Relief from knee pain starts here.

Relief from knee pain
starts here.
Table of Contents
How Knees Work
Common Conditions and Treatment Options
Surgical Procedures
What Sets Us Apart
RT
STA
Start the Journey to Pain-Free Knees
Your Source for Knee Relief
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How Knees Work
It goes without saying that our knees play a pretty important role in our ability to move about, so when injuries,
chronic conditions, bruises or skin wounds occur around the knee area, even routine movements can become
excruciating. What can you do to protect and treat your knees? How do you know when you need to see a
doctor, or consider a surgical treatment for knee pain? The answers start with a better understanding of how
our knees work.
The knee is a pivotal hinge joint that allows motions such as flexing and extending as well as some internal and
external rotation. It connects the femur (thighbone) to the hip, and the tibia (shinbone) and fibula (a shorter and
thinner bone that runs parallel to the tibia) to the ankle. The patella, or kneecap, is a small bone on the front of
the knee.
A number of ligaments, most notably the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL),
medial collateral ligament (MCL) and lateral collateral ligament (LCL), stabilize the knee and prevent it from
being overstretched or twisted. Two concave pads of cartilage called menisci act as a pad between the femur
and tibia, separating the bones and dispersing friction, along with synovial fluid that bathes the joint and
lubricates the knee.
Knee problems and knee pain are common, as the knee is a frequent point of contact during traumatic
accidents and is prone to wear and tear due to its weight-bearing nature. It is also a common site for arthritis
pain, which is caused by damage to the cartilage at the ends of the bones.
Did you know?
The knee is the largest joint
in the human body.
When climbing stairs, the
knee withstands up to four
times body weight.
More than 600,000 knee
replacements are performed
each year in the United States.
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Common Conditions and
Treatment Options
Arthritis
The most common type of arthritis of the knee is osteoarthritis, a chronic condition in which the cartilage that
cushions the movement of the joints wears away. Rheumatoid arthritis is another type of arthritis that affects the knee.
In rheumatoid arthritis, the knee becomes inflamed and cartilage may be destroyed. We provide an array of treatment
options for these conditions, depending on their severity.
These treatments include:
•Medicines and joint injection to reduce pain, swelling and inflammation
•Physical therapy and/or exercises to improve movement and strength
•Knee replacement surgery
Bursitis/Tendonitis
If you garden, play tennis or ski, you may be at a higher risk for developing bursitis or tendonitis. Bursitis is the
inflammation or irritation of the bursa, a fluid-filled sac located between tissues such as bone, muscle and skin. The bursa
helps lubricate and decrease rubbing, friction and irritation when you move your knees. Tendonitis is an inflammation
or irritation of a tendon, the thick cord that attaches bone to muscle. Bursitis and tendonitis are most often caused by
repetitive, minor impact on the knee, or from a sudden, more serious injury. Age also plays a role. As tissues and tendons
age they are able to tolerate stress less, are less elastic, and are easier to tear. The knee is prone to these conditions.
We treat bursitis and tendonitis with:
• Activity modification and rest
• Icing at the sight of pain
• Medicines and joint injection to reduce pain, swelling and inflammation
Cartilage Injuries and Disorders
Chondromalacia (KON-dro-muh-lay-she-uh) occurs when
the cartilage of the kneecap softens. This can be caused
by injury, overuse or muscle weakness, or if parts of the
knee are out of alignment.
Meniscal cartilage can be injured if the knee is twisted
while bearing weight. This may be the result of a sports
injury or even something simple, like twisting when getting
out of a chair. A partial or total tear may occur. The
seriousness of the injury depends on the location and the
size of the tear.
Our treatments for cartilage injuries include:
• Exercises to strengthen muscles
• Electrical stimulation to strengthen muscles
• Arthroscopic surgery
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Knee Fracture
Your bones are rigid, but they are also designed to “give” somewhat when an outside force is applied. However, if a bone
experiences an extreme force, it will break or shatter. Our knee fracture care follows one basic rule: the broken pieces
must be put back into position and prevented from moving out of place until you can heal properly and as comfortably
as possible.
