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FIXING KNEES: Maxing out on Surgery, Minimising Success

May 1, 2017

Your knee hurts. You’ve given it time……..it still hurts. Sound familiar?

You get referred for an x-ray or MRI. Some ‘wear and tear’ is found in the knee joint and maybe even roughened or torn cartilage (meniscus). You head to an orthopaedic surgeon who can offer anything from a minor clean out to a major joint replacement. This of course will fix the problem and, after some post surgical rest, your knee will be fine.

Ah, well, sometimes that is the case. Often it is not.

This may come as a surprise to you. We have the best scanning technology we’ve ever had, with super talented orthopaedic surgeons that can operate on what is found on these detailed scans.

How can we be only tracking at sometimes in this area?

There are 2 key explanations here:

  1. Findings on an x-ray or scan are not always significant to someone’s pain.
    They can be…….sometimes. Often people can experience knee pain that has little to do with normal age related wear and tear (“arthritis”) in the knee joint. In these people, getting an arthroscopic “clean out” is unlikely to make much difference to their pain.
  2. A scan of the knee is like taking a photo of someone and asking a stranger to take guesses at the persons’ personality, talents, hobbies, and who their best friend is.

A photo can’t predict what a person will do, nor can a scan tell us how a knee moves and functions!

Is it strong?
Is it stable?
Is there good balance in the knee?

Does the knee have good endurance? Or does it tire quickly? Can the person co-ordinate the knee with good function at the hip and foot to take the load off the knee?

A scan can never give you any of this information.
Which is why there are a lot of assumptions and guesswork linking scan results with many knee problems. The result? We’re only sometimes getting it right.So how do we improve on sometimes?The first avenue is Prehab. This involves building the knee up before turning to surgery. If there is any doubt as to whether your knee problem is an open and shut surgical case, we should do more to rebuild the knee before taking a knife to it. I know I have worked with a number of people over the years who have not required surgery in the end despite earlier planning to do so.

And then there is Rehab.
When your surgeon comes in the morning after surgery and says they are “happy” with how everything went they are only talking about the surgery they performed. It’s now that the work begins for the patient! The focus should be on building up the abilities of the knee with a comprehensive and customised therapist led program.

Now I’m not trying to start an argument against surgery; to me it’s not an either/or scenario. But the stats of outcomes of knee arthroscopies are simply not up to scratch so we need to rethink this entire process.

In summary, more discussion, thought and care is needed when considering whether to attribute knee pain to xray / scan findings. And if surgery is decided upon, the importance of functional rebuilding of the knee post surgery must not be understated. That’s a great starting point to help us improve on sometimes!

Grant Burrows
Osteopath