Knee1 Discussion with Dr. Steve Houseworth
December 19, 2002

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Knee1: Welcome to tonight’s Knee1 moderated discussion. We welcome your questions and your input, but please be advised that we receive more questions than can be answered, so we thank you in advance for your patience if your question is not immediately answered.

Knee1: Tonight's featured guest is Dr. Steve Houseworth. Dr. Houseworth specializes in Sports Medicine and Orthopaedic Surgery and sub-specializes the care of the knee and shoulder. He is a graduate of the United States Military Academy and Emory University School of Medicine. He is a Sports Medicine Consultant to Bahrain in the Middle East and currently practices in Colorado Springs, CO.

Knee1: Dr. Houseworth, thank you for joining us. Users, we welcome your questions.

Knee1: Dr. Houseworth, why don't we start by having you tell us how you began your career in orthopaedics?
Dr. Houseworth: Believe it or not, I was inspired by the doctors who took care of me when I was injured in football. I was impressed with all that they did to help me. I also was very impressed by the orthopaedic surgeons I met while in medical school and also have had wonderful mentors throughout my career.

Mr. Mark B.: Dr. H, I've heard about thermal shrinkage for shoulder looseness. Is this the same procedure as for the knee?

Dr. Houseworth: Yes, the same type of equipment is used for both the knee and shoulder. The rehabilitation after surgery differs.

Mr. Mark B.: Dr. H, Please tell me about the pain? How painful is a thermal shrinkage procedure? Thanks
Dr. Houseworth: I have found that my patients experience much less pain with the electrothermal procedures than the open surgeries. We use a regional block combined with a "pain buster" and a cooling blanket as well as pain medications to minimize pain.

Benito: I had a staph infection several years ago - does this make a potential knee replacement riskier?
Dr. Houseworth: Unfortunately, you are at more risk for an infection after the knee replacement operation.

John QR: Is golf a risky sport for those with knee problems? My water on the knee was caused by wrestling, which was a limiting factor.

Dr. Houseworth: Golf is less risky for injuries than pivoting sports such as basketball or football. However, the golf swing does create significant torque on the knees and may cause pain especially to those with cartilage tears or significant arthritis.

sean goldblum: Doc, I have had a lot of knee pain since I fell down on both of my knees on the pavement last summer. They did arthroscopy but the pain came back. Is there anything else that can be done?
Dr. Houseworth: A detailed physical therapy program working on creating muscle strength and muscle balance around the patella (knee cap), together with a stretching program may be of significant help. The use of Ibuprofen or similar medication may also help you.

Robert McKee: Doctor, I've got bad knee inflammation. They gave me naprosyn and it helps a bit but when it wears off my knees feel weird and sometimes they click and pop. Have you ever heard of this? What should I do now?

Dr. Houseworth: I would recommend that you see an orthopaedic surgeon for a further evaluation. This may include X-rays and an MRI. You may have a meniscus tear, which is causing your continued swelling as well as the popping.

Knee1: Dr. Houseworth, a lot of our users are interested to know as much as possible about non-surgical treatments for torn cartilage. What is the prognosis for trying to deal with a torn meniscus without resorting to surgery?

Dr. Houseworth: Sadly, I find that various non-surgical treatments for torn menisci only offer limited relief of symptoms. There is a lot of interest in the use of Glucosamine and Chondroitin to help reverse arthritis. I find personally that these supplements work partially for those with early arthritis. Weight loss and limiting intense weight bearing activities such as running also help to relieve symptoms.

maybaby: I have lately been suffering mild pain, swelling and instability in my knee. There is no known cause for my injury (no accidents, etc.), but after 2 weeks of RICEing my knee, I am seeing no improvement. I saw my doctor last week and she seemed to think it was just a sprain, but my limited activity is getting frustrating. It's pretty tight in the morning and tends to loosen up throughout the day and sometimes will "click" into place such that it feels perfectly normal. Any advice? Thanks.
Dr. Houseworth: I would recommend that you have an MRI soon to find out if you have a meniscus tear or perhaps a "loose body" in your knee.

robert stewart: Doctor Houseworth, can you tell me more about knee replacements. My grandfather had one that failed on him and it makes me worry about if they are still like that. Thank you.

Dr. Houseworth: There are many reasons for knee replacement failure. However, I believe that knee replacements are a tremendous blessing to countless patients throughout the world. Two long-term studies have shown "survivorship rates" as high as 93% at 15 years after surgery.

Kenneth Casavant: Doc, I'm 55 and get bad swelling in my knees when I am on my feet too much. Someone told me it might be gout but I think that is different. Is there anything I can do?
Dr. Houseworth: I recommend that you see your doctor when your knee is swollen. The doctor can take a sample of the knee fluid and send it for analysis to check for gout crystals in the fluid as well as take a blood sample to check for the uric acid level. In the meantime, you may benefit from Aleve or Ibuprofen if these medications do not bother your stomach.

margie: I recently had surgery on a torn meniscus. I'm still having pain and difficulty in walking. I also have arthritis. I had 2 cortisone injections and now I will be trying synvisc. What is your opinion with synvisc?

Dr. Houseworth: I believe that Synvisc is worth a try to help your knee pain. However, I have not had much success relieving my patients' pain with Synvisc.

Goldmember: Doctor, is there such a thing as "training through" knee pain. That is, can you prevent knee pain by exercising your knees more?
Dr. Houseworth: I would not feel comfortable knowing that one of my patients or a friend was trying to "train through" his/her pain. If the pain persists, I would recommend an evaluation by a skilled medical professional.

Bertha: Hello & thanks for taking my e-mail. Is over-weight a cause of knee problems? Also, I've heard about shots that delay an artificial knee. Can you comment?
Dr. Houseworth: We know that increased stress caused by "excessive weight" may accelerate the development of arthritis especially in previously damaged knees. The shots you mention include Synvisc and Hyalgan. Sadly, I have not had many patients benefit from these injections.

maybaby: What effect does exercise have on the wear and tear of a replaced knee?
Dr. Houseworth: I tell my patients that "you have 10 million cycles on your total knee. Please use them wisely." Low impact activities such as swimming and cycling would be better than running.

Knee1: Dr. Houseworth, we're just about out of time. Do you have any closing thoughts you'd like to share with our users tonight?
Dr. Houseworth: I applaud your users for their interest in their own health needs. I especially enjoy helping people learn how they can function better in life. I also wish to thank all those talented women and men who have developed the Body1 web site.

Knee1: Dr. Houseworth, thank you for joining us tonight. And to our users, thank you for logging in. We will be hosting another Knee1 chat in January with Dr. James Lubowitz. Until then, we wish you happy and healthy holidays!