Helping You with Your Knee Pain
If you have knee pain, Mr Dan Arvinte can help you live a less painful life and is available for private consultations at two locations in Bedford.
As part of a complete and personalised treatment plan, Mr Arvinte is able to offer total knee replacements, injections, keyhole surgery (arthroscopy), revision knee replacements and knee cartilage operations.
Following on from his article on Hip Pain, Consultant Trauma and Orthopaedic Surgeon, Mr Arvinte explains here the causes of knee pain and some clinical approaches to reducing or eliminating discomfort.
Written By Mr Dan Arvinte
Consultant Trauma and Orthopaedic Surgeon based in Bedford, UK
Phone: 01234 792 203
Finding the right pain to treat is the first priority.
Just as with hip pain, knee pain can be caused by a problem around the knee itself, or by a problem with another joint or a different part of the body (“referred
Taking a proper history, together with a thorough clinical examination, will identify the cause of the pain in more than 90% of cases. To support the clinical diagnosis, imaging investigations such as an X-ray, MRI, CT
or ultrasound (or a combination of these) may be necessary.
What problems around the knee can cause pain where you have no history of injuries?
- Inflammation of tendons or other soft tissues - tendinitis, tendinosis, bursitis
- Osteoarthritis - wear and tear of the cartilage stuck to the bones (articular cartilage); it can also be associated with meniscus tears (meniscus is the cartilage between the bones, which acts like a shock absorber
when walking or doing physical activities)
- Inflammatory arthritis such as rheumatoid arthritis, ankylosing spondylitis, gout and pseudogout, lupus, psoriatic arthritis
- Rare causes including infections, tumours, osteonecrosis (lack of adequate bone supply, for various reasons, leading to dead bone)
In the presence of injury, the knee can suffer fractures or damage to the ligaments, cartilage or tendons. These are usually treated in acute settings – for example, broken bones around the knee or quadriceps, or patella tendon ruptures, would require
emergency hospital treatment.
What problems around other joints or parts of the body can cause knee pain where you have no history of injuries?
- Hip osteoarthritis - it is not uncommon for hip osteoarthritis to cause knee pain!
- Spine osteoarthritis - usually associated with sciatic type symptoms
So what can be done to help you?
Before any treatment begins, a correct diagnosis is crucial. For example, the last thing you want is to have major knee surgery and return later with the same sort of pain you had before surgery because the real cause of the pain was in fact hip osteoarthritis.
Mr Dan Arvinte will see you, listen to you and conduct a comprehensive physical examination, with the goal of reaching an accurate diagnosis.
Where it is not easy to differentiate and identify the real source of pain, an injection with local anaesthetic into one joint (hip or knee) will tell which joint is responsible for the knee pain - and what pain relief to expect if you proceed with major
surgery such as knee replacement. Mr Arvinte will guide you through all the treatment options and help you reach an informed decision.
Similarly to the treatments for hip pain, we usually begin with the least aggressive path, unless there is strong evidence of severe cartilage damage, associated
with severe pain. This would usually consist of pain killers, anti-inflammatory medication, braces and physiotherapy.
Mr Arvinte has a close working relationship with a dedicated physiotherapy team.
Next, we can try intra-articular injections, but these often help only for a limited amount of time, depending on the severity of cartilage damage. Mr Dan Arvinte performs intra-articular knee injections in strictly aseptic environments (usually in a
special room in the outpatient clinic), under aseptic conditions. He uses corticosteroid, long-acting local anaesthetic or hyaluronic acid (joint lubricant).
Knee replacement surgery
If these treatments cannot control your pain, or the pain significantly interferes with your daily activities, or is preventing you from sleeping properly, then surgery may be required.
Before suggesting major surgery, such as a knee replacement, it is essential to corroborate the clinical findings, carefully considering these alongside the severity of pain and imaging from scans. It is true, however,
that severe osteoarthritis (severe cartilage damage) can be cured only by replacing the joint. Mr Arvinte will explain
to you in detail about this major type of surgical treatment. He is very experienced in knee replacement procedures and has excellent results in the UK National Joint Registry.
After the operation you will be assessed by a multi-disciplinary team including a physiotherapist, occupational therapist and doctor. This is to make sure your pain is under control, that you start mobilisation promptly and that everything at home is
adapted, to make your recovery as smooth as possible - and to ensure you get the full benefit from your surgery. Details of steps in rehabilitation after knee replacement surgery
can be found here.
Knee arthroscopy (keyhole surgery) is appropriate mainly for patients with mechanical symptoms (such as locking or catching meniscal injuries, or loose cartilage bodies), ligament injuries, small full-thickness cartilage damage, evidence of patella maltracking.
It is essential to corroborate the clinical and imaging results, to ensure the success of the procedure, within realistic expectations.
The place of keyhole surgery in the treatment of knee osteoarthritis is debatable and depends on the severity of osteoarthritis, associated injuries (meniscal injury, loose cartilage bodies), severity and nature of symptoms - and is recommended only after
trying other, non-surgical treatments. Mr Arvinte is very experienced in knee keyhole surgery and has performed more than 500 such procedures, to date. Both the NHS and British Association for Surgery of the Knee have useful
articles on keyhole surgery.
Revision (re-do) knee replacements
Patients with previously replaced knee joints can also complain of pain. The situation is usually more complex than in the case of a native joint and has to be assessed by a specialist trained in revision (re-do) surgery, as Mr Dan Arvinte is.
There are multiple reasons why a replaced knee can become painful: infection, instability, stiffness, impingement of soft-tissues around the knee, peri-prosthetic fracture, aseptic loosening. Again, a proper history and thorough clinical examination,
alongside well-chosen imaging, can shed more light on a diagnosis - and exclude problems associated with another joint or a different part of the body.
Revision (re-do) surgery may be necessary. Revision knee replacement is bigger surgery than primary knee replacement and is associated with higher risks and less predictable results. Mr Arvinte will take you through all
the steps involved and will guide you through the decision-making process. The American Academy of Orthopaedic Surgeons provides a
useful guide to revision (re-do) surgery.