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Knee Arthritis and Walking
Old 05-13-2014, 05:51 PM   #1
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Knee Arthritis and Walking

I was just advised by an orthopedic surgeon to stop walking for fitness and to either swim, cycle or use an elliptical. Since I really like walking I'm not that happy about this. One thing that complicates this for me is that while the doctor said said that I have bone on bone arthritis in the knee, my actual pain is not that great. Of course, that might make you wonder why I went to the orthopedic surgeon in the first place.

The situation is somewhat complicated (so I apologize for the somewhat long explanation).

17 years ago I had a tibial transfer to correct my knee alignment of my left knee. I also had arthroscopic surgery of the knee and learned that I didn't have much cartilage in the knee. The restrictions put on me were to not run and not to use leg extension machines. Anything else that didn't hurt was fine.

Flash forward until last year. I've been walking during this time in my hilly neighborhood and have a treadmill. Doing this I've lost 35 pounds but need to lose about 20 more to be normal weight.

About 3 months ago, I was increasing my walking including setting up a treadmill desk and doing some slow walking to increase steps. I also started doing some lower body strength training. When I did some lunges, my knees protested the next day. So I stopped doing them.

About 10 days later, the back of my thigh where it joins the knee starting hurting. If I pressed on the area it was excruciating. If I didn't press on it, I could feel it but it wasn't awful. So I took about 3 weeks off from doing walking or anything. The place didn't get better. The soreness in the knee did get better.

Long story skipped I had an MRI to see what was going on with the very sore place on the back of my thigh.

When I went in for the MRI results I was told that the area on the back of the thigh was likely a trabecular bone injury/microfracture (essentially a fracture of the inside part of the bone) which (since I couldn't recall any trauma to the area) might be a stress fracture from the greater walking I was doing.

I was also found to have Grade 4 chondromalacia patella, moderate proximal patellar tendinosis, mild insertional quadriceps and tendinosis. Chondral loss and thinning at various places. Osseous edema that was said to be compatible with trabecular bone injury/microfractures. No meniscus tear was seen but it was thought possible there might be a small tear. Also a small enchondroma along the distal femur.

The translation given to me by the orthopedic surgeon was the trabecular bone injury for which he told me to use a walker or crutches for 4 weeks, only using the affected leg for balance. He said during this time I could continue to use the Concept2 rower if it doesn't hurt my knees.

As for the rest of the knee he basically said it was bone on bone arthritis and that I should replace walking with swimming or cycling or using an elliptical. I guess I will -- if I have to -- replace my treadmill with an elliptical. But, I really hate the idea of having to give up walking in my (hilly) neighborhood.

Here is the part that confuses me. I did some reading on all this and saw that walking is often a recommended activity for mild or moderate knee arthritis. The exception seems to be severe arthritis which seems to be (at least on the internet) equated with bone on bone arthritis. But, when I read about severe arthritis that is bone on bone everything I read about is how much it hurts and the person is hobbling around and the knee locks up, etc.

The thing is that while I may not have much cartilage (and in some places apparently have none), my actual knee (apart from the trabecular bone injury) is not that painful. When I was walking a lot it would occasionally mildly hurt under the kneecap. And certain strength training exercises would hurt (the orthopedic surgeon told me not to do deep lunges, squats or anything else that bends my knee beyond 90 degrees). At this point, the pain under my kneecap which I sometimes (not always get) with heavy activity is not even severe enough for me take over the counter medication. I can feel it, but it is not a big deal.

So I was really startled to be told not to walk. I guess the point is that if I continue to walk on it -- even if it doesn't hurt that much now -- I will continue to damage my knee.

But, if my knee is so bad that it is bone on bone why doesn't it hurt more? I guess I have a hard time seeing it as being that severe when it really isn't that painful. Yet, I have the MRI report right in front of me.

Has anyone experienced anything like this? That is, not having pain that is all that severe but avoiding a particular activity in order to avoid or limit future damage?

