Okay. So initially patient comes into the office, they have knee pain, they have never been seen for this knee pain before it is been bothering them for two or three months. They’re like, what do I do? So we always, always try non-operative management. Okay. Non-operative management consists of what we have here. Physical therapy, diet, and exercise, walking aids, cold therapy, heating pads, heat therapy anti-inflammatories. And then once you know, that’s not effective. We think about cortisone injections joint fluid therapy. This is kind of known as viscosupplementation or a gel therapy for the knees is another common thing. But can we kind of go through a step wise progression of the treatment and then when that has all failed from the top to the bottom here, we’re looking at some type of surgical intervention.
So this is one thing that I didn’t have on the previous slide, but it’s probably the one most important things when we’re dealing with joint pain. So when you stand, you’re putting weight on your hip and your knee and the more you weigh, the more stresses you’re putting on the joints. So this is just for looking at knees. So we encourage patients before surgery or we encourage patients. Non-Operative management is weight loss. Operative management is weight loss. So encourage the weight loss because the patient could feel better if they lose weight and they will recover better if they end up having surgery if they weigh less. So this is just, this is to me, this is an amazing kind of a stat here. If you lose one pound, it’s like taking four pounds of weight off your knee. Okay? So just do the numbers on that. 10 pound weight loss is taking like 40 pounds of stress off your knee. So it even you know, if you can, yeah, I’ve lost two or three pounds but I can even lose more. But I mean it’s kind of very significant cause you’re essentially taking 30 pounds of weight off your knee when you’re weight-bearing so anything helps. Exercise. Can it help the joint? Can it hurt the joint? People say they can’t exercise because their knee hurts too. While this is certainly true, and it depends on the severity of the arthritic condition. However, the arthritic joint or any joint feels better if it’s stronger and the muscles are stronger around it. So we always encourage patients to do physical therapy, to do some sort of exercise, to maintain the strength in the muscles around the joint. So what we encourage patients who have arthritic knees, we try to say, okay, well you can’t walk on the concrete or you can’t jog anymore. So you should try more of a low impact exercise, which would consist of riding a bike or an elliptical machine or swimming. Swimming is probably the best exercise for joints because of the resistance from the water. And then also you’re not weight-bearing when you’re doing it. So those are some of the exercises that we encourage patients to do that so that they don’t aggravate their joint, but they’re able to maintain their strength.