painkillers and corticosteroid injections?


The evidence for pharmacological interventions such as painkillers and corticosteroid injections is not as strong. Long term use of these interventions can lessen their effects over time as well as having other negative health impacts such as gut irritability and even ulcers. They should only be used sparingly and in conjunction with lifestyle changes (e.g. exercise and weight loss).



Do I need to see a surgeon?


Surgical intervention such as a total joint replacement should only be considered when all appropriate conservative options, delivered over a reasonable period of time, have failed. Referral to an orthopaedic surgeon should be based on a significant decline in quality of life due to end- stage joint arthritis.



IN SUMMARY

To avoid progressing to end-stage joint arthritis and ultimately requiring a total joint replacement, it is vital to adopt lifestyle changes and prioritise regular exercise in order to relieve pain, increase function and improve quality of life.


So what does a typical exercise program look like?

We have put together a general exercise program to give you an idea of what you should be doing. Typically, stretches are to be done twice a day, and strength exercises once per day.


STRETCHES

Quad stretch

  • When standing, use your hand to pull your foot towards your bottom.

  • You should feel a stretch in the front of your thigh.

  • Hold this position for a minute.

Hamstring stretch

  • When standing place your leg on a chair.

  • Keep your leg and your back straight, and bend forwards at the hips.

  • You should feel a stretch at the back of your thigh.

  • Hold this position for a minute.

Calf stretch

  • Start by standing on a step.

  • Bring your foot halfway off the step and drop your heel towards the ground.

  • You should feel a gentle stretch in the back of the calves.

  • Hold this position for a minute.


STRENGTH

Mini Squats:

  • Start with your feet shoulder width apart and keep your toes and knees pointed forward.

  • Slowly bend down 1/4 way then back up.

  • Repeat 10 times for 3 sets.

Lunges

  • Begin by standing with one foot a large step-length in front of your other foot.

  • Make sure both feet are pointing forwards.

  • Slowly bend your knees so that your back knee lowers towards the floor, then come back up.

  • Repeat 10 times for 3 sets.


If you have any further questions, you are more than welcome to come and see us. We will be able to conduct a full strength and biomechanical assessment, and prescribe an individually tailored exercise program specifically targeting your needs.

Give us a call on 9875 3760

References:

Aaeboe, J., Bliddal, H., Messier, SP., Alkjaer, T., Henriksen, M., 2011. Effects of an intensive weight loss program knee joint loading in obese adults with knee osteoarthritis. Osteoarthritis Cartilage.19(7): 822-8. doi: 10.1016/j.joca.2011.03.006.

RACGP Guidelines: https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/ guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf

You do not need a Doctors' referral in order to make an appointment with a Physiotherapist

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