I do plan to talk more to the orthopedic surgeon about this when I go back in 4 weeks. I always kind of thought I would have a knee replacement in my future and I guess this is mostly about making that be farther away. And, I sort of agree with that, but I don't like having to not walk just to try to postpone the inevitable for a few years.
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Old 05-13-2014, 06:04 PM   #2
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I was just advised by an orthopedic surgeon to stop walking for fitness and to either swim, cycle or use an elliptical. Since I really like walking I'm not that happy about this. One thing that complicates this for me is that while the doctor said said that I have bone on bone arthritis in the knee, my actual pain is not that great. Of course, that might make you wonder why I went to the orthopedic surgeon in the first place.

The situation is somewhat complicated (so I apologize for the somewhat long explanation).

17 years ago I had a tibial transfer to correct my knee alignment of my left knee. I also had arthroscopic surgery of the knee and learned that I didn't have much cartilage in the knee. The restrictions put on me were to not run and not to use leg extension machines. Anything else that didn't hurt was fine.

Flash forward until last year. I've been walking during this time in my hilly neighborhood and have a treadmill. Doing this I've lost 35 pounds but need to lose about 20 more to be normal weight.

About 3 months ago, I was increasing my walking including setting up a treadmill desk and doing some slow walking to increase steps. I also started doing some lower body strength training. When I did some lunges, my knees protested the next day. So I stopped doing them.

About 10 days later, the back of my thigh where it joins the knee starting hurting. If I pressed on the area it was excruciating. If I didn't press on it, I could feel it but it wasn't awful. So I took about 3 weeks off from doing walking or anything. The place didn't get better. The soreness in the knee did get better.

Long story skipped I had an MRI to see what was going on with the very sore place on the back of my thigh.

When I went in for the MRI results I was told that the area on the back of the thigh was likely a trabecular bone injury/microfracture (essentially a fracture of the inside part of the bone) which (since I couldn't recall any trauma to the area) might be a stress fracture from the greater walking I was doing.

I was also found to have Grade 4 chondromalacia patella, moderate proximal patellar tendinosis, mild insertional quadriceps and tendinosis. Chondral loss and thinning at various places. Osseous edema that was said to be compatible with trabecular bone injury/microfractures. No meniscus tear was seen but it was thought possible there might be a small tear. Also a small enchondroma along the distal femur.

The translation given to me by the orthopedic surgeon was the trabecular bone injury for which he told me to use a walker or crutches for 4 weeks, only using the affected leg for balance. He said during this time I could continue to use the Concept2 rower if it doesn't hurt my knees.

As for the rest of the knee he basically said it was bone on bone arthritis and that I should replace walking with swimming or cycling or using an elliptical. I guess I will -- if I have to -- replace my treadmill with an elliptical. But, I really hate the idea of having to give up walking in my (hilly) neighborhood.

Here is the part that confuses me. I did some reading on all this and saw that walking is often a recommended activity for mild or moderate knee arthritis. The exception seems to be severe arthritis which seems to be (at least on the internet) equated with bone on bone arthritis. But, when I read about severe arthritis that is bone on bone everything I read about is how much it hurts and the person is hobbling around and the knee locks up, etc.

The thing is that while I may not have much cartilage (and in some places apparently have none), my actual knee (apart from the trabecular bone injury) is not that painful. When I was walking a lot it would occasionally mildly hurt under the kneecap. And certain strength training exercises would hurt (the orthopedic surgeon told me not to do deep lunges, squats or anything else that bends my knee beyond 90 degrees). At this point, the pain under my kneecap which I sometimes (not always get) with heavy activity is not even severe enough for me take over the counter medication. I can feel it, but it is not a big deal.

So I was really startled to be told not to walk. I guess the point is that if I continue to walk on it -- even if it doesn't hurt that much now -- I will continue to damage my knee.

But, if my knee is so bad that it is bone on bone why doesn't it hurt more? I guess I have a hard time seeing it as being that severe when it really isn't that painful. Yet, I have the MRI report right in front of me.

Has anyone experienced anything like this? That is, not having pain that is all that severe but avoiding a particular activity in order to avoid or limit future damage?

