Orthopedic Pain and it’s relation to Venous Insufficiency

Fran, an active medical office manager for her husband’s OB-GYN practice, decided to retire near the Gulf waters in Cape Coral. Happy in her Florida home, Fran immediately became involved in her community. She found herself on the go all the time.

As she stayed busy with all of her activities, her knee began to swell and ache. It was getting progressively worse until it began interfering with some of the things she enjoyed doing.

“I was having terrific pain in my right knee, the right side of the right knee,” she describes. “I also had a pronounced lump in the back of the knee, and I was very uncomfortable. The pain was excruciating. I couldn’t even drive a car for any distance because I would have to keep stopping to get out and walk. I couldn’t climb up a flight of stairs. I couldn’t exercise. It really stopped all activities for me..”

The pain finally wore her down so she made an appointment with an orthopedic surgeon to investigate what she naturally assumed was an orthopedic problem. She also saw her podiatrist who was concerned that part of her problem might have been related to her venous disease.  She was referred to Vein Specialists for further venous assessment. Fran was shocked by what Dr. Magnant’s evaluation uncovered.

“They did an ultrasound of the leg and found  severe leakiness in the check valves in the main superficial vein,” reports Fran. “ I had a leaking vein from the groin area all the way down the leg.

The first step

Knee joint arthritis and venous insufficiency often coexist because they affect the same patient population, patients over the age of 40. Therefore, patients slated for knee surgery, such as knee replacement, who have obvious signs of venous disease such as varicose veins or swelling should seriously consider a vein evaluation prior to major orthopedic surgery.

Research has proven that patients who have their varicose vein problems addressed before knee replacement have better outcomes in terms of postop risk of leg swelling deep vein thrombosis. Whether it’s varicose veins, a swollen leg or discolored skin, the patient is going to have a more difficult recovery because the leg is already swollen which leads to poorer wound healing because of the tenseness of the edema in the tissue.

More broadly I believe my colleagues in the medical field and patients in general should consider a vein evaluation before knee arthroscopy or knee replacement if they have signs or symptoms of venous disease. If surgery can be postponed or cancelled because vein treatment relieves the patient’s symptoms, even in a few cases, it’s worth it.

Sealing a vein is an outpatient procedure which takes less than an hour with almost immediate full recovery whereas a knee replacement requires making an incision, removing a knee and placing a new joint, with a more protracted recovery. If we can save five or ten percent of patients, at least for the short or medium term, who would otherwise undergo knee replacement by addressing their venous disease first, should we not try a less invasive option?

Forty million adults are affected by venous insufficiency, including one out of three people over the age of fifty. Consequently, there’s a thirty percent chance that there is going to be something that can be done to at least enhance a patient’s chances of having a good outcome from a knee replacement. It might even save them in the short or medium term from having to have the surgery.

If you have a knee that’s bothering you and the orthopedic surgeon says you need a knee replacement, stop and consider if you have varicose veins, a swollen leg, discolored skin or heavy legs – any signs or symptoms of venous insufficiency. Rather than having a total knee immediately, insist on a vein evaluation first.

Since her treatment at Vein Specialists, Fran feels like a new woman. She’s back to her activities. “Dr. Magnant gave me back mobility that I haven’t had for quite a while. I can walk up and down stairs. I’m back on the treadmill for forty-five minutes a night. Essentially, he gave me back the use of my right leg” says Fran.