The Breadth of Options Available for Knee Arthritis Treatment
Arthritis of the knee affects millions of Americans every year, and you know what is a shame about it? It stays around like the in-laws who just will not leave! Most of the time it is a normal part of aging and represents a simple wear and tear degenerative arthritis (osteoarthritis) process that accumulates over years and then starts to bother an individual like a pebble in one’s shoe.
There are other causes of knee arthritis as well, such as acute trauma. Mountain biking or motor vehicle accidents, sports injuries, etc. One may end up with a cartilage defect and/or a soft tissue injury which may produce arthritis at way too early of an age.
Additional arthritis generators include chronic activities like jogging. Typically this category includes weight bearing activities or sporting activities rather than non weight bearing activities like cycling or swimming.
So what treatments are available for the millions of people suffering from knee arthritis? There are 3 objectives when dealing with knee arthritis:
1) Relieve the pain
2) Stop the progression and maybe reverse arthritis
3) Avoid Surgery!
Typical onset of knee arthritis pain is insidious. Most people say “Where did this come from?” Initial treatment typically consists of over the counter medications such as acetaminophen and nonsteroidal anti-inflammatory medications like ibuprofen and naproxen. These can be taken on an as needed basis and should not exceed manufacturer dosing recommendations. Narcotic medications may be utilized for short term exacerbations, however, chronic usage brings with it several side effects. Two medications that can potentially alter the course of arthritis are glucosamine and chondroitin sulfate. Both are available over the counter and typically formulated together for optimal effect.
The second option for treatment is activity avoidance. This sounds strange, but if you happen to be a skier who frequents black diamond slopes, then shift to the easier slopes during times of discomfort. If you jog a lot and that activity becomes painful, start cross training with an activity that places less weight bearing stress such as cycling or swimming.
Physical therapy consists of strengthening the muscles around the knee in an effort to offload the stresses on the knee itself. This may decrease pain considerably and may allow the patient to either avoid surgery or substantially lengthen the time needed for a total joint replacement. Total joint replacements are not designed to last forever, so avoiding an eventual revision in 15 years or so is optimal.
Using a cane can unload 60% of the weight from a person’s knee. There are also knee braces called unloaders which can take significant pressure off the arthritic region of the knee causing pain. There are 3 “compartments” of the knee which can produce arthritis If a person has arthritis predominantly in one compartment, the unloader can be very effective.
Knee injections currently consist of two types. The most common involves cortisone, which is an intense anti-inflammatory solution that can provide relief potentially for months and can then be repeated. The medication doesn’t alter the course of arthritis, simply controls symptoms.
Hyaluronic acid injections, such as Synvisc, provide a “motor oil” substance to the knee and may propel the knee to produce more of its own. This may allow the knee to achieve pain relief for over a year. One potentially promising injection substance may involve stem cells, which could potentially alter the course of the disease and regenerate some of the arthritic cartilage.