How to protect one's knees throughout life

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

As we get older, knee pain becomes more common, but there are things that we can do to postpone or potentially prevent knee problems.

Here to talk with me about how, is Dr. Zachary Vredenburgh. He's an assistant professor of orthopedic surgery at Upstate. Welcome to "The Informed Patient," Dr. Vredenburgh.

Zachary Vredenburgh, MD: Thanks for having me.

Host Amber Smith: What is the average age of patients who come to see you with knee problems brought on by wear and tear as opposed to sports injuries or traumatic injuries?

Zachary Vredenburgh, MD: So, in general, that population's going to be a little bit older, naturally, as the more active patients with acute injuries tend to just be younger because those are the people that are more active in playing sports.

But usually these people with wear and tear, you know, "My knee just got sore or achy one day for no real reason," those tend to be in their 50s, 60s, 70s -- those decades of life, usually.

Host Amber Smith: Does that wear-and-tear patient population, is it evenly divided between people who live a very active lifestyle and those who are more sedentary, or not?

Zachary Vredenburgh, MD: What I see is usually it's more active people because that's the reason that they're noticing it. That's the reason that they're uncomfortable, or they want to go back to their walking a couple of blocks a day or running half marathons, even into their 50s and 60s.

So, it's usually the more active people, though there are some people that really for no reason, from their perspective, start having pain. But it could be that they just have bad arthritis, and even minimal daily activities bother them.

Host Amber Smith: Is it pretty evenly divided between men and women?

Zachary Vredenburgh, MD: I'd say so, just from my perspective, but in general, arthritis, I think, has a little bit of a skew towards women. So if you're talking strictly from arthritis perspective, it'd be a little bit more female, but pretty even all in all.

Host Amber Smith: So my question is, does being active, such as being a regular runner, does that help protect your knees, or does it set you up for problems later on?

Zachary Vredenburgh, MD: It's a little bit of a double-edged sword or a kind of a loaded question maybe, because running a lot and doing highly physical things can put more load and more force onto your joints, which over time can cause you to feel it more. But at the same time, being active and doing active things obviously helps keep your weight down, and anything to keep your weight down is helpful for the health of your joints in the long run, as well as just movement and active motion is good for your cartilage, in your knees and in your hips and ankles.

So, those things are going to be helpful in the long run, too. So, I don't think there's one, exactly right answer for that.

Host Amber Smith: Is it normal for knees to start popping and cracking when you move as you get older?

Zachary Vredenburgh, MD: It definitelyq can be. and it's not always necessarily a sign that something bad or ominous is about to happen.

We say that clicking, cracking, catching, all those types of symptoms, however you're going to describe it, are very nonspecific. They could mean just there's some air in there. It could be a little bit of inflammation. It could be a whole litany of things that are not concerning at all to us.

But it's really when those things start to become painful that our interest gets a little bit more piqued, or we go digging a little bit deeper. Or if the symptoms are more than just cracking, it's a true kind of catching or locking of the knee, and that can signify if there's something getting stuck in there or something that can be fixed.

Host Amber Smith: Is it normal that cartilage is going to thin out as a person gets older?

Zachary Vredenburgh, MD: Yeah, that's definitely a natural part of aging. There's not a whole lot you can do to necessarily prevent it, and it's a little bit unpredictable in terms of how fast or to what rate or what degree the cartilage does thin or wear out.

Host Amber Smith: What's likely to happen to muscles and ligaments as we age?

Zachary Vredenburgh, MD: So naturally, your muscles are going to weaken and get a little bit smaller, a little bit atrophied, as you do get older, although you can prevent that by staying active, continuing with strengthening exercises, things like that. The ligaments become a little bit more brittle, so a little bit more prone to injury, but as you lower your activity level, you worry a little bit less about those being injured and more just about the generalized kind of wearing out of the knee.

Host Amber Smith: If someone has a hip problem or a hip injury, is that liable to impact the knee, as well?

Zachary Vredenburgh, MD: This is something I see all the time, I'd say, is that someone comes in, and I see them one week for a hip or knee problem -- it can be either one. And then a few weeks later, a few months later, that problem's better. But now it's the adjacent joint.

