Knee Osteoarthritis Treatment
Osteoarthritis (OA) is a common problem for many people after middle age. OA is sometimes referred to as degenerative, or wear and tear, arthritis. OA commonly affects the knee & hip joints.
In the past, people were led to believe that nothing could be done for their problem. Now doctors have many ways to treat knee OA so patients have less pain, better movement, and enhanced quality of life.
What is arthritis ?
The main problem in OA is degeneration of the articular cartilage. Articular cartilage is the smooth lining that covers the ends of the leg bones where they meet to form the knee joint. The cartilage gives the joint freedom of movement by decreasing friction.
When the articular cartilage degenerates or wears away, the bone underneath is uncovered and rubs against bone. In time, the joint loses its a normal shape. Bits of bone & cartilage break-off & float inside the joint space causing pain, swelling & loss of movement
How does knee OA develop?
It is the most common type of arthritis It is seen in many people as they age, although it may begin when they are younger due to overuse and injuries Often more painful in weight-bearing joints like the hip, knee, and spine than in wrist, elbow and shoulder joints Not all cases of knee OA are related to a prior injury, however. Scientists believe genetics makes some people prone to developing degenerative arthritis. Obesity is linked to knee OA.
Knee OA develops slowly over several years. The symptoms are mainly pain, swelling, and stiffening of the knee. Pain is usually worse after activity, such as walking. Early in the course of the disease, you may notice that your knee does fairly well while walking, then after sitting for several minutes, your knee becomes stiff and painful. As the condition progresses, pain can interfere with simple daily activities. In the late stages, the pain can be continuous and even affect sleep patterns.
How do doctors identify OA?
The diagnosis of OA can usually be made on the basis of the initial history and examination.
X-rays can help in the diagnosis and may be the only special test required in the majority of cases.
In some cases of early OA, X-rays may not show the expected changes.
Magnetic resonance imaging (MRI) may be ordered to look at the knee more closely.
If the diagnosis is still unclear, arthroscopy may be necessary to actually look inside the knee and
see if the joint surfaces are beginning to show wear and tear.
OA can’t be cured, but therapies are available to ease symptoms and to slow down the degeneration. Recent information shows that mild cases of knee OA may be maintained and in some cases improved without surgery.
Your physician may prescribe medicine to help control your pain.
Acetaminophen is a mild pain reliever with few side effects.
Anti-inflammatory medication, such as ibuprofen and diclofenac.
Newer anti-inflammatory medicines called COX-2 inhibitors
Tramadol / Opiods :
Glucosamine and Chondroitin sulfate can also help people with knee OA.
If you aren’t able to get your symptoms under control, a cortisone injection may be prescribed.
A new type of injectable medication
The medicine helps lubricate the joint, ease pain, and improve people’s ability to get back to some of the activities they enjoy.
Physical therapy plays a critical role in the nonoperative treatment of knee OA.
In advanced cases of knee OA or when the knee is especially painful, a cane or walker may be recommended to ease joint pressure when walking.
Range-of-motion and stretching exercises will be used to improve knee motion.
People with knee OA who have strong leg muscles have fewer symptoms and prolong the life of their knee joint.
In some cases, surgical treatment of OA may be appropriate.
Surgeons can use an arthroscope (mentioned earlier) to check the condition of the articular cartilage. They can also clean the joint by removing loose fragments of cartilage. People have reported relief when doctors simply flush the joint with saline solution. A burring tool may be used to roughen spots on the cartilage that are badly worn. This promotes growth of new cartilage called fibrocartilage, which is like scar tissue. This procedure is often helpful for temporary relief of symptoms for up to two years.
Proximal Tibial Osteotomy
OA usually affects the side of the knee closest to the other knee (called the medial compartment) more often than the outside part (the lateral compartment). OA in the medial compartment can lead to bowing of the knee. As mentioned earlier, a bowlegged posture places more pressure than normal on the medial compartment. The added pressure leads to more pain and faster degeneration where the cartilage is being squeezed together.
Surgery to realign the angles in the lower leg can help shift pressure to the other, healthier side of the knee. The goal is to reduce the pain and delay further degeneration of the medial compartment.
One procedure to realign the angles of the lower leg is called a proximal tibial osteotomy. In this procedure, the upper (proximal) part of the shinbone (tibia) is cut, and the angle of the joint is changed. This converts the extremity from being bowlegged to straight or slightly knock-kneed. By correcting the joint deformity, the pressure is taken off the cartilage.
A proper joint angle actually allows the cartilage to regrow, a process called regeneration.
This surgical procedure is almost always successful. Generally, it will reduce your pain to a great extent. The advantage of this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions on activities.
A proximal tibial osteotomy operation buys some time before a total knee replacement becomes necessary. The benefits of the operation usually last for anywhere between 7-10 years if successful.
Artificial Knee Replacement
An artificial knee replacement is an ultimate solution for advanced knee OA.