I do plan to talk more to the orthopedic surgeon about this when I go back in 4 weeks. I always kind of thought I would have a knee replacement in my future and I guess this is mostly about making that be farther away. And, I sort of agree with that, but I don't like having to not walk just to try to postpone the inevitable for a few years.
Sorry to hear of your setback. My doctor told me that there are many people walking around, even running around with bone on bone arthritis. My brother has had bone on bone arthritis in one knee for years, and he does walk slowly, but he walks a lot.

If your neighborhood is safe for bike riding, and you decide to ride a bike for more of your exercise, I think it is a good idea to keep spinning and to emphasize low gearing (numerically high ratios).

Ha
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Old 05-13-2014, 06:25 PM   #3
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Sorry to hear this.

Different situation but I've had just about all my doctors advise me to quit running due to lumbar arthritis. But I've ignored their recommendation and so far been fine. Doing certain stretches help me manage the pain. I wonder if a physical therapist might be able to suggest some helpful stretches for your situation?

It's hard to stop doing something you've been successful with. Sure hope you can find some way to carry on. Switching to brand new exercise regimens can be problematic and I'd fear not following through with it.

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Old 05-13-2014, 07:11 PM   #4
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Many people have different perception of pain. Being overweight and the prior knee surgery have likely in combination contributed to the progression towards bone on bone arthritis. The bone on bone condition may have even contributed to the micro-fracture.My guess is that you are going to need a knee replacement at some point in the future. If I was you I would ask the orthopedic surgeon about it and if it might be better to get it done sooner rather than later to get you back to your walking so that you can get the weight off. If surgery is contraindicated then definitely try the other exercise options. I think Ha has picked the best one and that you should start with bike riding using the lower gears so that you burn calories but with minimal pressure on the knee. .
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Old 05-13-2014, 07:29 PM   #5
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I recommend you limit your walking to treadmill, and take up cycling in your neighborhood. The combination will create some "muscle confusion" which is considered good and may help goose the weight loss. If your knees start to ache from the bone/bone I would suggest periodic cockscomb injections.
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Old 05-13-2014, 07:48 PM   #6
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You mentioned where you walk as being 'hilly', could you try walking in a flatter area for a while? I know the hills around here make my knees hurt, my knees have no issues, the combination may be part of your issue.
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Old 05-13-2014, 09:57 PM   #7
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Responding to various comments:

I'm not that inclined to do cycling, either in the neighborhood or stationary. I prefer exercise where I'm standing not sitting. I have a Concept2 Rower (which I've been told that for now I can use if my knee doesn't hurt), but I find it hard to tolerate it for a long time. Years ago I actually did use a recumbent bike. In fact, it was when I was using it that my knee started hurting the first time, went and found out about my knee alignment issue and had the knee surgery. I never really loved the exercise bike and didn't like the sitting.

I'm way more inclined to get an elliptical than bike. Once I am off the walker, I am tempted to continue using the treadmill at 0 incline or maybe just at 1 or 2 at least for awhile to see if my knee hurts. If it doesn't then I am sure tempted to keep doing it at least part of the time. But, again, I may get an elliptical and see how I feel about that. I used one occasionally at the Y when I had a membership.

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Many people have different perception of pain. Being overweight and the prior knee surgery have likely in combination contributed to the progression towards bone on bone arthritis. The bone on bone condition may have even contributed to the micro-fracture.My guess is that you are going to need a knee replacement at some point in the future. If I was you I would ask the orthopedic surgeon about it and if it might be better to get it done sooner rather than later to get you back to your walking so that you can get the weight off. If surgery is contraindicated then definitely try the other exercise options.
I'm sure your right about the progression. I mean when I had my knee surgery 17 years ago I was told then that I didn't have a lot of cartilage under my kneecap and I've always been real careful so I should probably be glad that it hasn't given me trouble until now.

I've been reading up on knee replacements. The stuff about it is interesting. On the one hand, I keep reading about how they advise people to wait as long as possible in the hope to only have to do it once during a person's lifetime. On the other hand, I keep reading that people who don't wait until their knees are non-functional do better as success is higher when people go into surgery with better function.

The idea of only having to do it once in your lifetime seems appealing particularly when I read that there are more complications when people have a 2nd replacement. I'm not sure I want to be 75 or 80 and having a second knee replacement that fails (I'm 60 now).

