Advice for a 50-year-old suffering with knee problems

Q: I am a 50-year-old athlete who still enjoys playing basketball and running. When I was a teenager I had my cartilage removed from my right knee. I was good for a long time but over the last several years whenever I play or run, my knee hurts and swells.

My doctor told me I had arthritis and should stop playing sports. I have tried some anti-inflammatory medicines and had a Cortisone shot that helped for a little while. The doctor said when the pain gets bad enough I will need a knee replacement. I still want to be active and want to know if there are any other treatments that I could do.

A: There are two types of cartilage in the knee joint. The first is the type you likely injured as a teenager known as the meniscus. This is a C-shaped or O-shaped shock absorber between the two bones of the knee that when torn can cause pain.

Years ago when an athlete tore the meniscal cartilage it was removed in its entirety. Over the years we have found that this led to significant early arthritis at a much younger age. Today we have tried to either sew back and save the whole meniscus or at least save as much of it as possible.

The more important type of cartilage that becomes a factor as we get older is articular cartilage, which lines every bone in our body and is essentially the rubbery stuff on the end of a chicken bone.

When this wears thin — such as a car tire losing its tread — this is known as osteoarthritis and can lead to pain, limited motion, swelling, and impaired function. Anti-inflammatories and Cortisone shots are two methods that are effective in many patients.

Visco supplementation, the application of an all natural lubricant in the knee joint, can be effective for many patients. It usually lasts six to 12 months. I would encourage you to ask your orthopedic surgeon to determine if you are a candidate. Many NBA and NFL players have used Visco supplementation such as Synvisc to prolong their athletic careers.

If the majority of your arthritis is on one side of the knee, an unloader brace can take pressure off of that side and also allow you to return to sports activity with improved function. This too should be discussed with your doctor.

The indication for either partial or total knee joint replacement is when you can no longer live with the pain or function. As young as you are, this should be put off until “your knee tells you it is time to do the surgery.”

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