A couple of months ago, Sam Torrence was part of three in five adults suffering from knee pain. Now, he’s recovered from knee surgery and is on his way to the US Open Pickleball Championships in April.
“I was limited in my ability to bend, to kneel, to stretch, at nighttime I was in excruciating pain that would wake me up,” Torrence said.
Torrence sought help from Dr. David Doherty, UTHealth orthopedic surgeon with Memorial Hermann Joint Centers in Sugar Land. Dr. Doherty said he encourages patients to try a variety of conservative options first, including the following:
- Anti-inflammatory diet
- Exercise to strengthen the knee - The most conservative way to eliminate and prevent knee pain is a diet with anti-inflammatory foods, exercise that strengthens muscles around the knee and potentially losing weight that’s adding stress on the knee.
- Cortisone injection
- Hyaluronic acid injection
“One of the more popular ones in my patient group is a hyaluronic acid injection, which is, has a long track history of being used in cosmetic industry. A lot of people use it on their face to help fill in fine lines and wrinkles. It does a similar thing inside of your knee where it’s going to increase the water content inside of cartilage so it kind of can push together some crevices or some of those active areas that are really causing that inflammation and it also lubricates inside of the knee,” Dr. Doherty explained.
Doherty said hyaluronic acid can bring pain relief for a few months at a time.
Another popular option: platelet-rich plasma or PRP.
“It’s a very interesting treatment where we take a sample of the patient’s blood, spin it really fast and take the substance at the top, which is highly, it has a high concentration of healing factors and other things in the body that factor in injury and so we put that super dose of those healing factors inside of a knee, and it goes to areas of concern. It works on them and after a few weeks or a month, patients are often left with a much less symptomatic knee,” Dr. Doherty said.
Knee replacement surgery
Torrence tried a variety of pain relief options but ultimately decided it wasn’t cutting it for him.
“We talked about the fact that if we’re going to do surgery, then we’ve got to do it in a timely fashion for getting ready for the Open so I ended up not for going anymore shots because I didn’t think I was getting anything done with them,” Torrence said.
During an operation to replace his joint, Dr. Doherty used robotic technology for an accurate insertion.
“What I like about robotic surgery, which I utilize in a high percentage of my patients is... ultimately we’re left with the product that is reproducible and we know it’s going to work,” Doherty said.
A month after surgery, Sam was back to light exercise. By mid-April, he expects to be 100% back to normal.
Dr. Doherty warns that jumping to knee replacement without trying all other conservative options first will not yield good results. He said, if you replace the joint too early (before they’ve had a lot of arthritis or before it’s bone on bone) the patient will likely have trouble because a knee replacement is meant to relieve pain and restore function but if you have a healthy knee, it’s never going to feel as comfortable as a healthy knee.
What are the qualifications Dr. Doherty looks at to decide on whether to do surgery and which technique to use?
“Whether it’s degenerative changes in injury, or you might have an inflammatory condition that destroys your joint from an autoimmune standpoint. Regardless, the treatment pathway is fairly similar. The total knee replacement umbrella encompasses a variety of different pathways where we can take a patient and look at their specific needs, we marry those needs with their anatomic considerations and ultimately our goal is to restore function for that patient, to take away the pain that they’re experiencing on a daily basis and to give them the opportunity to get back out and do the things turn out only they enjoy doing in their life, but the things they need to do,” he said. “There are some patients that can have a knee replacement done with minimal resection of soft tissues and ligament preservation, and there are some patients where those ligaments are too diseased to keep in place and so we have to do more work and then replace those with the technology within the knee replacement.”