On the other hand, unless I wait until I'm 75 to have one it seems like there is a reasonable chance of having to have a replacement anyway. That is, if I waited until my knee was horribly painful and had one when I was 70 then it might need to be replaced when I'm 80 or 85 (I realize I might not be around then, but I might be). So, maybe it is better to do it sooner rather than later and perhaps have to do it again in my mid to late 70s. I'm going to talk to the orthopedic surgeon about it.

I don't mind giving up the walking for something else if doing it might mean I never have to have a knee replacement and I won't have worse pain than I have now (which is really not bad at all). But, if I have to give up walking now and I'm still going to have to replace the knee in a few years, then maybe it is better to do it sooner.
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Old 05-14-2014, 09:22 PM   #8
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Hmmmm, my wife had bone on bone arthritis and no cartilage; she could walk but the pain was acute; cortisone injections helped earlier but later had no affect; each knee became unstable and the pain became excruciating. The only remedy from our orthopedic surgeon was total knee replacement surgery which she had on both knees, one three years ago (at 59) and the other last January (at 62); she walks fine and is at 80 percent of her former self on the last knee replaced. She's 100 percent on the first one replaced. There are some new surgical techniques for knee replacement surgery and I suggest you get a surgeon who knows what's he doing. We had traditional knee replacement surgery not the new kind in which you can walk right fairly well, including up and down stairs, within one or two days after surgery. Minimally Invasive Total Knee Replacement (Rush Univ. Medical Center, Chicago). We know someone who had this minimally invasive total knee replacement surgery and swears by it!

I probably have the beginning onset of knee arthritis. It became very painful for me to run and walk. I stopped running and jogging. I went to an acupuncturist for 6-8 treatments and it appeared to halt the pain. I don't run a lot (but I have occasionally run a mile just to see if I can do it), but walking is good; I can do the elliptical and bike without a problem and I did take up swimming, which is really good for the knees.

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Old 05-15-2014, 12:03 AM   #9
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I have gone almost 40 years with bone on bone in one knee. I don't run on it or twist it. Other than that it I do everything I want to do.(hike bike swim dance) If it gets sore I take an OTC pain reliever. Why fix what works well enough?



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Old 05-15-2014, 02:39 AM   #10
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Your lucky Chuckanut! I think most people with the bone on bone do have a lot of pain. But if you don't and don't hurt then it's fine.

I've sort of been like that since I had knee surgery. I knew I didn't have much cartilage but didn't have much pain and that has been since 17 years ago. But, the question going forward is whether I will start having pain if I keep walking for fitness. I may try to do a little bit of walking after I can walk again (right now I'm still non-weight bearing due to the trabecular bone injury). But I'll probably mix it up with using an elliptical and using the rower. And I'll see what happens.
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Old 05-15-2014, 12:54 PM   #11
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I don't know anything about your diagnosis, but just wondering if a personalized consultation in a Z-Coil Pain-Free store would do anything for you....

Sandy Lee, owner of the Arlington, TX store is a wealth of information - she once cracked the bone below her knee ... not the same, I know.

I stopped in there recently and described my walking challenges. While they are admittedly different challenges than yours, she fixed me right up with personalized fit shoe choices, including a BioTrex walking shoe with the corrective inserts I needed.

My better half has been wearing Z-coils for years.

YMMV.

If you don't live close, you could just call her to talk at first. See Z-CoiL® Pain Relief Footwear® -The Original Spring Shoes to find the store locator.

Kindest regards.
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Old 05-15-2014, 02:37 PM   #12
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My brother has had bone on bone arthritis in one knee for years, and he does walk slowly, but he walks a lot.
My knee begins to bother me if I do not walk and cycle at least several times a week. My theory is that without a certain amount of use the knee does not produce enough of the synovial (sp?) that lubricates the joint. If I stop walking and cycling for several weeks, I begin to feel it at night as a mild knee pain. That is the warning sign for me.