So, I think it is very common that once your gait gets altered, or you have a problem in one joint, that things can migrate as the other joints are picking up the slack.

Host Amber Smith: So everything's connected?

Zachary Vredenburgh, MD: Yes, it definitely is. Like the song "Head, Shoulders, Knees and Toes."

Host Amber Smith: Well, let's talk about the things that can go wrong with knees over the course of time.

What's the most common complaint you hear from patients with wear-and-tear issues?

Zachary Vredenburgh, MD: It's generally a soreness and swelling after a long day of being on your feet or walking around. A lot of these people feel stiff in the morning, and then once you get into, like, a small amount of activity, just walking a little bit, it actually sometimes feels a little bit better.

But again, at the end of the day, it's often swollen, painful, sore, achy, sometimes some of that catching and clicking that you're talking about, those seem to be the most major for anyone without an acute injury. And I think people sometimes are surprised because they come in and they say, "You know, I didn't do anything. And then all of a sudden on this day, at this time, my knee started hurting. And something must have happened."

But what's really happened is they've had arthritis, and they've had arthritis for a long time, and there's just going to be one date and one time where all of a sudden it starts bothering them, and even though it's often pinpointed to a specific point in time, it's not a specific injury, but it still seems to happen acutely.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, and I'm talking with orthopedic surgeon Dr. Zachary Vredenburgh about how to care for our knees as we age.

I understand that osteoarthritis is one of the five leading causes of disability among seniors. What is that and is it inevitable as we age?

Zachary Vredenburgh, MD: Osteoarthritis is basically, the wearing out of the cartilage in whatever joint we're talking about. We're talking about the knee today, but it's when the cartilage starts to thin or fragment or soften and, it is a natural part of aging.

Not everyone ends up getting arthritis, but it is a natural thing that just does happen, for -- it can be a multitude of reasons.

Host Amber Smith: If we had a parent or grandparent with osteoarthritis, does that make us more susceptible?

Zachary Vredenburgh, MD: Yes. There is definitely a genetic component, and, again, it's not a one-to-one, where if your mom and dad both had arthritis, you're going to have it for sure, but there's definitely a strong predisposition to genetics in causing people to have arthritis later in life.

Host Amber Smith: If we have it in our hands, say, does that set us up for a chance that we would also develop it in another joint, like our knee?

Zachary Vredenburgh, MD: There does seem to be some correlation, but what we often think about when you start complaining of multiple joint complaints of swelling or inflammation or especially of some arthritis, we often think about the more systemic causes, like a rheumatoid arthritis or something like that, and that's different than osteo.

So osteoarthritis would just be arthritis that just kind of happens, maybe traumatic in nature, but rheumatoid arthritis or some of the more rheumatologic conditions that can cause arthritis are because of a systemic inflammatory-type process, which is treated a little bit differently.

Host Amber Smith: Do they have the same symptoms, rheumatoid arthritis and osteoarthritis?

Zachary Vredenburgh, MD: In general, yeah. You're going to have joint pain, joint swelling, stiffness. sometimes the rheumatologic processes can be a little bit more aggressive or abrupt in happening, and it's not my area of expertise, but the medications these days seem to be doing a much greater job of controlling patients from having rheumatoid degenerative joint disease.

They still might have other symptoms, but the arthritis and the need for joint replacements and things like that seem to have really gone down, as the medications have become better to treat those conditions.

Host Amber Smith: So focusing on osteoarthritis, can anything be done to prevent it, once symptoms emerge?

Zachary Vredenburgh, MD: In short, not really.

Zachary Vredenburgh, MD: You can treat the symptoms, and that's what we aim to do with all the conservative treatments, things like anti-inflammatory medications, doing low-impact activities, so you're not feeling the pounding on the joints over and over again, keeping a nice, healthy weight, because your knee sees multiple times your body weight, so even a couple of pounds, up or down, one way or the other, can have a big effect on how much force you're feeling in the knee. As well as, for that matter, physical therapy to help off-load the knee joint and strengthen the muscles around it, so you're feeling less force.

Host Amber Smith: Are knee replacements ever a treatment for someone with osteoarthritis?

