- How Does Weight Affect My Knees
- Coping with the Worn Knee
- The Female Athlete - ACL injuries
- Acute Knee Injury
- SONK - Patient Info
- General information about the knee
How Does Weight Affect My Knees
We are a growing population, not just in number but also in size! In 2011 almost 25% of the English population was obese and these numbers continue to rise.
Most of us understand that being significantly overweight can cause all sorts of problems with health such as high blood pressure, heart disease and diabetes, but what is it doing to our joints?
As rates of obesity have gone up in the UK, so have rates of osteoarthritis of the knee.
What is osteoarthritis of the knee?
Osteoarthritis, sometimes called OA, degeneration or ‘wear and tear’ is the progressive loss of a joint’s articular cartilage, this causes the joint to become stiff and painful. Articular cartilage creates a smooth protective covering over the ends of our bones so that we can move our joints freely without friction. Articular cartilage is only a few millimeters thick, over the years it can become worn away and the joint can become painful, this is osteoarthritis.
How do I know if am overweight?
Body mass index (BMI) and waist circumference can be used to estimate if you are a healthy weight. You can work out your BMI by dividing your weight in Kg by your height in meters2. A waist circumference over 102cm for men or 88cm for women is considered obese.
|What is a healthy BMI for an adult?|
|less than 18.5||Underweight|
|18.5 – 24.9||Ideal|
|25 – 29.9||Overweight|
|30 – 39.9||Obese|
|40 +||Very Obese|
There are many different individual tests and signs described in the knee and for most of these the sensitivity and specificity has not been adequately reported. Surgeons therefore tend to have a set of primary signs or findings that confirm a particular diagnosis backed up by a set of secondary or confirmatory signs. For example a ‘full house’ of findings for a torn meniscus is a history of a twisting injury, knee effusion (current or history of) and specific deep tenderness on the postero-medial joint line. In the absence of a ‘full house’ then confirmatory examination is indicated including McMurray’s test, squat duck walking, or palpation in the figure 4 position.
This observation leads on to other points. The full house mentioned above assumes that the patient is in the right broad age group category for the specific diagnosis of meniscal injury and that the diagnosis will lead to an appropriate treatment. It should be remembered that the purpose of history and examination is to lead to a diagnosis that results in a management plan that hopefully leads to patient benefit. This might mean for example sometimes all that is required is a decision whether a patient needs an arthroscopy or not, based on mechanical symptoms, where reaching a specific diagnosis may not be required. Knee examination and radiographs might, for example, show a severely arthritic knee but if the patient has only mild pain then arthroplasty is unlikely to be indicated. Again, history and examination are targeted towards a diagnosis leading to management decisions.
To achieve this, we note that knee problems will present with various characteristic patterns that will lead to the patient being categorised in to a diagnostic box. Specific direct questions may be needed to aid this process. This is not asking ‘leading questions’ but ‘direct questioning’ that helps focus the patients mind onto the specific symptoms and the examiner onto specific possible diagnoses. For example to detect ACL deficiency the specific question ‘do you trust your knee?’ or ‘did you hear a pop at the time of injury?’ may need to be asked to lead to that diagnosis.
Dealing with your Insurance Company
During every step of the process, you need to keep your insurance company informed in order to obtain approval for further appointments, physiotherapy or MRI or surgery etc.
Each insurance company is different with a different level of requirement but they are usually very helpful. If you have any difficulties or need any specific procedure codes and information for the insurance company then please contact Nicki on the office phone number or by email.
Please enquire about Outpatient consultation prices for uninsured or self pay patients
Inside The Clinic
You will be offered an appointment time and Mr Spalding makes every effort to try and keep to that time. However as you may appreciate sometimes appointments may take longer and there may be a wait. It is a balance between keeping to time and offering everyone a high quality of service.
It is helpful if you could please bring with you:
- Referral letter from the GP if it has not already been sent by the GP.
- Any previous letters or correspondence relating to your knee problem.
- Any relevant xrays or MRI scans
- Shorts or appropriate clothing as it is important to be able to examine the whole knee and leg during the consultation.
In clinic Mr Spalding will spend time discussing your symptoms and then examine your knee(s) prior to discussing various options for treatment.
It may be necessary to take xrays which can either be performed on the same day or at a later time. MRI scans are usually performed on another day if required.
You may well have had physiotherapy prior to the operation and it is expected that you would go back to the same physiotherapist afterwards for the post operative rehabilitation.
Sometimes it is appropriate to undergo different physiotherapy and this should be discussed with Mr Spalding. He has a network of linked physiotherapists who have similar interest and dedication to helping knee problems.
We currently recommend therapists within our physiotherapy network, though this is ever expanding.