Most of the people I know who have had knee replacement surgery are not as mobile as I, so my plan is to avoid the surgery as long as possible.
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Old 05-15-2014, 02:43 PM   #13
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FWIW, I have read that some of these computerized surgery machines allow the surgeon to position the replacement joint much more precisely, within 2 degrees of perfect alignment versus 6 degrees when done by hand. At least that is what I recall from one article.

Supposedly, the more precisely aligned the artificial joint is the less stress on it, and thus it lasts longer. Maybe, the engineers in the group can comment on that.

Or maybe, this is all propaganda from companies that like to sell expensive machinery to hospitals.
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Old 05-15-2014, 03:27 PM   #14
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I think I would get a second opinion, perhaps from a rehab physician who is not a surgeon - someone who is concerned with maximizing function without excessive pain or causing further damage.
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Old 05-16-2014, 09:22 PM   #15
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I think I would get a second opinion, perhaps from a rehab physician who is not a surgeon - someone who is concerned with maximizing function without excessive pain or causing further damage.
This is a good idea. I had TKR on right knee when i was 54 (58 now) but not until it was excruciating to take ten steps. Vacations were no fun; cooking a meal was painful -- standing in the kitchen. I took Mobic for ten months, which helped a lot, but aggravates ulcers. I am prone to ulcers every couple years and dr. (or maybe I did that) took me off it.

The ortho dr. thought I should have the surgery a couple years before i gave in. I was hesitant because of the fifteen years--then you need another one. From what I have read, the second replacement is not nearly as successful. My ortho said the newer knees last 20-25 years in lab tests, but no humans have had the newer ones (from Germany) long enough to know.

I do stick with elliptical and stationary bike these days, only because left knee is being ornery. I would vote for going easy on your knee. TKR is not fun, even tho the titanium one works great.

If you are not in pain, put it off as long as possible....and get a second opinion.
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Old 05-17-2014, 11:44 AM   #16
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If I was ever considering a knee replacement I would certainly get a second opinion. To be clear, the orthopedic surgeon has not mentioned that as a possibility at all. I just know from my general knee condition and the surgery I had with my knee 17 years ago that a knee replacement is the likely ultimate solution if I start having a lot of pain.

On the waiting as long as possible, what I was reading said that function after TKR is often tied to function right before surgery. That is, the people who were doing the best and could walk the most before surgery tended to do the best after surgery. Those who waited until they could barely walk at all tended to not have as much function after surgery. So, from that, I might think it was best to wait until I was having considerable pain but still could walk fairly well and wasn't totally at the last possible minute. Of course, I haven't researched it in depth yet so I know there are other considerations. Surgery is itself a risk so from that standpoint I would always want to wait. I do think that all this is awhile away so I'll research that part of it more at the time and would definitely get a second opinion before doing anything.
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Old 05-17-2014, 01:51 PM   #17
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Keep the knee and legs strong. Read up on how to encourage your body to make more of that lubricating synovial fluid. Great stuff for sore knees. Avoid the surgery as long as possible. Your body will tell you what you can and can't do, what it likes and what hurts it.
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Old 05-17-2014, 03:03 PM   #18
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Maybe doing treadmill/bike/concept 2 will allow you to continue losing weight which might put you in a better position to resume walking. Dittoe about getting a second opinion, including consulting with a physical therapist. Best wishes for getting thru this situation.
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Old 05-19-2014, 03:33 AM   #19
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I was ("officially") diagnosed with both knee bone-on-bone in 1998 after having arthroscopy , and told by two surgeons (the last one in 2001) that "Sooner or later" I'll need knee replacements.

Haven't gotten them yet, (which reminds me that, now the weather's improved and we're back from Europe, it's time to resume stair climbing).............sometimes the knees hurt, (even on the elliptical) in which case I wear a 'sleeve'....mostly it's manageable.
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Old 05-19-2014, 08:55 PM   #20
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I noticed this week that after using the Concept2 4 days last week my knee is hurting a little. It isn't severe but I'm taking a few days off until it gets better. I was supposed to have my first physical therapy appointment today but got derailed by a sore throat and fever. I'm supposed to do PT for 6 weeks - some if it will be while I'm not weight bearing and some after I can talk again. I'm hoping I get a lot of good tips there that will help me in future.
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