Knee Joint Pain: A Complete Treatment Guide- Conservative, Medications, PT, Surgery

Conservative Treatment For Knee Joint Pain

1. Knee Joint Rest

Applying crape, ace bandage, braces or cast achieves prevention of Knee Joint Movements. Movements are restricted until inflammation is healed or pain is reduced to tolerable level.

Indications for Braces or Ace Bandage:

Indications for Braces or Ace Bandage

2. Cold Compression Therapy

Cold compression therapy is provided by applying ice bag over shoulder joint.

Indications for Cold Compression Therapy-

Indications for Cold Compression Therapy

  • Joint Swelling
  • Joint Hematoma (bleeding)
  • Tendonitis
  • Bursitis
  • Septic Arthritis
  • Knee Joint Sprain

3. Heat Compression Therapy

Heat therapy helps to improve blood circulation and is avoided if shoulder joint bleeding is associated with pain.

Heat Treatment

Indications for Heat Treatment

  • Knee Joint Sprain
  • Knee Osteoarthritis
  • Knee Rheumatoid Arthritis
  • Bursitis
  • Tendonitis
  • Heat Therapy is also advised for pain observed following surgery.

Medications To Treat Knee Joint Pain

1. NSAIDs (Non Steroidal Anti-Inflammatory Medications)

Indications for anti-inflammatory medication are inflammatory diseases and chronic pain caused by inflammation. NSAIDs are prescribed for following diseases causing knee joint pain.

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Tendonitis
  • Bursitis
  • Knee Joint Sprain

Most common NSAIDS prescribed are as follows-

  • Motrin – 600 to 800 mg tablets every 6 to 8 hours
  • Naproxen- 375 to 500 mg tablets every 12 hours.
  • Daypro- 600 mg every 12 hours
  • Celebrex- 100 mg every 12 hours

2. Opioids

Opioids are also known as narcotics. Opioids are prescribed for chronic pain of all type which includes nociceptive and neuropathic pain. Short acting opioids are prescribed for mild to moderate pain or breakthrough severe pain. Following Opioids Are Most Commonly Prescribed For Chronic Pain:

Short Acting Opioids-

  • Hydrocodone-
    1. Vicodin, Lortab and Norco
    2. Dosage- 40 to 60 mg per day
  • Oxycodone-
    1. Oxy IR and Percocet
    2. Dosage- 40 to 60 mg per day
  • Morphine-
    1. MS IR and Morphine Sulphate
    2. Dosage- 60 to 100 mg per day

Long Acting Opioids-

  • Oxycodone-
    1. Oxycontin
    2. Dosage- 40 to 120 mg per day
  • Morphine-
    1. MS Contin
    2. Dosage- 100 to 300 mg per day
  • Methadone- Dosage- 40 to 80 mg per day
  • Fentanyl Patch- Dosage- 25 to 100 microgram per day

Indications for Opioids-

  • Knee Joint Fracture
  • Knee Joint dislocation
  • Knee Joint Subluxation
  • Septic Knee Joint
  • Chronic severe pain not responding to NSAIDs: Bursitis, Tendonitis and Knee Joint Sprain

3. Antiepileptic Analgesics

Neuropathic pain may not respond to NSAIDs or Opioids. Research has indicated neuropathic pain do respond to few anti-epileptics (medications prescribed for convulsions).

Indications for Antiepileptic Analgesics-

  • Neuropathic pain
  • Chronic pain resistant to NSAIDs or opioids,
  • Opioids are contraindicated when patient is dependent or addicted to opioids
  • Serious opioid side effects- Opioids are contraindicated
  • Serious NSAIDs side effects- Opioids are contraindicated

Anti-Epileptics Medications-

  • Lyrica (Pregabalin)- Dosage- 300 mg per day.
  • Neurontin (Gabapentin)- Dosage- 600 to 1200 mg per day.

4. Antidepressant Analgesics

Antidepressants are effective in treating neuropathic pain not responding to NSAIDs and Opioids.

Indications for Antidepressant Analgesics-

  • Neuropathic pain
  • Chronic pain resistant to NSAIDs or opioids
  • Opioids are contraindicated when patient is dependent or addicted to opioids
  • Serious opioid side effects- opioids are contraindicated
  • Serious NSAIDs side effects- opioids are contraindicated

Anti-Depressants Medication-

  • Elavil (Amitriptyline)- Dosage- 25 to 100 mg per day
  • Cymbalta- Dosage- 60 to 120 mg per day

Physical Therapy (PT) For Knee Joint Pain

  • Improve Joint Flexibility
  • Improve Joint Movement
  • Prevent Joint Stiffness
  • Strengthen Leg Muscles
  • Prevent Muscle Atrophy

Indications for Physical Therapy To Treat Knee Joint Pain-

  • Knee Joint Tendonitis
  • Knee Joint Osteoarthritis
  • Rheumatoid Arthritis
  • Knee Joint Sprain
  • Knee Joint Bursitis
  • Post Surgery

Watch How Physical Therapy Exercises are done in Knee Joint Pain Treatment

Interventional Therapy For Knee Joint Pain

a. Corticosteroid Injection of Knee Joint-

Procedure is performed under local anesthesia.

