Innovations in knee care: Women and knee arthritis; controlling pain; partial replacement

Mayo Clinic's global leadership in advancing treatment of musculoskeletal disorders spans nearly a century. Teams of physicians at the Mayo Clinic Department of Orthopedics are on the forefront of research and innovations to enhance patient care, such as designing the first metal plate used to fix fractures securely and implanting the first artificial hip in the U.S. Through the years, at Mayo Clinic has been recognized as a leader in the field of orthopedics, consistently placing among the top institutions by reputable rankings such as the U.S. News & World Report.

Building on this orthopedic legacy, Mayo Clinic knee specialists offer the most advanced, effective and comprehensive knee services available.

Women and knee arthritis

Osteoarthritis is a common and painful inflammatory joint condition resulting from degeneration of cartilage. Women older than 50 experience knee arthritis more frequently than men do. They also tend to delay seeking relief from pain, as compared with men.

Is there a biological basis driving this gender difference?

Mayo Clinic orthopedic surgeon Mary I. O'Connor, M.D., hopes to answer this question. As chair of the Department of Orthopedic Surgery at Mayo Clinic in Florida, Dr. O'Connor leads a new international investigation to discover molecular insights that may lead to new treatments or prevention.

Notes Dr. O'Connor: "Because I'm different from a man at a chromosomal level, do I have a difference in my nerve fibers, different enervations that make me experience pain differently? Do my different hormone receptors affect pain processing or disease course?" The study will analyze knee tissue and bone specimens for possible molecular differences in pain fibers and hormone and vitamin D receptors between female and male patients.

Controlling pain

Mark J. Spangehl, M.D., orthopedic surgeon at Mayo Clinic in Arizona, is committed to answering a key question for knee replacement patients: Which method of postoperative pain control is best for comfort and for recovering mobility?

Typically, patients at Mayo Clinic undergo one of two types of pain control. Dr. Spangehl's study compares these two methods. One is a peripheral nerve block in which an anesthetic solution is injected around two nerves near the knee. While data show it provides excellent pain control, there is some suggestion it may also slow recovery. There are also rare injuries to the nerve.

The second method of pain control relies on a combination of medications injected into the knee just before the surgery is completed. Explains Dr. Spangehl: "At Mayo Clinic, we pride ourselves on efficiency. But we also want to make sure that we remain focused on doing what is best for the patient's recovery — and this study will provide the evidence to help us make those decisions."

The team hopes to publish its analysis sometime this year.

Partial replacement

The specific pain of patellofemoral arthritis is its signature: a stabbing sensation in the front of the knee while going up or down stairs. Anyone can develop this form of arthritic degeneration in only a portion of a kneecap — the back — but athletes often do. Now orthopedic surgeons at the Mayo Clinic W. Hall Wendel Jr. Musculoskeletal Center in Minnesota have a new approach that spares the remaining healthy knee. Called a patellofemoral partial arthroplasty, the procedure replaces only one knee compartment. In the past, patients typically were subject to a total replacement of all three knee compartments.

Explains orthopedic surgeon Diane L. Dahm, M.D.: "The vast majority of cases with this kind of arthritis should be treated without an operation. But if that fails to give relief, we've refined a partial approach that is less traumatic for the patient." Benefits of patellofemoral partial arthroplasty include:

  • Reduced pain and hospitalization
  • Faster recovery of mobility
  • Less blood loss

Dr. Dahm notes that comprehensive aftercare with physical and occupational therapy is vital to positive outcomes. "After-surgery recovery is well supported at our Musculoskeletal Center so patients regain strength, agility and stability, and a return to pain-free mobility."

The key to the knee: Comprehensive care

Knee pain is a common clinical complaint for people of all ages and occupations. It may result when cartilage is torn or a ligament ruptured due to an accident, fall or injury. Medical conditions such as arthritis, infections or gout also may cause knee pain.

Most cases of knee pain are managed successfully through patient-directed care such as rest, icing or short-term use of anti-inflammatory medications. More-complicated injuries may require physical or occupational therapy, or bracing the knee. Knee pain that cannot be managed by these measures may require surgery.

Whatever intervention is needed, the key to successful outcomes is the team approach among Mayo Clinic physicians. At the W. Hall Wendel Jr. Musculoskeletal Center, a group of Mayo Clinic's orthopedic experts works for the patient by accessing state-of-the-art technology to provide diagnosis, outpatient treatment and rehabilitation for all types of musculoskeletal conditions. As a result of the center's integrated design and comprehensive capabilities, patients quickly and conveniently go from radiographic imaging to clinical consultations to treatment areas.

The Musculoskeletal Center also includes the Department of Physical Medicine and Rehabilitation. This integration assures that patients receive the highest quality, comprehensive care that is individualized to their particular needs.

For more information

This article originally appeared in the March 2013 issue of Mayo Clinic Connection.