Knee pain- to go for knee surgery or not?

Someone I know, who is obese had been suffering from knee pain lately. Usually she does not move around much and is quite sedentary.

When she saw the specialist, she was told that her cartilage had dried out because there was no more synovial fluid. The suggested option was knee replacement surgery to be done on both knees.

Initially the thought of operation terrified her and so she tried to explore other alternatives from the surgery. I subsequently referred her to an occupational therapist whom I had earlier brought my mom to. Occupational therapy is different from physiotherapy as occupational therapy focuses on regaining the functions of activities of daily living- ie the therapy is targeted to help the patient to walk, climb stairs, etc which the patient may not be able to do due to pain or an injury. Whereas physiotherapy is usually done right after operation to regain function of the body part but not on the purpose of the use of the body part for daily activities.

The occupational therapist uses massage techniques to identify muscle stiffness and tightness. From there, he determined the postural and muscle imbalances and recommended methods to relief the condition- however, as part of a trained medical professional who used to be attached to a local government hospital, he knows when the patient requires surgery.

From one session, he told her that her quadriceps muscles (the muscle located at the front of the thighs) were weak. With her weight problem, part of the front thigh actually ‘fall over’ towards her knees (you may noticed that those who are overweight do not have well formed knees). It is the pressure that contribute to the drying of her synovial fluid causing the knee pain. But according to him, the fluid had not completely dried out and therefore occupational therapy is possible- but it will take longer and much more effort on the part of the patient. Whereas if the fluid had completely dried out, surgery is required.

If the lady was to follow the therapy, she would need to perform simple exercises that are targeted to strengthen her quad muscles and stretches to relieve some tight muscles. She also must lose weight. It requires diligence and a whole lot of self discipline. Also, she would need to pay for treatment sessions which comes up to about RM100 per session- she would need to take about 10 sessions first.

I always remember that the occupational therapist had emphasized that even though her knee cap had little fluid, the knee is not the cause of the problem. So basically operation is not going to solve her problem long term.  It is her weight and weak muscles. With massage (it differs from the Thai or Indonesian massage), he would remove fluid buildup in certain muscles, loosen tight muscles and enable smooth fluid flow. He said that once all that is in, with correct posture, her knee condition will be strengthened and she may not require the operation. And if she wanted to contemplate the operation, she should at least make sure her quad muscles are strong enough to help support her. Else if not, a lot of pressure will go to the knees and bones- and in some cases, steel inserts may even cause a crack at the femur bone. Also, the inserts does not last forever- it’s only about 10 to 15 years.

The lady thought about it, and in the end, she decided she would go straight for the operation without any exercises or attempt to lose weight first. There would be two operations on both knees in a span of short time apart. The pain after the operation was terrible and unbearable. As the result, she lost appetite to eat and lost a little weight- but quickly regained it later when the pain was gone.

She had the operation last year, and after that, her knees no longer gave her any pain. Because of that, there is even less control in her food intake- she took whatever she liked and continued living the sedentary lifestyle. Because there was less pain, there was less incentive to maintain the health.

But what the therapist said always remained in my mind- that she was not solving the cause of her problem. Her knees had to work very hard and endure great amount of pressure from her weight, and the fact that her quads muscles were not strong enough to absorb part of the pressure.

This is a food for thought for those who have osteoarthritis on the knees and are contemplating knee surgery- that the cause of your knee pain may not be from the knee. Traditional Chinese medicine would say it is ‘wind dampness’ that cause the blockage, so the fluid and nutrients are not effective delivered to the knees. It can be corrected by exercise, qi gong, herbs (to dispel the ‘wind’ and dampness) and acupressure/acupuncture/acu cupping therapy. By doing that, you would be going to the root cause and solving the problem directly and in the process, improve the overall health of your body.