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Surgery not only option to ease knee pain

Tom Hindman
Longtime Charleston orthopedic surgeon Tony Majestro displays knee joint images. At left is a normal joint, in the middle is one worn by arthritis and at right is a knee implanted with an artificial joint.
CHARLESTON, WV -- Maybe it hurts when you head down the stairs or step off the curb.Maybe it's worse. You've given up something you used to enjoy, like running or hiking.As people reach middle age, knee pain is a common complaint.Have you headed down the path that leads to surgery, with no turning back?Not necessarily, say local orthopedic surgeons and partners Tony Majestro and Manuel Molina.Majestro, who operates mostly at Charleston Area Medical Center, has been solving knee, hip and other bone and joint problems for more than 40 years.Molina, another longtime practitioner, works mostly at Thomas Hospital.Both say there are several non-surgical ways to address knee pain, including weight loss, appropriate exercise or physical therapy, anti-inflammatory medication and injections.Majestro starts with an X-ray and conservative treatment.Medication or injection will reduce the pain and give the knee a chance to heal "if it's a mild injury or aggravation of mild arthritis," he said.Sometimes no further treatment is needed.But if the pain persists, he'll move on to order an MRI, a more sophisticated imaging tool.A scan that reveals clear fluid is an indication of mild arthritis. "If we see blood, that indicates a torn ligament," he said.However, a mild tear still can be treated conservatively, perhaps with a knee brace.
Severe tears require surgery.Most people suffer from "a little wear and tear" on their knees, especially if they're overweight, and Majestro noted that West Virginia has a 30 percent obesity rate."One extra pound puts 4 pounds of pressure on the knee," he said. "Twenty-five extra pounds is like carrying a 100-pound sack on your back."Molina expressed sympathy for those who struggle to lose weight. The exercise needed to take off those pounds "can be hard with stiff, painful joints," he said.However, a loss of 20 to 25 pounds can mean a significant reduction in pain. Even if the pain persists, exercise will improve joint strength and flexibility and put the patient in better shape for surgery and recovery, he said.  
If surgery is indicated and the joint is not completely destroyed by arthritis, the orthopedist can perform arthroscopic surgery, which involves a small incision and use of a camera to let the surgeon see inside the joint and repair as needed.
Both cartilage tears and arthritis can be addressed with this type of surgery, Majestro said, "and a lot of people do quite well."The tall, lean Majestro himself had knee repair surgery about 15 years ago. He tore some cartilage while either ballroom dancing with his wife or playing tennis.He used a crutch for a few weeks after the procedure but missed only one day of work. He has no knee pain today."My partner did a good job," he said of Molina.Knee replacement surgery is indicated when conservative treatments have been exhausted and the joint is "bone on bone," with its normally smooth, gliding motion lost.Majestro used to perform joint replacements only on people over 60. These days he treats individuals in their 50s and even 40s, if alternatives have been tried unsuccessfully and the person has suffered a loss of function.He noted that an artificial knee is an improvement for such patients, but they cannot expect it to function like the one they were born with."They can't crawl or work on their knees," he said. "They can't run or jump . . . It's not a normal knee."However, all is not lost. With care, artificial knee recipients can golf and even play doubles tennis, he said.If the patient follows the activity guidelines, today's artificial knees can last 15 to 20 years. And even when wear occurs, sometimes the surgeon may be able to replace components rather than the entire joint.Majestro has seen many advancements in knee surgery during his career. Patients used to spend 15 days in the hospital after surgery. Now they may leave after a day or two or even on the day of the procedure.With less invasive techniques, the muscles recover faster, he said.Molina said the process is so much easier and the outcome so positive that "people often wish they'd had it sooner."Today's surgical tools cause less injury to muscle and joint tissue, and the result is faster healing. Better implants also "don't create as much injury and inflammation," Molina said.While more people in their 50s and 60s are having knee surgery, often due to obesity, surgeons also are treating more patients in their 80s and even 90s, he said. People are living longer and want to retain as much function as possible.Molina described an 88-year-old patient who had both knees replaced. "She came back in dancing one day," he said.  At 54, he, too, has seen great strides in his field, and it excites him to think about what is yet to come."I'd like to know where we're going to be in 10 to 15 years," he said.He foresees a day when surgeons no longer implant replacement joints; instead they'll have sophisticated new procedures for restoring natural joints.  "I hope technology has the chance to advance in the way it has over the last 20 to 25 years."  
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