Our treatment options for a fractured knee or kneecap include:
• Cast immobilization
• Bracing
• Traction
• Arthroscopic and open surgery
Ligament Injuries
Two commonly injured ligaments in the knee are the ACL and PCL. An injury to these ligaments is sometimes
called a “sprain.” Because they stabilize the knee in a rotational fashion, if one of them is significantly damaged,
the knee will be unstable when planting the foot, causing the knee to buckle and give way. The ACL is most often
stretched or torn (or both) by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an
automobile accident or football tackle.
The MCL and LCL are usually injured by a blow to the outer side of the knee, causing the ligament to stretch or tear.
These blows frequently occur in sports such as football or hockey.
We treat ligament injuries with:
• Icing (right after the injury) to reduce swelling
• Exercises to strengthen muscles
• A brace or splint to immobilize the joint
• Arthroscopic surgery (in some cases, including reconstruction of the damaged ligament)
Most knee problems are the result of a direct blow or
sudden movement that strains the knee. Such injuries
are very common in sports. Arthritis and inflammation
are also major contributors to knee problems. These
conditions can be caused by genetics, gradual wear
and tear or certain rheumatic diseases such as
rheumatoid arthritis and lupus.
Our orthopedic surgeons have spent years studying
and advancing ACL reconstruction, meniscus
repair and other joint preservation and restoration
techniques to help provide better movement. Our
comprehensive knee care starts with an evaluation
of your medical history, along with a physical
examination and diagnostic tests (such as X-rays, CAT
scan, MRI and Arthroscopy), to accurately identify and
recommend the proper course of treatment to bring
you pain relief and improved knee function.
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Surgical Procedures
Arthroscopy
Procedure
Arthroscopic surgery is an extremely valuable tool in the treatment of joint conditions. It allows us to examine,
diagnose and treat problems inside a joint. An arthroscopy can be more precise than an X-ray or open surgery in
evaluating certain problems. Our physicians are highly skilled to perform arthroscopic surgical procedures on many
joints in the body, including the knee.
We use arthroscopy to aid in:
• Diagnosis of synovitis, an inflammation of the lining in the knee. The procedure can then be used to remove the
inflamed lining.
• Reconstruction of the ACL or PCL of the knee.
• Repair or resection of torn meniscus (cartilage) in the knee.
During an arthroscopic procedure, one of our physicians will examine your joint by inserting a pencil-sized
instrument known as an arthroscope through an incision in the skin. The arthroscope is made up of a tiny lens, light
source and video camera. The camera displays a large image of the joint on a television screen,
allowing us to look at cartilage and ligaments throughout your knee and locate the
source of damage and pain.
Through an additional one to two small incisions made around the joint
area, we can insert surgical instruments and perform a repair as
needed. In most cases, the incisions made during arthroscopy leave
tiny scars that are almost unnoticeable.
Post Surgery and Recovery
After surgery, our staff will provide you with instructions on
post-operative care and exercise procedures. Most of the
time, hospitalization is not necessary. In fact, many of our
patients are able to have their arthroscopic surgery on
an outpatient basis and are home several hours after
the surgery.
It is not unusual for patients to go back to work or school
or resume daily activities within a few days. Athletes who
are in good physical condition may in some cases return
to athletic activities within a few weeks, but each patient’s
arthroscopic surgery and recovery time is unique. Let us help
you determine if arthroscopy is right for you.
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Partial Knee Replacement
Procedure
The knee is a combination of three joints, or compartments. Osteoarthritis may affect all parts of the knee, or the
damage may be limited to one compartment. If nonsurgical treatments such as medications and use of a walking
support are no longer helpful, you may want to consider knee replacement surgery. Knee replacement surgery is a
safe and effective procedure to relieve pain, correct leg deformity and help you resume normal activities.
If only one knee compartment is damaged, we may recommend a partial or unicompartmental knee replacement,
in which only the damaged compartment is resurfaced with an implant. The most common partial knees go on the
inside compartment, or medial side, of the knees.
Newer surgical techniques permit the partial knee implant to be inserted through a small incision without splitting
the quadriceps muscle, which is routinely done in total knee surgery. There is much less swelling and bleeding,
and partial knee replacements require significantly less recovery time than total knee replacement surgery. The
procedure itself takes approximately 1 to 2 hours. There are three basic steps:
There are three basic steps to the procedure:
1
2
3
Prepare the bone
Our surgeon will remove the cartilage and bone from the damaged compartment of your knee.
