4 August: Q&A with Mr David Macdonald

I’ve been having problems recently with my knees especially the right one. It is often swollen, aches and is painful to bend. I have quite a manual, weight bearing job and have to go up and down flights of stairs regularly over the course of a day.

I am 60 so am some way off of retiring yet. I am trying to manage the pain with painkillers but my GP thinks I need to see a specialist. What do you think is the likely course of treatment?

Mr David Macdonald, Consultant Orthopaedic Surgeon replies:

Your GP is correct. It does sound as if you need specialist advice from an orthopaedic surgeon, if you are keen to continue in a heavy job.
It is likely you have osteo arthritis (the most common type of arthritis in the UK) in your knee. You will need an examination and probably an X-ray. In some circumstances when the cause of the pain is unclear more specialised investigations may be required, such as an MRI scan.
The treatment options will depend on the severity of the arthritis. It may benefit from physiotherapy or injections. Surgery may be required if non-surgical treatments have not helped.
Surgery may by “key hole” surgery if the arthritis is not to advanced, or in more severe cases a joint replacement. Joint replacement surgery can be either a partial knee replacement or a total knee replacement, depending on how much of the knee is affected.
Joint replacement surgery should be considered a “last resort”, especially if you can still work. Most surgeons would only recommend such surgery if your quality of life is severely affected or perhaps if your job is “at risk” from the severity of the arthritis.

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