Knee Osteoarthritis

What is it?
Osteoarthritis of the knee is a very common affliction, affecting millions of older Americans. It is one of the leading causes of disability, and one of the most common reasons to see a physician. There are many kinds of arthritis, with osteoarthritis being the most common. Osteoarthritis (OA) is a slowly degenerative process, leading to erosion of the cartilage covering the ends of the bones. The cartilage acts as a shock absorber and when worn away, the ends of the bones can rub together, causing pain.

The symptoms most people experience typically include pain and stiffness that is worse in the morning, or after activities. The pain is usually aching in nature, but can be sharp with certain movements. Most people develop the pain gradually, but it is also possible to experience acute exacerbations of pain. Some people have pain that is worse with cold weather or changes in the weather. Many patients lose motion in the knee as the disease progresses.

What causes it?
There are many causes of arthritis. Most often, OA occurs from gradual “wear and tear” although in those circumstances another cause exists making the person more susceptible. There is a genetic component to developing OA in some cases. Prior surgery such as a total meniscectomy can cause OA. Prior injuries as well, such as old fractures and ligament injuries can cause instability and cartilage damage that can lead to OA.

Many people ask if running long distances can cause OA. As long as you don’t have a structural abnormality to you knee, such as a mal-alignment, you should not develop it from running.

There are several grades of arthritis, from mild to severe. Mild OA does not necessarily lead to severe cases. Most of the time there is a slow progression in the severity of the disease, although it can take years to worsen significantly. Once you have OA, it is unlikely to resolve however.

What are the conservative (first line) treatments?
Lifestyle modifications: Try changing from high impact activities (running, jumping) to low-impact activities such as cycling or swimming. Keeping your weight down can greatly help relieve the pain as well. In severe cases of OA a cane can be used with the opposite hand to help unload your knee.

Physical therapy: Keeping the muscles that surround the knee strong can help stabilize the knee and take pressure off the cartilage and bone surfaces. You can do this at home or with a therapist.

Medications: Non-steroidal anti-inflammatory medications (Advil, Motrin, others) can help calm the inflammation down and may help with the pain. Tylenol helps with pain as well. Some people have relief from taking chondroitin sulfate. It is not certain that these medicines have any benefit for OA.

Injections: In some advanced cases, corticosteroid injections will be given to help calm down the inflammation. These can be given every few months and are safe and very effective.

What if that fails to relieve my condition?
Depending on your age and activity level, you may be a candidate for either a partial or a total knee arthroplasty (total knee replacement). This is a good option for people in their 60’s and 70’s who have failed other modes of therapy. For younger patients, there are other options to try before going for a replacement.

Arthroscopic surgery is reserved for people with meniscus tears and cartilage defects. It is not recommended for treating arthritis alone.

How successful is surgery for this?
Total knee replacement surgery is one of the most successful operations there is. Over 90% of patients have complete relief of their pain and can go back to normal activities, including low-impact sports such as light skiing or doubles tennis.

What can I do to prevent the development of OA?
Stay active and keep your weight down. Also, don’t smoke. Smoking damages everything in your system, including the cartilage in your knee.