Transcription:

Scott Webb: If you're like me, one or both of your knees hurts every now and again. And though it's most likely osteoarthritis and you won't require a new knee, providers like my guest today would know for sure. And I'm joined today by Dr. Corey Jackson. He's an orthopedic surgeon with Genesis and he's here to tell us the most common causes of knee pain and what can be done to help those of us who suffer from it.

This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. And Dr. Jackson, thanks for your time today. We were just talking off the air and I said I'm 53 and, you know, one or both of my knees hurts occasionally, and you can usually take some Tylenol, things like that. But I want to ask you, since I've got you here, when should someone who's having occasional or mild knee pain talk to their doctors?

Dr. Corey Jackson: Well, definitely, at some point, if you have the occasional pain that's been chronic. I think at some point you have to bite the bullet and just go get it checked to make sure there's not something unusual. But for the most part, if somebody has just mild knee pain that happens, you know, once or twice a week and Tylenol or ibuprofen seem to take care of it, I don't necessarily think that that's something that you have to just go run out to be evaluated, especially if you are getting up there in age. You know, the likelihood of it being something other than arthritis is probably pretty uncommon.

Scott Webb: Yeah, that sounds about right. I'm sure for a lot of us, it is arthritis. That is the culprit. And maybe we have you now go through, you know, the many or at least the most common causes of knee pain.

Dr. Corey Jackson: Fifty-three years of age, you probably have TMB syndrome. It's an ailment that I see a lot in my office. We call it too many birthdays.

Scott Webb: Yeah.

Dr. Corey Jackson: A lot of wear and tear. Being a knee and hip reconstructive surgeon, the majority of patients that I see, it's all arthritis related. Some common issues that I see or some common reasons that people have knee pain, number one would be osteoarthritis. Some people suffer from rheumatoid arthritis, which would be like an autoimmune disorder where your body actually identifies the knees as being foreign and will actually start attacking them. And that's typically something that would need to be eventually evaluated by a rheumatologist. But there's some blood work that can be done initially by, you know, somebody like myself to identify whether that's an issue. It's not something that you can typically see on an x-ray to decipher whether it's rheumatoid or osteoarthritis.

Also very commonly, we see cartilage injuries. You know, the articular cartilage, which covers the knuckle of the knee can be damaged, or there's also another type of cartilage inside the knee called the meniscus, very commonly gets beat up as we get older, just from normal wear and tear. And then things that we do as a child can affect us as we get older. You know, somebody might have a basketball injury or football injury, or was in a car accident, and you can have some long-lasting effects from those injuries as we get older as well.

Scott Webb: Yeah. I often wonder if I'm a sort of, you know, kind of paying for our childhood transgressions. I remember being out at recess and, you know, playing tackle football without any pads or anything. I wonder if just at some point the bill comes due for that for a lot of us, that those things we do as kids or, as you say, accidents, things like that. I wonder is that sort of your take on that, that eventually that bill needs to be paid.

Dr. Corey Jackson: You know, it's really strange, Scott, because there are people that I see that have been very active their whole life. So they run marathons and we'll have some women more so than men, I think, that I see in their late sixties and seventies that will run a marathon a year that have zero arthritis. And so there's really no explanation for that. But certainly, as a child, I thought I was invincible and didn't really think that the small injuries that I had would catch up to me. But I'm 45 now and I feel it every year.

Scott Webb: Yeah, every one of those birthdays. Yeah. There's no doubt. And you mentioned the blood test for diagnosis. What other ways do you diagnose knee pain?

Dr. Corey Jackson: When you see an orthopedic surgeon, we're really going to get x-rays on almost everybody that walks in the door. You don't want to miss some of the simple things. And probably the biggest thing that I run into that I deal with from an education standpoint is we need to get an x-ray before we get an MRI. Anybody that walks in my office will get an x-ray. And the other important thing is that, if you're over 35, it really needs to be a standing x-ray, where we see what your weight does to the knee joint when you're standing with the x-ray because the very, very big difference from, you know, the x-ray that you'll get in the ER, where they have you laying on a table, just in case you may have a fracture versus when we stand you up and see that the joint space is completely gone. So the most common diagnostic tests that pretty much everybody gets in my office we'll be an x-ray and then we really base the treatment off of that. If the joint space is okay and everything looks good and you've had this issue years or months and mechanical symptoms, you know, at that point, we may consider an MRI or do some treatments prior to any other intervention or any other advanced diagnosis.

Scott Webb: You know, I've heard of these, you know, I watch sports and played sports and I can remember when they first came sort of into focus into play and referring to scopes, scoping the knee. But I don't really know what that means exactly. Like I think I do, and I think a lot of people do. But what does that mean to have your knee scoped? And what are you scoping for?

Dr. Corey Jackson: So a knee scope is when we put a small camera in your knee. And we now have it attached to a video monitor. So it's almost like a video game. But there are two small incisions that are probably a centimeter or less in size. And this eight millimeter camera gets inserted into the knee. And through the other hole, you can then manipulate you know, the knee and use instruments to take care of whatever you might find in the knee. But generally, when we're scoping, it's for somebody that doesn't have much arthritis that has pain and locking of their knee. And and I would say 90% of the time, it's for a meniscal tear or tear in the shock absorber of the knee. And a lot of times we'd just have to go in there and trim that portion out.

