Dodgy knees are the last thing on your mind in your 20s and 30s. Yet what we do when we're younger can head off what's becoming a rite of passage for the over 55s – knee replacement surgery.
The number of knee replacements in Australia has leapt by almost 30 per cent in the last decade but many of these operations could be prevented if only we – and the health system – were kinder to our knees. As our birthdays click by, we're conscious of preserving our hearts and brains but knees not so much. Yet the pain of knee osteoarthritis can pave the way for other health problems by driving people into inactivity.
So how can we sidestep knee trouble? Avoiding weight gain – which doubles the risk of osteoarthritis – and keeping leg muscles strong with strength training can do a lot to prevent knee problems, says Alasdair Dempsey, a senior lecturer in Biomechanics and Sport Science at Perth's Murdoch University.
"Strength training reduces the risk of osteoarthritis by strengthening the muscles that support the knee joint – we know that people with knee osteoarthritis have muscle weakness. Strength training also helps with weight loss," he says.
But because injuries to the knee can increase the chances of developing osteoarthritis, it's also important to get professional help from a physiotherapist or an exercise physiologist to strengthen muscles after a knee injury, he adds.
"If osteoarthritis does develop, exercise can help reduce pain and improve function – this can delay the need for surgery and potentially help avoid it."
But we also need a health system that makes physiotherapy more affordable so we can reduce the need for surgery where possible, says Matthew Williams of the Australian Physiotherapy Association.
That's why a new approach to treating knee osteoarthritis could be a breath of fresh air. Called the Osteoarthritis of the Knee Clinical Care Standard and developed by the Australian Commission on Safety and Quality of Health Care, it recommends GPs and consumers look at options like weight loss and exercise with the help of physiotherapists, exercise physiologists and dietitians – and knee replacement as a last resort.
This means Medicare and private health insurers need to rethink the current system that disadvantages those who opt for physiotherapy first rather than surgery, says Williams.
"Because Medicare usually partially funds only five sessions with a physiotherapist in a calendar year, people with knee problems who might benefit from a program to help prevent surgery may have to pay $1000 upwards for treatment – while surgery which is covered by Medicare costs them little or nothing," he says.
"Knee replacements aren't without problems. As many as one in five people are dissatisfied with the outcome – they're often still in pain, for example. The surgery also has risks such as infection and cardiovascular complications. It's a fantastic operation if all other options are exhausted but often it's the first port of call.
"Yet reducing just five to 10 per cent of your body weight, together with an exercise program to strengthen muscles around the knees can result in a 30 to 50 per cent reduction in knee pain," says Williams. He co-ordinates a program at Sydney's Royal North Shore Hospital of exercise and dietary advice for people waiting for knee surgery which has helped 15 per cent of them remove themselves from the waiting list.
"But there just aren't enough of these programs," he says.
In Norway, Denmark or Sweden it's a different story. If knee osteoarthritis gets a grip, the first resort is increasingly a program of physiotherapy, education and lifestyle change, says Dr Christian Barton, a researcher with La Trobe University which now trains physiotherapists to use one of these programs – Denmark's GLA: D www.gladaustralia.com.au (Good Life with Arthritis from Demark) which has been shown to improve function, reduce pain, reduce the use of painkillers and the number of sick days.
"We need to get in early to try and prevent the need for surgery. We know what works – but there just aren't enough services," he says.
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