KNEE PAIN: WHAT CONSERVATIVE OPTIONS ARE THERE?

June 17th, 2022

“We work in a Sport Centre with physiotherapists and Biokineticists and we treat the bulk of injuries and arthritis complaints conservatively. Only if conservative treatment is not successful, we revert to surgery” says orthopaedic surgeon, Dr Hannes Jonker.

From Dr. Jonker’s quote, it is evident that he is keen to treat many knee injuries or minor strains of the knee conservatively when appropriate. This week we find out when conservative treatment of the knee is relevant.

Runners often present overuse injuries of the knee, and it is common for the orthopaedic surgeon to treat jumper’s knee, ITB, and quadriceps strains, conservatively.

A soft tissue injury of the knee will result in bruising (or contusion in medical terms) in and around the knee area. Normally the bruising will heal within five to seven days and one should be able to return to normal play. However, if the bruising fails to improve or swells a lot within these five to seven days, it is crucial to make an appointment with an orthopaedic surgeon.

People who are inactive for a long time, start training, and then develop knee pain is another overuse injury of the knee that receives conservative treatment. Dr Jonker advises conservative treatment by means of strengthening exercises guided by a biokineticist, combined with some symptomatic remedy.

Dr. Jonker will consider knee reconstruction when conservative treatments have failed to relieve pain and when the pain impairs one’s quality of life. If conservative treatment is effective for the patient to maintain his or her level of activity and quality of life, surgery is not necessary. However, if a patient feels that despite conservative treatments, he or she wants to reduce pain, and improve quality of life, Dr. Jonker may consider surgery.

There are also conservative treatment options for osteoarthritis, which can include over-the-counter medication, supplements, anti-inflammatory drugs, and even painkillers and analgesics prescribed by general practitioners. While cortisone infiltrations are still the gold standard, other options, such as growth factor or PRP infiltrations and even stem cells have shown promising results in the last few years. Many patients also get relief from peri-articular or intra-articular injections. These injections will last from two weeks to about six to eight weeks and is not a permanent solution to the problem.

Dr Jonker explains that there is a rise in patient requests for a “gel” that the doctor infiltrates into their knee or knees. “There is such a product available in the market. Only, patients have the misconception that you inject something that is in a gel form into the knee that will fill the space where the arthritis is. But what is important to know, is that the “gel” basically turns into a watery substance within 48 hours after the infiltration. Dr Jonker explains that it is the supplemental active substances in the knee that give them anti-inflammatory pain relief. In this conservative treatment case, it is important to realise that it is an expensive treatment and many medical aid plans in South Africa do not cover this specific product and treatment. Dr Jonker only uses the “gel” infiltration on a selective basis because many of the patients he treats for osteoarthritis are pensioners. He concludes about this treatment option “Yet if the treatment is requested despite my advice, I will provide it. There are very few side effects”.

Then there is the supplemental business for osteoarthritis and joint pain, which is a thriving industry in South Africa.  In any retail pharmacy, you will find a wide variety of supplements to choose from. Many patients do get relief from supplemental treatment but the treatment is expensive if used over a long period of time, and many patients do not experience relief from the supplemental treatment. Nevertheless, if supplements are effective for you, use them.

For a consultation with Dr Hannes Jonker contact 018 293 3474

written by Elmari Snoer BusinessBrainz
RESOURCES: INTERVIEW WITH DR. HANNES JONKER

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