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Health & Medicine

2002-03-01 15:09:00

‘Football knees’ come back to haunt

Question:  I am 51.  I played football until I was 24.  I had three knee surgeries on my right knee and one on my left knee.  I have had fluid drained off my knee several times and have taken cortisone shots quite often.  I am now living with all of the pain and discomforts.  My doctor mentioned doing a bursa sac removal.  He did not explain it that well, preferring instead to let the specialist do so.  I have not seen him yet.  What kind of procedure is a bursa sac removal?

Answer:  Among today's active but aging population, painful knees are a very common problem, which can cause great discomfort on a daily basis.  Certain activities such as competitive football, heavy manual labor, weightlifting, or injury to the knees can accelerate the natural process of 'wear and tear' arthritis, or osteoarthritis.  This disease affects millions of Americans of all ages, but is most common after the age of fifty.  There are several treatment options for this fifty-one year old patient with painful knees, which are likely the result of osteoarthritis accelerated by years of competitive football, several minor injuries and several subsequent surgical procedures.  The first line of defense is typically an anti-inflammatory medication such as ibuprofen.  Once these medications become less effective, a patient may be offered cortisone shots.  These steroid injections placed directly into the knee joint will often alleviate a patient's pain and allow a higher level of activity for several months, if not longer.  The downside to these injections, however, is that they tend to become less effective with each subsequent administration, and can only be given up to three times per year.  Any patient who experiences frequent, painful swelling of a knee as a result of arthritis may benefit from drainage of the fluid on an occasional basis.  Removing the fluid from the knee, however, does not address the underlying problem of osteoarthritis, and is considered a symptomatic treatment.  As the arthritis remains after the fluid is removed, it is likely that the swelling will recur as the patient's activity increases.  In a similar way, surgical removal of the bursa sac does not address the basic arthritis, and may only provide short-term relief.  The bursa sac is a small, flat, water-containing sac which sits in front of the knee and serves to keep the skin from adhering to the underlying muscles and tendons.  The bursa sac is quite sensitive to direct trauma such as a fall on the knee, and can become very swollen and tender.  A bursa sac, which remains inflamed and painful over a prolonged period of time, and does not respond to conservative treatments such as anti-inflammatory medication, ice packs and compressive wraps, may require surgical exploration and removal, but this is rare.  Knee replacement may be an option for you, but only as a last resort.  The indications for total knee replacement have been steadily growing over the past ten years, but fifty-one is still considered quite young to contemplate this type of surgery.  A patient of this age would have to display advanced arthritis affecting most of the knee on X-rays, severe pain in the knee, which has failed conservative treatments such as medication, physical therapy, and injections, and extreme limitation of activities due to pain and loss of motion.  A motivated patient in this situation may be expected to do quite well after a total knee replacement.Your knee, which has had several surgeries, requires cortisone shots and occasional removal of fluid, and which is constantly painful, would be expected to continue to worsen slowly over time.  The body's natural process of osteoarthritis will cause your knee to swell, and will lead to a smaller range of motion with time.  As discussed, there are many treatment options available which can make this type of situation manageable for you until knee replacement is appropriate.