Dr. Renny Uppal, MD
What is Osteoarthritis?
There are many types of arthritis (osteoarthritis, post-traumatic, rheumatoid, etc). The most common form is osteoarthritis, also known as degenerative joint disease (DJD). While the exact cause is unknown, contributing factors include: previous injury, aging, misalignment, genetics, and obesity. Osteoarthritis is characterized by the breakdown of the articular cartilage, the firm whitish-colored rubbery protein material covering the ends of bones. It acts as a cushion and bearing surface between the bones, allowing them to glide smoothly over each other with almost zero friction. Osteoarthritis commonly affects large weight-bearing joints such as the hip and knee, but may affect any joint.
What are Symptoms of Knee Osteoarthritis?
The number one symptom of osteoarthritis of the knee is pain. The causes of pain in osteoarthritis include: irritation and pressure on the nerve endings in the bones, inflammation of the joint lining (synovitis), muscle tension and fatigue. The pain may progress from mild soreness and aching with movement to severe pain even during rest. The second symptom is loss of easy movement. As the lining cartilage wears away, the joints no longer glide smoothly. Eventually, the ends of the bones become rough and irregular, with resulting stiffness. This lack of mobility, in turn, often causes the muscles serving the knee to weaken, and overall body coordination suffers. Other symptoms common to osteoarthritis include grinding and “popping” sensations, joint swelling, and feelings of locking or giving way.
How is Knee Osteoarthritis Diagnosed?
The diagnosis of osteoarthritis is usually made based upon the patient’s medical history, physical examination, and x-ray findings. An MRI may be helpful in some cases to confirm the diagnosis and rule out any other conditions.
How is Osteoarthritis Treated?
Osteoarthritis is not a curable condition. The disease usually progresses slowly or worsens over many years. Therefore, treatment goals include decreasing pain, swelling, and inflammation, while increasing or maintaining joint function. To achieve these goals, a number of different treatments are used. Non-operative forms of treatment may include physical therapy, icing, activity modification, and bracing. Medications such as Tylenol, aspirin, or anti-inflammatories help decrease pain and swelling. An over-the-counter supplement containing glucosamine and chondroitin sulfate may be taken long-term to help alleviate symptoms and possibly slow progression of the disease. Cortisone injections into the joint may reduce acute symptoms for several months. Three or four steroid injections may be given per year, in each affected joint, without harm. Some relatively new injectable medications (Synvisc, Hyalgan, or Supartz) may help alleviate symptoms for 6 to 12 months in certain patients. These are administered by a series of 3 or 5 weekly injections, and may be repeated as needed.
Non-surgical Treatment Options
|Treatment||Benefits and Possible Adverse Effects||Duration of Effects|
|Exercise||Decreased pain and stiffness. Improved daily function and activity level. Some types of exercise will aggravate some people.||Indefinite.|
|1. Tylenol||Pain relief.||Indefinite.|
|2. COX-2 Selective||Pain relief.||Indefinite as long as symptoms are improved and no adverse effects occur.|
Small risk for upset stomach and possible aggravation of high blood pressure.
|3. Non COX-2 Selective||Pain relief.||Indefinite as long as symptoms are improved and no adverse effects noticed.|
d. Many Others
|Decreased inflammation. Potentially higher side effect profile, with increased risk for stomach problems like ulcers and bleeding.|
|4. Glucosamine /Chondroitin Sulfate||Potential benefit in preventing breakdown of articular cartilage.||Indefinite if symptoms are improved.|
|5. Narcotics||Short-term use for acute pain.||Short-term.|
|1. Corticosteroids: (Celestone, Kenalog, Dexamethasone)||For acute flare-ups, gives pain relief by decreasing inflammation.||Short-term: 1-6 months (per injection) Long-term: May be repeated every 3-4 months.|
| 2. Visco-Supplementation (Hyalgan, Synvisc, Supartz)
-Series of 3-5 given once a week.
|Thick, viscous fluid injected into the joint which coats the cartilage surface, decreases inflammatory mediators and promotes the production of normal joint fluid.||Long-term: Up to 6-12 months. May be repeated if good response.|
|1. Elastic or Neoprene Knee Sleeve||Offers added knee support during daily activities||Long-term: Worn as long as needed and symptoms are improved.|
|2. Unloader Brace||Reduces the weight placed on the affected compartment of the knee.|
Is Surgery an Option?
If the previously mentioned conservative treatments fail, then surgical intervention may be an option. An arthroscopic outpatient procedure can be done to “clean up” the joint, and is successful in relieving symptoms in 65-70% of appropriately selected patients. If only half of the knee joint is arthritic, and the rest is relatively normal, an osteotomy may be a good option. In this operation the surgeon cuts and realigns a portion of the tibia (shin) bone to allow most of the load with weight-bearing activities to pass through the unaffected side of the knee. Taking the stress off the arthritic cartilage results in significant pain relief and improved function for up to 10 to 15 years. As a last resort, a total joint replacement can be performed. During this procedure, the worn surfaces of the joint are removed and replaced with smooth-surfaced metal and plastic components. Ninety percent of knee joint replacement surgeries are successful. However, patients are restricted from engaging in certain activities (such as squatting, running, jumping, etc.) after knee replacement surgery.
|Removal of abnormal tissue. Washing out debris from joint. Trimming torn cartilage.||Variable – depends on underlying arthritic condition as opposed to meniscus tears.||Limited benefit for degenerative arthritis. Some benefit if arthritis is associated with a mechanical problem such as a meniscus tear.|
|Osteotomy||Surgically cutting the tibia (shin bone) to correct misalignment of the joint.||Long-term 10 years||Does not eliminate the arthritic changes in the affected compartment. Only successful if arthritis is limited to one compartment.|
|Replacement of one side of the arthritic joint rather than the entire joint.||Long-term 5-10 years||Only successful if arthritis is limited to one compartment. Activity modification is required.|
Total Knee Replacement
|When all other treatments have failed, the entire joint is replaced.||Long-term 10-15 years||Activity modification is required. Range of motion is limited to to 110-120°.|
We are committed to helping our patients maintain an active and healthy lifestyle. Please talk with your doctor about what treatments are best suited for your individual problems and needs.