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Knee Disorders
Condition
Knee Osteoarthritis
Osteoarthritis is the final common pathway of joint degeneration in the knee. In the knee, damage to the articular cartilage, menisci, or ligaments can lead to accelerated onset of arthritis. Additionally, having an excessively bow-legged or knock-kneed alignment can also lead to a higher rate of osteoarthritis. Obesity has been associated with a higher incidence of knee osteoarthritis. In addition to mechanical factors, genetic factors have some influence on the development of osteoarthritis. Osteoarthritis has a higher prevalence in certain families. This has been attributed to a number of gene mutations as well as the tendency for anatomical abnormalities to be passed from parent to offspring.
The pain felt from osteoarthritis often does not match the degree of arthritis on the radiographs. For example, many patients present with severe arthritis that has taken many decades to develop and complain of pain for only a few months. The factors responsive for pain in arthritis are currently not fully known. Currently, most experts feel that the pain is carried from the bone directly under the cartilage, the tissue surrounding the joint (the synovium), nerves that are overly sensitized, as well the normal variations between individuals.
Currently, the treatment of osteoarthritis of the knee has focused initially on medical treatment and surgery only as a last resort. Medical treatments include tylenol, non-steroidal anti-inflammatory medications, COX2 inhibitors, chondroitin sulfate and glucosamine, and in rare cases, narcotic medications.
Non-steroidal antiinflammatory drugs (NSAID's)are the mainstay of treatment but can be associated with stomach irritation, ulcers, and gastrointestinal bleeding in rare cases. Currently, Celebrex ® (celecoxib)is the dominant COX 2 inhibitor. It is associated with less risk of bleeding but can be associated with elevation in blood pressure. Chondroitin sulfate and glucosamine have been used for decades, initially in the veterinary world. These medications are safe, relatively inexpensive, and potentially as effective as NSAID's. They are not directly regulated by the FDA. We would recommend that our patients be aware of variations of drug content in different chondroitin sulfate and glucosamine supplements.
The nonsurgical treatments include the use of a weightloss regimen in cases of obesity. These include dietary modifications, engagement in an aerobic exercise program, and occasionally psychological counseling. Many patients with knee arthritis have excessive pain in the case of vigorous aerobic exercise such as walking or cycling. In these cases, a water aerobics program may be particularly helpful. In cases of severe morbidity, consideration should be given to weight-loss surgery by a "bariatric" surgeon.
Many patients with knee arthritis have deconditioned muscles which expose the joint to increased force and can lead to concurrent tendinitis or irritation of the soft-tissues around the joint. In clinical practice, one often sees patients with severe arthritis by physical exam and by radiographs who have very little pain. Most of these patients have very well developed muscles around the knee. It is based on this principle that many patients are treated with physical therapy for their knee arthritis. Activities such as yoga and Tai Chi have been shown to decrease the pain associated with knee osteoarthritis. It is very important to avoid the "no pain, no gain" mentality when engaging in these activities.
If the knee is malaligned either bowlegged or knock-kneed, the damaged compartment can be "unloaded" through the use of a heel wedge in the shoe or a brace on the leg. The heel wedge is thought to work by changing the posture of the foot on the ground and therefore changing the alignment of the knee. For example, if a patient has arthritis in the inner aspect of the knee, a shoe wedge is placed on the outer part of the foot. This has a tendency to change the standing alignment of the knee from bowlegged to knock-kneed. Another, more effective way, to accomplish this is by using an "unloader" brace which grabs onto the upper and lower leg and essentially forces them into a more optimal alignment. These braces can occasionally be cumbersome and quite expensive. If all of these steps fail, the patient may be a candidate for surgical treatment. The ultimate plan will depend on patient factors as well as the overall status of the knee on physical examination and on radiographs.
Condition
Knee Osteoarthritis
Osteoarthritis is the final common pathway of joint degeneration in the knee. In the knee, damage to the articular cartilage, menisci, or ligaments can lead to accelerated onset of arthritis. Additionally, having an excessively bow-legged or knock-kneed alignment can also lead to a higher rate of osteoarthritis. Obesity has been associated with a higher incidence of knee osteoarthritis. In addition to mechanical factors, genetic factors have some influence on the development of osteoarthritis. Osteoarthritis has a higher prevalence in certain families. This has been attributed to a number of gene mutations as well as the tendency for anatomical abnormalities to be passed from parent to offspring.
The pain felt from osteoarthritis often does not match the degree of arthritis on the radiographs. For example, many patients present with severe arthritis that has taken many decades to develop and complain of pain for only a few months. The factors responsive for pain in arthritis are currently not fully known. Currently, most experts feel that the pain is carried from the bone directly under the cartilage, the tissue surrounding the joint (the synovium), nerves that are overly sensitized, as well the normal variations between individuals.
Currently, the treatment of osteoarthritis of the knee has focused initially on medical treatment and surgery only as a last resort. Medical treatments include tylenol, non-steroidal anti-inflammatory medications, COX2 inhibitors, chondroitin sulfate and glucosamine, and in rare cases, narcotic medications.
Non-steroidal antiinflammatory drugs (NSAID's)are the mainstay of treatment but can be associated with stomach irritation, ulcers, and gastrointestinal bleeding in rare cases. Currently, Celebrex ® (celecoxib)is the dominant COX 2 inhibitor. It is associated with less risk of bleeding but can be associated with elevation in blood pressure. Chondroitin sulfate and glucosamine have been used for decades, initially in the veterinary world. These medications are safe, relatively inexpensive, and potentially as effective as NSAID's. They are not directly regulated by the FDA. We would recommend that our patients be aware of variations of drug content in different chondroitin sulfate and glucosamine supplements.
The nonsurgical treatments include the use of a weightloss regimen in cases of obesity. These include dietary modifications, engagement in an aerobic exercise program, and occasionally psychological counseling. Many patients with knee arthritis have excessive pain in the case of vigorous aerobic exercise such as walking or cycling. In these cases, a water aerobics program may be particularly helpful. In cases of severe morbidity, consideration should be given to weight-loss surgery by a "bariatric" surgeon.
Many patients with knee arthritis have deconditioned muscles which expose the joint to increased force and can lead to concurrent tendinitis or irritation of the soft-tissues around the joint. In clinical practice, one often sees patients with severe arthritis by physical exam and by radiographs who have very little pain. Most of these patients have very well developed muscles around the knee. It is based on this principle that many patients are treated with physical therapy for their knee arthritis. Activities such as yoga and Tai Chi have been shown to decrease the pain associated with knee osteoarthritis. It is very important to avoid the "no pain, no gain" mentality when engaging in these activities.
If the knee is malaligned either bowlegged or knock-kneed, the damaged compartment can be "unloaded" through the use of a heel wedge in the shoe or a brace on the leg. The heel wedge is thought to work by changing the posture of the foot on the ground and therefore changing the alignment of the knee. For example, if a patient has arthritis in the inner aspect of the knee, a shoe wedge is placed on the outer part of the foot. This has a tendency to change the standing alignment of the knee from bowlegged to knock-kneed. Another, more effective way, to accomplish this is by using an "unloader" brace which grabs onto the upper and lower leg and essentially forces them into a more optimal alignment. These braces can occasionally be cumbersome and quite expensive. If all of these steps fail, the patient may be a candidate for surgical treatment. The ultimate plan will depend on patient factors as well as the overall status of the knee on physical examination and on radiographs.
