The Knee Surgery Decision

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by Dan Felix, CFT

A study published in a September 2008 edition of the New England Journal of Medicine showed that arthroscopic surgery doesn’t provide any significant benefit for moderate to severe arthritis of the knee. Arthroscopic surgery uses two long probes to re-knit your knee ligament. It does not require the knee to be cut fully open.

Some of my clients are injured, disabled or elderly. Many have some sort of knee inflammation, irritation, or injury. Knee injuries are often enough to change the lifestyle of a person, let alone remove the joy from movements that were once simple and effortless.

To understand our options to knee surgery, we need to understand the problem. Arthritis is an auto-immune disease, that is, a disease that is caused by our own immune system attacking a tissue or organ in our bodies. Early in life, our immune system takes an inventory of all our tissues and chemistry. Some tissues and fluids remain hidden during this inventory and the immune system never includes them. Any tissues or fluids not on the inventory list are considered foreign and the immune system will try to remove or neutralize them if it finds them.

As we age the fluid in our joints seeps out. When it does, through injury or over use, it then becomes discovered by the immune system. The immune system responds by sending antibodies to attack and neutralize what it considers to be foreign tissue or fluid. In the case of our knee that battle occurs in the joint itself. The battle causes inflamation and the joint swells. The swelling only aggravates the situation.

There is not much any surgery can do to stop the immune system’s relentless attack. There are some things we can do.

First, keep the joint moving. Think of your knee as the rusty hinge on a screen door. As long as the hinge regularly moves it can’t keep rusting as fast. The movement won’t get rid of old rust but it will keep new rust from forming. So, keep using your knees.

Second, calm down your immune system. There are drugs that can almost disable your immune system throughout the body or only at the joint but that is not a healthy long-term solution. Turning the immune system off anywhere in the body can lead to other, bigger problems. We can, though, calm it down. In doing so the immune system won’t attack the joints so vigorously but it will continue to protect us from other threats. We can calm the immune system by avoiding foods that aggravate it and by remaining hydrated. Stay away from acidic foods like tomatoes as these typically arouse the immune system. Drink plenty of water, but not all at once. Avoid letting the joint get cold as this causes fluids to leave the joint until the heat returns. Alcohol, sugar and red meat also annoy the immune system. You do not have to eliminate these from your life, just don’t make them a steady diet.

Third, there are over-the-counter medications that can help lessen the pain and swelling in a joint. These medications are anti-inflammatories, not pain killers. They are designed to decrease the inflammation not mask the discomfort. Tylenol®, Aleve®, Motrin®, and Advil® are some of the more familiar names.

Joints stiffen and inflame when they are motionless for any length of time so the best time to take an anti-inflammatory is just before bed and shortly after you wake up. I often recommend one-half dose, before bed and a full dose with your morning meal. That keeps the inflammation minimized. You can still take another full dose in the afternoon if you are experiencing discomfort. Be sure to read the labels so that you know the maximum doses per day. Our goal is to stay well below the maximum dosage.

Some knee joints can become so damaged that knee surgery is our only hope. Today’s surgeries are very effective, but they are not a casual decision. Your doctor is the best resource to determine if you need surgery. If you know you’ll need surgery then you should have it as early as possible, when the joints are sufficiently healthy to improve your recovery from the surgery.

It is highly likely that you will always have some form of discomfort in your knee. With these suggestions you can still lead the kind of life you want, hopefully without surgery.

Questions/comments to questions@danfelix.com


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