Position the metal implants
The ends of the femur and tibia are capped with metal coverings that recreate the surface of the joint. The
metal components are cemented to the bone.
Insert a spacer
A plastic insert is placed between the two metal components to allow for a smooth gliding surface.
Post Surgery and Recovery
Walking, knee movements and physical therapy begin as you experience less pain. Often these activities start
the day after surgery. But you will begin putting weight on your knee immediately after surgery. You may need a
walker, cane or crutches for the first several days or weeks until you become comfortable enough to walk without
assistance. In most cases, patients who have had a partial or unicompartmental knee replacement go home 1 to 3
days after the operation.
A physical therapist will give you exercises to help maintain your range of motion and restore your strength. You
will most likely resume your regular activities of daily living by 6 weeks after surgery. Our staff will manage your
progress and be available every step of the way.
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Total Knee Replacement
Procedure
Total knee replacements are one of the most successful procedures in all of medicine. At Orthopedic Surgery
Specialists, we stay at the forefront of advances in total knee replacements in order to provide a safe return to
your active lifestyle.
In a traditional total knee replacement, the damaged areas of the femur, tibia and kneecap are removed and
replaced with prostheses. The procedure itself takes approximately 1 to 2 hours.
There are four basic steps to a total knee replacement procedure:
1
2
3
4
Prepare the bone
Our surgeon will remove the damaged cartilage surfaces at the ends of the femur and tibia along with a small
amount of underlying bone.
Position the metal implants
The removed cartilage and bone is then replaced with metal components that recreate the surface of the
joint. These metal parts are cemented into the bone for optimal fixation.
Resurface the patella
The undersurface of the patella (kneecap) may be cut and resurfaced with a plastic button. We perform this
procedure on a case-by-case basis.
Insert a spacer
A plastic insert is placed between the two metal components to allow for a smooth
gliding surface.
Post Surgery and Recovery
After surgery, you may receive medication to help with pain
management. Walking, knee movements and physical therapy begin
as you experience less pain, many times starting the day after surgery.
Patients usually remain in the hospital for 2-3 days following total
knee replacement surgery, then either return home or proceed to
a rehabilitation facility. Physical therapy is an important part of the
recovery process following knee replacement surgery.
More than 90% of people who have total knee replacement surgery
experience a dramatic reduction in knee pain and a significant
improvement in the ability to perform common activities of daily
living. Total knee replacement will not allow you to do more than
you could before you developed arthritis, but realistic post-surgery
activities include unlimited walking, swimming, golfing, driving,
ballroom dancing and other low-impact sports. Because every patient
is different, we work with you to develop an individualized plan for
recovery and healing and manage your progress every step of the way.
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What Sets Us Apart
We’re More Than Just Bone Doctors
At Orthopedic Surgery Specialists, we understand musculoskeletal conditions and injuries. Our multidisciplinary team of
board-certified orthopedic surgeons has pursued advanced training in several musculoskeletal subspecialties including
joint replacement, arthroscopic surgery and sports medicine, and stays at the forefront of medical advances in the
prevention, diagnosis and treatment of orthopedic conditions. We have decades of combined experience in providing
high-quality, comprehensive orthopedic care to North Texans of all ages. Plus, we’re known for using the least invasive
surgical techniques whenever possible to promote better joint health and to minimize pain.
To help Orthopedic Surgery Specialists meet the growing need for advanced fracture surgical care for athletes and aging
baby boomers, our Dr. Jay Bender has completed the country’s first fellowship program in geriatric orthopedic surgery
and trauma. The unique program, offered at the University of California at San Francisco, is one of the most respected
orthopedic trauma fellowships available in the United States. It’s another way that Orthopedic Surgery Specialists is
helping lead the way in caring for the orthopedic needs of North Texans.
Personalized Care, Advanced Services are Our Cornerstones
At Orthopedic Surgery Specialists, we want to serve you with compassion, precision and speed. Our on-site ultrasound
capabilities allow us to do all three. For years, orthopedic surgeons have relied on X-ray images to assist in diagnosing
and treating a variety of musculoskeletal conditions. Although still a clinical necessity, X-rays provide a limited picture of
the tissues that may be involved in an injury.
Today, advanced ultrasound technology enables our orthopedic surgeons to see your anatomy in real time for quicker
assessment and diagnosis of an injury or to guide an injection with on-target accuracy into just about any joint in your
body. Ultrasound imaging is also painless and there’s no radiation involved. Having this technology right in our office
allows us to diagnose and/or treat many conditions with minimal downtime and recovery time for you.
