New treatment relieves knee pain after surgery

A new, minimally invasive treatment shows promise for relieving knee pain after surgery, especially total knee replacement. Michael Lupi, D.O., of Physician Partners of America Pain Relief Group – Jacksonville, Fla., is pioneering this procedure, called a peripheral nerve stimulator of the genicular (knee) nerve.

Dr. Lupi recently became the first doctor in the country to perform this surgery as a treatment for pain after a total knee replacement.

“This treatment blocks one or all three of the branches of the genicular nerve in the knee, leading to long-term pain relief,” Dr. Lupi said. “Peripheral nerve stimulation is a promising treatment of chronic knee pain that can’t be controlled by replacing the knee joint.”

What Leads ot Knee Pain in the First Place? 

Arthritis of the knee, also known as osteoarthritis, is a major reason for replacing the knee joint. If often comes with age, when people lose cartilage; but there are other reasons a person might develop knee problems that may require surgery.

• Excess weight puts extra pressure on knees joints. Every pound of weight a person gains leads to three or four pounds of extra pressure on their knees.
  Genetics makes some people more likely to develop knee problems. Others inherit abnormally shaped bones around this joint.
• Women, especially those over 55, are more likely to develop osteoarthritis of the knee than are men.
• Repetitive stress injuries caused by squatting, kneeling or lifting heavy objects increases the chance of developing knee joint problems.
• Sports can be a two-edged sword when discussing knees issues. “On the one hand, being physically active can strengthen your knee joints and reduce the risk of osteoarthritis,” said Dr. Lupi. “But with that comes a risk for athletes like long distance runners, soccer players, or tennis players. They have a higher risk of osteoarthritis, especially if they injure their knee.”
• Other illnesses can increase your chances of knee osteoarthritis, such as rheumatoid arthritis, metabolic disorders and hormone imbalances.

Pain is the number one symptom of knee arthritis. The pain is more intense when you are active, but it subsides with rest. Swelling and a warm sensation in the joint are other symptoms. Stiffness, especially after sitting for a while or after waking up, is another common symptom.

How Does a Doctor Diagnose Arthritis of the Knee?

A physical exam by your doctor is the first step in diagnosing osteoarthritis. Your physician will review your medical history and note symptoms. He or she is interested in seeing what makes your pain worse and what relieves it.

Your doctor will also ask about your family history to find out if other members of your family have had this form of arthritis. your doctor may order some tests, including:

X-rays – These will show cartilage damage, bone damage, as well as bone spurs.

MRI scans – Magnetic resonance imaging scans may give your physician a clearer view of the joint than x-rays. This is especially true when joint tissues are damaged.

Additional testing – Your doctor may use blood tests to rule out other conditions that may be the source of your pain. These include immune disorders like rheumatoid arthritis.

Traditional Treatments for Arthritis of the Knee

Losing weight, even just a little, can dramatically reduce knee pain from osteoarthritis. Adding exercise to strengthen the muscles around the knee and stretching exercises to make the joint more flexible and stable will likely result in reducing pain.

Pain relievers and anti-inflammatory drugs such as Tylenol, Advil, Motrin, ibuprofen or Aleve may provide temporary relief. Over-the-counter pain medication should not be taken for more than ten days without checking with your doctor. If you take it longer, your chances of developing negative side effects increases.

If over-the-counter medication does not ease your knee pain, your doctor may provide prescription pain medication or anti-inflammatory medication. Injections including corticosteroids or hyaluronic acid can reduce inflammation and restore lubrication to the knee.

Alternative therapies like acupuncture or supplements including glucosamine, chondroitin, or SAMe capsaicin may provide temporary pain relief.

Braces for post-knee replacement surgery are easy to get and come in two types. There are “unloader” braces that are designed to remove weight from the side of the knee that is affected by arthritis. “Support” braces are designed to support the entire knee.

Physical therapy can show you how to increase the strength and flexibility of your knee joint. Occupational therapy will teach you how to go through your daily activities at work or at home with less pain.

Total Knee Replacement Surgery

When common treatments do not work, a total knee replacement surgery may be the best choice. The purpose of the knee replacement is to decrease pain and increase function. But what if pain continues after the total knee replacement?

Opioid painkillers are the first thing many patients, and some doctors, reach for to control knee pain after surgery. But now we know how addictive they are. Dr. Lupi, who has long campaigned against opioid abuse, has embraced the peripheral nerve stimulation (PNS) in addition to other minimally invasive procedures to control pain.

Peripheral Nerve Stimulation Helps Knee Pain After Surgery

To see if you’re a candidate for peripheral nerve stimulation, you will first get a temporary nerve block to decide if this controls knee pain after surgery. If the block reduces your pain by at least 70 percent, you could be a candidate for a PNS trial. This trial involves thin wires with electrodes attached to the treatment area on the outside. it usually lasts between three and seven days.

If the trial gives you 70 percent or more relief from your pain, you can consider a permanent stimulator implant. This small device produces an electrical stimulation that blunts the pain at the genicular nerve. You control the level with a hand-held remote.

“This is an exciting development in pain medicine,” said Dr. Lupi. “And I encourage knee replacement patients still experiencing pain to get an evaluation.”