Scott Webb: Let's talk about knee surgery or knee replacement surgery. When is that indicated?

Dr. Corey Jackson: This is a question that I get several times a day. And it's a very easy answer. You do not have surgery until you have pain every day, so pain that affects your life detrimentally or you can't do things because of your knee pain. If somebody has an issue that has really affected their quality of life, and then they have x-rays that show that they have bone-on-bone arthritis, at that point, we would consider doing a knee replacement. But I have several people that have severe arthritis that say, "Listen, you know, it bothers me once in a while, these injections work, or I use Tylenol and ibuprofen," and I look at their x-rays and say, "Oh, you got to be kidding me." I say, "I don't know how you're walking." But that person's not going to get a knee replacement. They'll tell me when they're ready. And I think that's probably the most important thing is you have to do surgery based on people not based on x-rays.

Scott Webb: Yeah, that sounds right. And my mom had a knee replacement surgery on one of her knees, and it's exactly the way she put it. It's just like her knee just sort of told her. You know, she was in her early 70s and she was like, "You know, that's it. I just can't take the pain anymore. My quality of life is suffering." And so when we think about in those cases, the more extreme cases when knee replacement surgery is indicated, what's the process like? What's the recovery like? How long does it take someone, because I know that there was a period of time shortly after the surgery that she didn't feel great about things and, you know, and she was pretty miserable. And then, it started to get better and she went to PT and, today, she would tell you it's the best decision she ever made, which I'm sure a lot of your patients would say. Well, what's that in between there? What's that like for folks?

Dr. Corey Jackson: Yeah. There's been a big evolution in the process of having these knee replacements done. Back when I started, you had surgery, you were in the hospital for three days and you were getting some really strong narcotics or we're putting you on a morphine pump. And this has slowly transitioned here over the course of the past, you know, 15 years of these surgeries being done with the nerve blocks. Some patients are going home on Tylenol only and going home the same day. So really, that picture depends on how healthy you are, how sick you are, your weight will play a role in that. Are you diabetic? Do you have heart disease? Those things will play into the decision, whether you go home or whether you stay the night. Typically, most people, if they don't qualify going home the same day, they're typically going home the next day as long as their pain is controlled and their blood work looks okay.

But for the most part, you have this knee replacement, it's not fun. You know, we do nerve blocks that will help people for about 24 to 36 hours. And then during surgery, I inject a lot of medication in and around the knee, you know, to numb the nerves and that will hopefully last for five days. And if we can get you past those first two to five days, it's going to be a big difference in your recovery. Because if you can start moving this knee right away, you're going to get better faster. And then the process beyond that, I usually tell people, "Listen, the first two weeks are going to be tough." A lot of ice, a lot of elevation, you know, work with a therapist, do as much as you can to get this thing going. And generally when they see the two-week mark, they're finally starting to get over the hump. And then four to six weeks, they're starting to finally say, "Okay. I think there's some value in my decision. I really second guessed my decision, you know, five days into the surgery."

Scott Webb: Yeah. That's exactly how it was from my mom. About a week later, she indicated that was the worst decision she'd ever made. And then she got better, right? She started getting better, feeling better, feeling stronger. And within, as you said, about six weeks or so, she was like, "You know what? This is pretty good. I'm liking this."

Dr. Corey Jackson: That's right.

Scott Webb: Yeah. So, you know, as you said, it, it's kind of a last resort and your body will tell you, and then the patient will tell the doctor and so on. I want to give you a chance to have takeaways today. You know, my takeaways are, you know, the difference between sort of chronic and acute. And that most of the time, it is some form of arthritis and can be treated fairly easily. And so there's every good reason to speak with our providers. But give you a chance in your words, what are your takeaways when it comes to knee pain?

Dr. Corey Jackson: My takeaway would be, if you've been suffering from knee pain for three months, you probably need to have a look at it. If it's something that's just sporadic every now and again and ibuprofen takes care of it, you can put it off, you know, for probably a couple of years. But eventually, if you're having this chronic issue, it needs to be looked at, x-rays need to be obtained. And really depending on what those x-rays show, I think the most important thing that I can't stress enough to people is that do the surgery or do any type of surgery only if the symptoms require it. If it's something that you can live with with injections, you know, we really didn't touch on injections much, but you have cortisone injections. There's some gel injections that kind of knee and you put this off as long as you can, as long as you have quality of life, because it can't be undone. And the fact of the matter is 90% of people do fairly well. But if you're one of the 10%, then that really stinks, that's not fun. That's not fun for the patient. That's not fun for the surgeon. I really try to educate my patients in terms of keeping your joint health, keeping your legs strong and doing everything you can to avoid the knife.

Scott Webb: Yeah, that sounds right. I'm glad you mentioned injections. We didn't get to that. But there are lots of options. And as you say, a lot of times, this can be treated pharmacologically, if you will. We don't need the knife, if you even actually use a knife anymore, maybe that's just a metaphor, you know, going under the knife. But doctor, this has been really educational, really fun. I hope listeners enjoyed it as well and got something from this and really just understand that, you know, they listen to their bodies, speak with their providers, only consider surgery as perhaps that last resort. So thank you so much. You stay well.

Dr. Corey Jackson: Oh, thank you, sir.

Scott Webb: And for more information, go to genesishcs.org/orthopedic.

And thanks for listening to Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.