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Start the Journey to Pain-Free Knees
Preventing Injuries
Maintain a healthy weight
Extra pounds put additional strain on your knees, increasing the risk of injuries and osteoarthritis.
Prepare your knees for activity
Athletes should take time for conditioning to prepare muscles for the demands of sports participation.
Ensure that your technique and movement are the best they can be.
Vary your routine to stay strong and limber
Weak muscles are a leading cause of knee injuries. Mix up your routine with balance and stability training, as
well as stretching and flexibility exercises, to help your knees avoid injury.
Exercise appropriately for your condition
If you have osteoarthritis, chronic pain or recurring injuries, consider low-impact forms of exercise, such as
swimming or water aerobics. Avoid high-impact activities.
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When to See Our Specialists
The knee has to support the weight of the body as you run, walk, jump and climb stairs. The stress on the knee means
that knees are more frequently injured than other joints. When knee pain interferes with your ability to carry out
everyday activities, or disturbs your sleep, it may be time to contact Orthopedic Surgery Specialists.
Why is arthroscopy necessary?
Diseases and injuries can damage otherwise healthy knee cartilage, ligaments, muscles and tendons. Arthroscopy
helps us accurately identify the source of damage, whether it be disease, inflammation or loose bodies of bone or
cartilage. Through arthroscopy, we may then be able to repair the damage or recommend another course of action.
Aren’t I too young for knee replacement?
With new techniques and technology, joint replacements are lasting longer than ever and are more suitable for active
people of all ages. Pain relief is the major advantage of knee replacement, with restoration of joint mobility a big factor
as well. If your knee pain is interfering with your life, you may want to consider joint repair or replacement at any age.
Will I have to change my lifestyle after knee replacement?
In general, you will want to avoid high impact exercises such as running or jogging on hard pavement. Implants are
durable, but will wear out with heavy use. To insure a long life for your implant, talk with one of our orthopaedic
surgeons about what results you can expect and make sure you have a realistic idea of what you will be able to do
after the surgery.
Preparing for Surgery
Ready your environment for post-surgery arrival
Arrange for help upfront so that when you get home you are ready to let recovery and healing begin without delay.
Talk to your doctor about medications and potential illnesses
• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen
(Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs. It is very important for us to also know which drugs you
should still take on the day of your surgery.
• Tell us if you have been drinking a lot of alcohol, especially more than one or two drinks a day. If you smoke, try to
stop. Smoking can slow down your healing.
• Let us know about any cold, flu, fever, rashes or other illness you may have before your surgery. If you have not
seen a dentist in the past two years or have known loose or broken teeth, these should be evaluated before knee
replacement. A bad tooth is a type of chronic infection.
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Your Source for Comprehensive
Knee Care
W. University Dr.
2900 I-35 North, Suite 200
Denton, Texas 76201
OrthoSurgeryDenton.com
5
I-3
Phone: 940-323-3400
Oak St.
I-3
5
A Tradition of Caring
At Orthopedic Surgery Specialists, we have been helping lead the way in knee preservation and replacement for
more than two decades. Our board-certified, fellowship-trained orthopedic surgeons strive to bring the latest
techniques to the care of our patients who are ready to resume active lifestyles, sooner. We work in collaboration
with orthopedic-focused nurses, therapists and staff members at Texas Health Presbyterian Hospital Denton who
are also trained to care for joint patients.
We believe patient education is an important part of your joint health. Therefore, we make it a priority to explain
signs and symptoms, potential causes, treatment options and prevention methods to you. We also will provide you
with resources we feel will be helpful for better understanding your specific condition. If you have questions or
concerns about your orthopedic health, please don’t hesitate to contact our staff.
This information is an educational resource only and should not be used to make a decision on medical treatment. All decisions about the proper
course of medical treatment should be made in conjunction with your surgeon or a licensed health care provider.
Orthopedic Surgery Specialists is part of Texas Health Physicians Group, a network of more than 800 physicians, nurse practitioners and physician
assistants dedicated to providing safe, quality care for the communities throughout North Texas. Physicians employed by Texas Health Physicians
Group practice independently and are not employees of the hospital or Texas Health Resources.
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