Knee Arthritis

Treatments for the arthritic knee include the following:

Conservative (No surgery) Treatments

This is always a good place to start and if in the early stages of arthritis can give good results for long periods of time. Successful conservative treatment can delay the need for surgery for months or years.

Building up your thigh muscles allows the shock to pass through the muscle rather than through the inflamed joint and relieves your pain. You can achieve this by doing regular quadriceps (thigh muscle) strengthening exercises. Leg raising or leg extension exercises using ankle weights to strengthen the quadriceps muscle group can help support the knee joint during load and lead to better function and reduce symptoms. 240 repetitions per leg per day (8 sets of 10, three times per day) are required.

Have a course of physiotherapy.  A good physiotherapist can help with strengthening exercises and other physical techniques to help maximise knee function and mobility.

Take up a low impact exercise programme. Swimming, walking and stationary cycling are excellent ways to keep mobile and retain function of the knees. Joint surface cartilage is nourished by synovial fluid which requires movement for optimal penetration to the cartilage cells in the deeper layers. Movement is vital for joint function.

Reduce weight if required. More than half of Australian adults are overweight and excess weight places enormous stress on the knees and leads to early arthritis.  A GP will give advice on dieting, exercise, and possibly medication. It may be helpful to seek advice from a dietician. Approximately three times your body weight goes through each knee with each step you take. Sensible weight reduction will definitely reduce the pain of osteoarthritis.

Try a course of cartilage supplements. There is very little science behind the use of supplements for arthritis. Some people find that they work very well and some people find that they do not work at all. If  trying a supplement I suggest using  it for a month and then stop it. Once stopped look for a worsening or deterioration in symptoms. If symptoms are the same on and off the supplement then it is almost certainly not helping. If  symptoms become worse after stopping  then start the supplement again.  I am not aware of any evidence that any supplement can actually reverse the arthritic process or be helpful as a preventative agent. There are many reports of patients benefiting from taking these compounds and the chance of suffering side-effects appears to be very small. The exact mechanism of action of these compounds remains unknown.

Anti-inflammatory medications are very useful in treating the symptoms of arthritis although they do not appear to affect the underlying condition. It is reasonable to take anti-inflammatories as long as complications and side effects do not occur. Common side effects of non-steroidal anti-inflammatory drugs (NSAID’s) include dyspepsia, reflux oesophagitis, stomach and duodenal ulcers, fluid retention, hypertension, and asthma in susceptible individuals (heartburn, reflux and kidney problems). Some patients tolerate NSAID’s for years without suffering complications.

Cox 2 inhibitors are a relatively new class of NSAID that gives relief of pain and symptoms of arthritis but has fewer of the side effects of traditional NSAID’s.

Treatments delivered by injection

Cortisone injections into the arthritic knee may reduce inflammation and relieve symptoms for a while but do not affect the underlying disorder. The injections do not cause skin problems or thinning of the bones like cortisone tablets and can give good pain relief  for a period of time.

Visco-supplementation (‘tricking’ the body into thinking it has normal joint lining fluid again) with hyaluronic acid based fluid substitutes  may give relief of symptoms of arthritis for several months and may put off the need for surgery in some patients.

Surgery

As the arthritis in your knee progresses the non surgical treatments become less effective in relieving symptoms. In such instances surgical treatments may be required.

Surgical options range from minor operations conducted on an outpatient basis to major procedures such as total knee replacement. The main surgical procedures used to treat osteoarthritis of the knee are:

Arthroscopy (keyhole surgery – no overnight stay required)

Arthroscopy involves inspection of the inside of the knee joint with a small telescope and camera.  The image is projected onto a television monitor via a fibre optic cable and allows me to fully inspect all of the interior structures of the knee joint without needing open surgery. Despite the fact that the incisions are quite small, a large amount of surgery can be performed within the knee. Arthroscopic surgery is usually performed on a ‘day only’ basis (an outpatient procedure). The aim of this procedure in the arthritic knee is to examine the specific location and severity of the arthritis. I then remove loose bodies and floating cartilage, treat meniscal tears, remove excess and inflamed synovium and wash out debris from the knee.

Satisfactory results are achieved in about 60% of patients. The results of arthroscopy in the arthritic knee are difficult to predict pre-operatively and can be disappointing. It is possible for symptoms to increase following arthroscopy for a few months and if a satisfactory result is not achieved further surgery may be required.