Early Treatment Equals Long-Term Freedom

When it comes to joint pain, there’s a big benefit to catching injuries early and treating them quickly. Four local physicians explain why you shouldn’t wait.

The one good thing you can say about pain? It’s a strong incentive to seek treatment. So, naturally, orthopedic specialists stress that it’s important to heed your body’s warning signals. The faster someone seeks orthopedic treatment the faster they can expect to return to the healthy, active lifestyle they enjoy.

For Dr. Kenneth Klein, a non-surgical orthopedic specialist with Beloit Health System, this translates to seeing patients of every age and physical condition. Klein says most patients fall into distinct groups.

Dr. Kenneth Klein

“Many of my patients are moderately active but get involved in some kind of activity for which they are not conditioned,” Klein says. “I call them the weekend warriors. They participate in some kind of sport and are easily injured. This would include sprains, tendon pulls, dislocations and more severe injuries such as a torn meniscus or rotator cuff. Or, they do some kind of yard or gardening work that irritates joints and muscles not usually used in that way.”

Another group involves people who have traumatic injuries from accidents, falls and other unavoidable situations. These patients may come in with a broken collarbone, fractures or dislocations.

“The third group are those who have spent years in work and recreational activities that have led to wear on knee, hip, elbow and shoulder joints,” he says. “Over time, not only do these joints become chronically painful but arthritis has settled into the damaged cartilage surrounding the joints.”

The key to treatment begins with a thorough understanding of the patient’s history, any potential causes of the pain, and the patient’s overall physical condition, Klein says. Usually by the end of an initial exam, Klein feels he has a fairly good idea of what is wrong, sometimes without need for X-rays, CAT scans or MRIs.

“I believe this is critical to successful treatment,” Klein says. “It is difficult to fix the problem without knowing exactly what the patient has been doing that might cause it. Communication is also a vital part.”

Once the diagnosis is made, Klein determines a treatment program that may include physical therapy, vitamins and herbal supplements, pain management medications, and oral and injected medications to reduce inflammation and swelling.

“All of these are used to help patients heal themselves without surgery,” Klein adds. “The goal is to work closely with patients to get them back to their normal lifestyles regardless of age. If they work full-time or are retired, are relatively sedentary or extremely active, we want them to recover and live pain-free with little or no residual effects for the rest of their lives.”

Dr. Marko F. Krpan

Knees are perhaps the most vulnerable joints in the human anatomy, so it’s not surprising that Dr. Marko F. Krpan, a board-certified orthopedic surgeon with Mercyhealth, in Rockford, says he sees patients all the way from young children to older adults.

“Knee damage occurs in patients of all ages, starting with young children engaging in roughhouse play or sports,” Krpan adds. “Left untreated early on, these knee injuries can lead to wear-and-tear damage with degenerative arthritis long-term, as much as 20 to 25 years later. The pain and extent of this can come on gradually, or it can suddenly become more evident.”

Nonsurgical options include resting the joint, medications and therapy, but if those options are exhausted it’s time to decide if surgery is the patient’s best shot at living pain-free.

“We always do everything we can to help the patient heal without resorting to surgery, but sometimes surgery is the only option,” says Krpan. “The good news is that recent advancements in medications have made it more possible to deal with conditions such as rheumatoid or psoriatic arthritis that often accompany these injuries. Psoriatic arthritis is an autoimmune disease in which the patient’s immune system attacks the cartilage around the knee and other joints.”

One of the benefits of joint replacement is that the damaged cartilage is removed, thus eliminating the trigger for the inflammatory process.

“With reconstructive knee surgery, the structures of the joint are repaired, improving function and decreasing the conditions that result in inflammation or instability, therefore eliminating the pain,” Krpan explains. “Torn ligaments and tendons, including anterior cruciate ligament (ACL), are repaired, restoring the patient’s stability and balance. Joint replacement removes the entire damaged cartilage and bone, eliminating pain from both the injury and arthritis.”

Krpan adds that, because of today’s more aggressive methods, recovery is quicker than in years past.

“Twenty years ago, knee surgery patients remained in the hospital for three to five days,” he says. “Now, patients may go home the same day, or in some cases the day after surgery. Same-day releases are reserved for a smaller, select group of patients who can more easily tolerate pain and activity. These patients are usually younger and free of other underlying health issues.”

Also in the past, patients were often advised to wait as long as possible to have knee replacement surgery because those implants only lasted from 10 to 15 years.

“Today’s knee prosthesis can last from 25 to 30 years, better than double, giving patients decades of pain-free living,” Krpan says. “A knee replacement performed on patients in their 40s to 50s is likely going to last their lifetime. This vastly improves their quality of life and allows them to continue to live an active lifestyle.”

Shoulders are also a common source of pain in all ages. Dr. Andreas J. Fischer, a board-certified orthopedic surgeon with OSF HealthCare in Rockford, says some fractures, dislocations and other injuries can be treated without surgery, but when they are severe or long-termed, surgery may be the patient’s best option.

