Knees and Hips

Should I have arthroscopic knee surgery?

DEAR DOCTOR K: I'm a lifelong runner with severe knee pain. I hate the thought of surgery, but hear it's not such a big deal these days, using arthroscopy. How do I know if I'm a good candidate for it?

DEAR READER: Arthroscopy is a technique used to diagnose problems in the knees and other joints. If a problem requiring surgery is identified, arthroscopic surgery can be performed. To appreciate how valuable arthroscopic surgery is, you have to understand what things were like back in the "old days" -- like when I was in medical school.

When is the right time for a knee replacement?

DEAR DOCTOR K: I have osteoarthritis that's gotten worse over the past few years. My doctor has explained the pros and cons of knee replacement, but it seems like the timing is up to me. How will I know when the time is right to replace my joint?

DEAR READER: If your experience with a knee replacement is like that of most of my patients, you'll know when the time is right only after the time has passed. I've rarely met a person who had a knee or a hip replacement who did not say, after the surgery, "I should have had the surgery long before I finally did." That surely was my experience with hip replacement due to osteoarthritis. Looking back, I should have had the surgery at least two years before I did.

Should I be worried about complications from a hip replacement?

DEAR DOCTOR K: My doctor says I need hip replacement surgery. She says it will help my pain. But I'm worried about complications. Should I be?

DEAR READER: I get a lot of questions about hip replacement surgery, and I'm in a good position to answer them: I had a hip replacement about a decade ago. Before I give a more detailed answer, let me cut to the chase: The benefits of hip replacement surgery greatly outweigh the risks.

I’m having knee pain, can you describe the anatomy of the knee so I can understand more?

DEAR DOCTOR K: I've been having a lot of knee pain. Would you describe the anatomy of my knee so that I can understand more when I see my doctor about it?

DEAR READER: Joints are places where two or more bones meet, to allow a part of your body to move. And the knee joint is a remarkable structure. It is a complicated network of bones, cartilage, muscles, tendons and ligaments. These structures, working together, allow us to walk, kick, squat, stand back up and do the Twist. (I know that's a dated reference!)

How serious is Osgood-Schlatter disease?

DEAR DOCTOR K: My 12-year-old daughter has been doing gymnastics for years. Lately she's complained about pain in her knee. Her doctor says it's Osgood-Schlatter disease. How serious is this?

DEAR READER: This is a case where the name makes the condition sound worse than it is. Osgood-Schlatter disease is a common, temporary condition. It causes knee pain in older children and teenagers, especially those who play sports. About 20 percent of kids who play sports develop this condition. It starts when a kid's growth spurt starts, and major symptoms typically go away at the end of a teenager's growth spurt.

How can I recover quickly from a knee replacement?

DEAR DOCTOR K: I'm having knee replacement surgery next month. What can I do to speed my recovery and get back on my feet as quickly as possible?

DEAR READER: I'm glad you asked, because you are very important in making the outcome of your surgery completely successful. A knee replacement is major surgery. During the procedure, the surgeon removes damaged sections of your shin bone and thigh bone. He or she cuts the bone to precisely fit the shape of the replacement implant, then attaches the artificial joint at the knee.

How can I relieve my knee pain without surgery?

DEAR DOCTOR K: I'm in my 60s. My knees have started to hurt, especially when I'm climbing stairs. Can you recommend any nonsurgical ways to relieve this pain?

DEAR READER: Knee pain is one of the most common reasons for doctor visits. As you get older, knee pain can limit your mobility and take away your independence. The keys to keeping your knees healthy? Strengthening muscles around the knees, improving balance and losing weight.

Will running wear my knees out faster?

DEAR DOCTOR K: I'm 68. I've jogged regularly for decades, but I've recently developed a touch of arthritis in my knees. Will continuing to run make my knees wear out faster?

DEAR READER: Having mild arthritis in the knees should not stop you from running. And, in case you were wondering, running probably did not create the problem in the first place.

After a joint replacement, do I need to take an antibiotic before a dental procedure?

DEAR DOCTOR K: I had knee replacement surgery several years ago. More recently, I had my hip replaced. I am scheduled to have a root canal next month. Do I need to take antibiotics before my dental procedure?

DEAR READER: Almost any type of dental work -- extractions, gum surgery, root canals, even routine cleanings -- can injure the gums and other soft tissues of the mouth. The most obvious evidence of this is that they bleed. Bacteria live inside our mouth. When gums are injured, bacteria from the mouth can enter the bloodstream.

How can I relieve knee pain from chondromalacia?

DEAR DOCTOR K: I saw my doctor because of aching pain in my knee, which sometimes buckles unexpectedly. He says I have chondromalacia. What is this, and what can I do to relieve the pain?

DEAR READER: The joints in your body are cushioned by cartilage. This tough, rubbery tissue covers and protects the ends of bones inside a joint, allowing them to glide smoothly against one another as the joint moves. With chondromalacia, the cartilage inside a joint softens and breaks down. The ends of the bones can rub together, causing pain. Chondromalacia can affect any joint, but the most common location is inside the knee, see the illustration on the right.