Continual swollen knee (sorry long thread)

[HARRI2]

Hi I'm new to this forum and was wondering if anyone has any help with my knee problem.

In the last 4 years I have had 2 surgeries (one on each knee) for cartilage tear , arthroscopy.

After my second op , on my left knee , I completed all physio and returned to work feeling 100% (I work at sea , sometimes a very physical job) 6 months after I had returned I woke up with a swollen knee and immediately thought I had a repeat tear in my cartilage , I spent 2 more weeks at sea doing light duties and taking the Ibprufen but my knee got worse and swelling increased.

On returning home and visiting my consultant , MRI scan was called for and results where no cartilage damage , I was then refered to a specialist who concluded I had osteoarthritis (this is over a matter of 3 months of test etc) my knee still swollen and muscle wastage becoming an issue due to lack of movement. I then had a steroid injection which had an immediate affect and my knee felt great unfortunately less than 2 weeks later it flared up again. I was then given a synovial fluid replacement and my knee and slowly (over a month or so) returned to normal , no more swelling. I since returned to work and looked after my knee as much as I could but 12 months later it has flared up again and the constant ice pack Ibprufen Glucosamine Cod liver Oil etc etc are having no affect , and as the consultant stated when I had the last treatment , its the end of the road if this doesn't work!! So here I am at the end of the road wondering if anyone has any ideas , thoughts , similar experiences advice , I'm open to anything.
I'm 38 fairly fit slightly overweight , and looking for a miracle cure , have a young son and an out of work police officer partner (car accident 3 years ago in work , whole other story) who rely on my very well paid job for their lifestyle and this problem concerns me greatly for my future working capability.

Any replies appreciated
Paul

[Heidi]

Hi Paul,

Sounds like you've had a rough ride!

As far as I am aware the only real solution to osteoarthritis is a knee replacement. Obviously this is not what you want at this stage.

You sound as though you have been doing all the right things (anti-inflammatories/ice etc).

Strengthening the muscles surrounding the knee is important in trying to reduce symptoms by keeping the joint strong, but obviously this is difficult when you are limited by pain.

Did your physio give you VMO strengthening exercises? If you're not sure about this then he/she probably didn't. These can really help. Also flexibility of the quads and hamstrings especially.

Have you tried wearing a good, supportive knee brace. This will help to keep the knee warm and with compression to reduce swelling and limit twisting and side-ways movements.
I can recommend the Mueller HG80 with steel springs....follow this link:
http://www.return2fitness.co.uk/Supports_And_Braces/Knee_Supports/muellerhg80bracesteelsprings

Also what about TENS? This is a good method of pain relief which I am currently using with an arthritis patient to good effect. The units can be bought quite cheaply now and can be used everyday.

Sorry theres quite a lot of ideas bundled together here!...but hopefully you will find some of them helpful.

[HARRI2]

Thanks for the reply will look into the knee support and excercises as have not heard of VMO. A nagging doubt that I have had about my diagnosis is the fact that I don't have any pain associated with my symptons , only swelling and then reduced mobility because of this , I have often wondered if there was an alternative reason for my problems.
On the knee support front , I was using a couple I have the other day and during the night I noticed an itching sensation on my knee and found that the vein going over my knee cap had enlarged and was bulging above skin level. I put an ice pack on it for 20 mins and it settled down but left a bruise. I was wondering if the support and swelling together had reduced the blood flow in and around my knee !!!! It just gets worse and worse doesn't it!!

Hope this extra info helps

Paul

[Heidi]

Ok, thanks. If there isn't any pain at all, progress on with strengthening the knee, concentrating initially on VMO contraction. There is a paragraph about VMO on this page:

http://www.sportsinjuryclinic.net/cybertherapist/front/knee/patella_dislocation.htm

Although it is not only in dislocations that this can be a problem. VMO is bascially fibres of the Vastus medialis muscle, just above and to the inside of the knee cap. It is important in stabilising the knee caps movement.

To get it contracting by sitting with the legs out in front and a towel rolled up under the injured knee (so it is slightly bent). Push the knee down into the towel so it straightens and the foot lifts up slightly. Put your fingers on these fibres to make sure they are firing.

I'm planning on writing some pages for VMO strengthening at some point soon so there will be more information about what you can do.

As for the brace, was it too tight? It shouldn't constrict the blood flow and should either have a gap at the back or front to allow for expansion.

Heidi

[HARRI2]

Thanks once again for your reply , it makes a lot of sense as I feel i have very weak/small muscles around the knee but like everyone I ignore this problem and just get on with life until I have these flare ups.Have searched and found a good set of excersises that concentrate on knee and posture (hip and ankle also) I shall see how i get on , first thing is to reduce swelling enough to make them worthwhile.
Yes I think the strapping was probably too tight , have ordered a new brace as recommended by your good self.

Thank you for your time

Paul