Joseph Yao, M.D.
Many truck drivers experience knee pain. Osteoarthritis (OA) is the most common form of arthritis and is due to wear of the smooth, low friction surface called articular cartilage (AC) that coats the ends of our bones where they come together to form joints. Human AC is similar to the white, soft surface found on the end of a chicken drumstick. You can easily gouge AC by pressing a fingernail into it.
OA usually affects older people. But, the durability of AC is genetically determined, so it wears out faster in some individuals than others. Injury can damage AC and hasten its wear leading to earlier onset of OA. This is called post-traumatic arthritis and can occur after the knee striking the dashboard in a motor vehicle accident or a fall onto the knee.
OA most often affects the side of the knee joint closest to the opposite knee (the medial side) and the kneecap joint. The outside of the knee (the lateral side) is affected less frequently. The knee becomes more crooked as the AC wears out and grows thin. A person with severe medial side OA will have a “bowleg” deformity such that the space between the two knees increases.
Drivers with knee OA will initially experience pain with activities such as walking, climbing into their cabs, squatting and weather change. Those with more severe OA will have night pain, making sleep difficult, resulting in fatigue.
Treatment can include weight loss if a driver is overweight, NSAID medications (e.g., ibuprofen, naproxen, etc. if not medically contraindicated), acetaminophen, occasional steroid injections, heat, low impact activities, knee brace, walking support (e.g., cane), cartilage building supplement called glucosamine/chondroitin sulfate, hyaluronic acid injections and knee motion exercises to prevent stiffness.
Arthroscopic debridement (cleaning the knee using a scope) generally provides no long-term benefit for knee OA. Osteotomy (cutting the bone) to realign the knee can be effective in younger drivers with isolated medial or lateral OA. Knee replacement (KR) involves removing the arthritic joint surface and implanting prostheses to serve as a new joint surface. Partial KR (aka unicompartment KR) has been around for decades, but has recently become more popular. It usually involves just replacing the medial side of the knee. Total KR (aka TKR) involves replacing all of the knee joint surfaces.
It is usually best to delay KR as long as possible, especially in young, active people because the implants can wear out or come loose, requiring the KR to be redone. This is often true in people with physically demanding jobs. Revision KR is associated with more complications, a shorter prosthesis lifespan, and poorer function compared with primary (first time) KR.
Dr. Joseph Yao has undertaken extensive subspecialty training in joint replacement after completing an orthopedic surgery residency. Dr. Yao has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.
Ramp Media Group, 2010