Goal of Corticosteroid Injection

  • Achieve Optimum Pain Relief
  • Treat Joint Inflammatory Diseases
  • Diagnostic Procedure To Evaluate Pain Relief

Indications for Corticosteroid Injections To Treat Knee Pain-

  • Knee Joint Tendonitis
  • Knee Joint Bursitis
  • Knee Joint Arthritis

b. Peripheral Nerve Block-

Severe pain is occasionally treated with femoral nerve block or field block. Femoral nerve supplies the sensory nerve branches to knee joint. The femoral nerve block is performed for pain relief.

Indications for Peripheral Nerve Block To Treat Knee Pain -

  • Chronic Pain Not Responding To Opioids and NSAIDs
  • Post Surgery Severe Pain
  • Achieve Optimum Pain Relief Prior To Physical Therapy
  • Neuropathic Pain Caused By Surgery
  • Diagnostic Injection To Evaluate Pain Associated With Tingling, Numbness And Weakness
  • Knee Joint Stiffness

c. Lumbar Epidural Injection

Indication for Lumbar Epidural Injections To Treat Knee Pain-

  • Diagnostic injection to rule out spinal cause of pain like disc herniation, foraminal or spinal stenosis.
  • Therapeutic lumbar epidural steroid injection is performed to treat chronic knee joint pain.

Surgical Treatment Options For Knee Joint Pain

a. Knee Joint Arthroscopy

  • Surgery is performed under local or general anesthesia.
  • Arthroscope (endoscope) is inserted into knee joint.
  • Knee joint examination is performed under direct vision using camera of the arthroscope.
  • Procedure is diagnostic and therapeutic.

Indication for Therapeutic Arthroscopy To Treat Knee Pain

  • Removal of loose cartilages and fragments causing pain
  • Removal of inflammatory soft tissue in patients suffering with osteoarthritis and rheumatoid arthritis
  • Repair of tendon or ligamental tear
  • Removal of disease and worn out cartilage fragments
  • Repair of Meniscus tear

Watch 3D Video of Knee Joint Arthroscopy

b. Close Knee Joint Reduction

Close Knee Joint Reduction procedure is performed under deep sedation or general anesthesia.

Indication for Close Reduction-

  • Knee Joint Subluxation
  • Knee Joint Dislocation
  • Knee Joint Fracture

c. Open Knee Joint Reduction

Open Knee Joint Reduction Surgery is performed to expose knee joint. The joint dislocation is reduced to normal anatomical position. During surgery, ligaments, tendons and meniscus are examined for any tear or laceration. Excision of disease tissue or suturing of the two segments repairs the tear.

Indication for Open Knee Reduction Surgery -

  • Knee Joint Subluxation
  • Knee Joint Dislocation
  • Knee Joint Fracture

d. Repair of Torn Knee Joint Tendon

The partial or complete tear of the tendon associated with knee joint is repaired by arthroscopy or open surgery.

Indications for Tendon Repair-

  • Chronic Pain
  • Stiff Knee Joint
  • Unstable Knee Joint
  • Partial or complete tear of tendon

e. Meniscus Tear Repair

Meniscus tear is repaired by arthroscopy or open surgery. Surgical Options for Meniscus Tear Repair Are-

  • Meniscus Removal (Meniscectomy)
  • Meniscus Repair
  • Meniscus Replacement

f. Open Fracture Reduction

In few cases more than one bone may be fractured. Knee joint fracture involves one of the following bones-

  • Tibia
  • Patella
  • Femur

Indication for Open Reduction-

  • Failed Close Reduction
  • Unstable Knee Joint Following Close Reduction

g. Open Reduction of Knee Joint Dislocation

In few cases more than one joint may be dislocated. Knee joint dislocation involves either or both following joints:

  • Femero-Tibial Joint
  • Femero-Patellar Joint

Indication for Open Reduction-

  • Failed Close Reduction
  • Unstable Dislocation Of Knee Joint Following Close Reduction

h. Partial or Total Knee Joint Replacement

Indications for Partial or Total Knee Replacement-

  • Advanced Osteoarthritis
  • Advanced Psoriatic Arthritis
  • Advanced Rheumatoid Arthritis
  • Failed Dislocated Knee Joint
  • Irreparable Meniscus Tear
  • Erosions of Joint Articulating Cartilage

Surgical Procedure-

Total Knee Replacement-

  • Open Surgery
  • Ends of the femur and tibia bones are shaved
  • Articulating surface of femur and tibia shaped to accommodate prosthesis
  • Following supporting structure of the knee joint are removed-
    1. Articulating Cartilage
    2. Both Menisci
    3. Anterior and Posterior Cruciate Ligament
  • Collateral ligament preserved
  • Polyethylene meniscus helps to transmit weight from metallic head of femur to metallic head of tibia.

Total Knee Replacement Hardware-

  • Femoral Head Prosthesis- Metallic round head near normal shape
  • Tibial Head- Metallic Flat Base
  • Patellar Plate- Metallic or Plastic Flat Object
  • Polyethylene Meniscus- Flat dish shaped polyethylene, the artificial meniscus is inserted onto the tibial surface.
  • Weight transmitted through plastic and not metal over metal

Total Knee Replacement Hardware

Partial Knee Replacement-

  • Knee joint is divided in to medial and lateral compartment.
  • Knee joint disease may affect one of the 2 compartments.
  • Unicompartmental knee replacement is a partial knee replacement.
  • Surgery involves replacement of either medial or lateral condyle of femur and tibia.
  • Recovery is faster and post op rehab is less intense than following total knee joint replacement.

Partial Knee Replacement

Also Read:

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 5, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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