Dr. Andreas J. Fischer

“Collarbones, for example, mostly can heal on their own,” Fischer says. “Some shoulder dislocations can as well, but when the dislocation is too serious, surgery may be warranted.”

He adds that rotator cuff tears are among the most common and most painful of shoulder trauma. He sees patients mostly in their 40s to 60s for this type of injury, often after they’ve experienced accidents, falls, overreaching above their heads, or repeated motions.

“The rotator cuff is a system of four muscles that surround the shoulder joint and help patients lift items over their heads,” he explains. “This includes such everyday actions as washing hair. It’s more of a sleeve tear than a tendon tear, in which the muscle is pulled away from the bone. It is extremely painful and requires intensive physical therapy and a long period of recovery.”

Other shoulder pain is best treated with reconstruction or joint replacement surgery, Fischer adds.
“Shoulder pain doesn’t always simply result from trauma or years of wear causing bone-on-bone friction, but also is complicated by arthritis which sets in when the adjacent cartilage is damaged,” Fischer says. “Arthritis causes inflammation and swelling in addition to the base injury. When nonsurgical techniques such as therapy and medication aren’t effective, then we talk to the patient about replacement or reconstructive surgery. It’s always the patient’s choice.”

Anatomical joint replacement is the most common treatment for shoulder pain, he adds. This surgical procedure replaces the old joint with a prosthesis.

“The good news about this procedure is that it not only cures the patient’s pain, but it also removes all the arthritis because there is no longer any cartilage for it to attack,” Fischer says.

Further, he performs reconstructive surgeries called reverse arthroplasty, in which the shoulder is rebuilt because the rotator cuff has been injured in the past and is totally gone.

“In this case, we reverse the joint socket and ball, which allows the patient to use the deltoid muscle to lift the arm,” Fischer adds. “It will never be the same as the original, but it does facilitate sufficient movement upwards.”
Recovery from shoulder surgeries can take up to six weeks and involves intensive therapy along with pain management medication. There’s also a stepped program of precautions to prevent overuse and extension that might reinjure the shoulder.

“I ask patients to raise their arms forward no more than 140 degrees to begin with,” Fischer says. “The patient determines how quickly the recovery happens. Some can push through pain better than others.”

Hip joints are also a common source of orthopedic pain and inflexibility. For Dr. Gregory G. Dammann, a board-eligible orthopedic surgeon for FHN in Freeport, one of the most innovative hip replacement surgeries has proven to be a huge benefit. After all nonsurgical options have been exhausted, he says anterior hip surgery is replacing the traditional posterior method in most cases with significant success.

Dr. Gregory G. Dammann

Until about 10 years ago, hip replacement surgery began by cutting through the extensive muscle layers in the back of the hip. Anterior surgery takes the opposite approach.

“It is a more direct way to reach the hip joint,” Dammann adds. “We retract the muscles and cut into the front of the hip area. The replacement procedures are the same, but the major advantage is what happens after surgery.”
Dammann explains that, because fewer muscles are affected, patients experience considerably less post-operative pain and require fewer precautions.

“We are able to use X-ray during the process,” he says. “In terms of cutting into the pelvis from this position, the patient has less chance of dislocation and improved levels of wear on the prothesis. And the other benefit of hip replacement remains the same: by removing the damaged cartilage around the hip, we also remove any arthritis that may have set in.”

Arthritis is a secondary source of pain for patients with any kind of joint trauma, Dammann says. It targets the cartilage lining the joint bones, causing inflammation and pain.

“Surprisingly, age varies widely in patients requiring hip treatment,” he adds. “We see young patients who have suffered hip displacement, sometimes because the socket was not formed properly and other times because of trauma. However, patients in their 60s to 80s make up the majority of my patients at FHN Memorial Hospital. Beyond that, I see patients as old as 90.”

Each patient is assessed thoroughly before any decision is made to operate, he stresses.

“Once the anterior hip surgery is complete, some patients go home the same day, while others may stay overnight depending on their health,” Dammann says. “Physical therapy begins immediately either at a referred facility or with in-home care, depending on the patient’s conditions. The vast majority of my patients begin therapy the next day.”

Dammann adds that patients routinely use walkers about one week after surgery and walk with a cane for two weeks. By three weeks, they should be walking without any ambulatory assistance. Physical therapy sessions usually continue for three to four weeks after surgery.

“Middle-aged patients can range from their 60s to 80s with the expectancy of living relatively pain-free after hip dysplasia,” he says. “There truly is not a hard, fast age for this type of surgery. Quality of life is the criteria, with the goal of living as active a lifestyle as they choose without suffering constant pain. The key is to treat the hip as early as possible to ensure more years of active living.”

Because joint pain can begin at just about any age, the best way to avoid years of discomfort, inflexibility and the loss of work and leisure activities is to seek treatment quickly.