Zachary Vredenburgh, MD: Yeah, so that is the end treatment, if you really go through a lot of conservative treatments. There's other things; you could have a whole, hours-long talk on treatment of knee arthritis. But if you get through a lot of other things, there's some types of injections that you can try, some nerve ablations, other medications that are a little bit newer and still really being studied.

But if you get to the point where nothing's really helping anymore, then your replacement becomes, really, the ultimate solution, but also obviously with more risk.

Host Amber Smith: Are you usually able to get some relief to patients without having to go all the way to a knee replacement?

Zachary Vredenburgh, MD: In my practice, I don't do knee replacements.

I'll often treat these patients up until the point they end up saying, "Hey, enough is enough, and I think replacing my knee might be the only option." But I definitely see a lot of these people who, their symptoms are greatly improved and good enough, and even if it's not for the rest of their life, for five or 10 years, they can be active and happy and do the things that they need to do without having to have some of the restrictions that you may have to have after a knee replacement or the surgery and the recovery time when they're still at a younger age, I think is worth it.

Host Amber Smith: Now what about the people who were athletes in high school and college? If they had injuries to their knee back when they were in their teens and young twenties are they more likely to have problems when they hit their 40s and 50s and older with the knee? ,

Zachary Vredenburgh, MD: There's some specific injuries that definitely have a correlation with causing arthritis later in life.

So things like having had a fracture, broken bone, into your knee joint, we call a tibial plateau fracture, especially if it's not perfectly reduced or perfectly aligned, can cause problems.

ACL injuries: We know anyone who injuries their ACL (anterior cruciate ligament), which is the surgery that we do all the time, no matter what, those patients seem to have a higher rate of arthritis later in life.

Other broken bones, things that make the alignment in the lower extremity, can put more force on the knee and cause problems with arthritis. So there are definitely certain injuries that can lead to more arthritis.

But a lot of times, just the day-to-day, or "I played a lot of basketball when I was younger" -- we don't really know that that causes arthritis. It's more these specific instances where you have major injuries to your knee.

Host Amber Smith: Well, let's talk about what things people can do as adults to help preserve their knee function.

How important is weight control? And does 20 pounds make a difference?

Zachary Vredenburgh, MD: Yeah, I'm a big believer in maintaining a healthy weight, one to keep the force off the joint to possibly lower the symptoms that you're having and also maybe the progression of arthritis. So that really hasn't been born out well in the (medical) literature.

And 20 pounds, I'm sure, would make a big difference. I even try to get people, if you can even just lose 5 pounds, I think that can have a big deal on your overall well-being of your knee and also just how it feels.

Host Amber Smith: How do you recommend maintaining muscle strength and range of motion?

Zachary Vredenburgh, MD: I think working with therapists is really a key point of that.

I think sometimes people think, "How's this going to help me? It's not changing arthritis, you're just strengthening. You're not affecting the joint itself, but it really seems to have good results, both just anecdotally with what I see in the office, but also .In the literature. It's pretty strongly supported by our (orthopedic) academy as well.

Even if you just go to a therapist a few times and learn some of the exercises and some of the techniques that they're teaching you, and then bringing those to the gym or to your home exercise or things like that, those are all great ways to stay active and also to keep the strength in your knee.

Host Amber Smith: Does footwear impact how well our knees absorb the impact of our movements? I'm thinking about running or even just walking.

Zachary Vredenburgh, MD: Yeah. I would say so. Anything where you're going to have more cushion, to an extent, is going to be helpful in off-loading the knee and absorbing loads. There are some people, though, that argue that we weren't born with sneakers on our feet, so maybe barefoot is the best way to go. And I think there's still some debate or there's, if you've seen the shoes that are made to look like your bare foot, there's some back and forth about what the best thing to wear on your feet is.

Host Amber Smith: Well, Dr. Vredenburgh, I thank you for making time for this interview.

Zachary Vredenburgh, MD: You're welcome. Thanks for having me again.

Host Amber Smith: My guest has been Dr. Zachary Vredenburgh. He's an assistant professor of orthopedic surgery at Upstate. "The Informed Patient" is a podcast covering health, science, and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.