Osteoarthritis (OA) is a common type of arthritis characterized by gradual loss of cartilage from the joint. It most often affects the hands, knees, hip and spine.
Aging: one of the strongest risk factors: over 80% of people over 55yrs have some type of arthritis. Female gender
Obesity: perhaps the strongest modifiable risk factor. One study found that patients with the highest body mass index (BMI) had a 6 to 8 x greater risk of OA than those with the lower BMI?s.
Repetitive knee bending.
Repetitive, low- or high-impact activities when previous injury or preexisting joint abnormalities.
The most common symptoms include pain that is worse with activity, stiffness, some loss of joint motion and changes in the shape of the affected joints. The disease is usually slowly progressive, usually with intermittent worsening, although it can stabilize in some patients.
Stepwise Approach to Treatment of Osteoarthritis of the Knee
Step 1: Conservative non-surgical treatments
Modification of exacerbating activities
Avoid high impact exercises, such as running and stair climbing; avoid prolonged standing, kneeling or squatting
Several studies have shown that exercise is important
in the management of osteoarthritis, and is modestly effective in reducing knee pain.
Physical therapy: strengthening exercises (including quadriceps), range of motion of hip, knee and ankle
Low-impact exercise, such as swimming and biking
Pool therapy: a study showed that group-based exercise in water over 1 year can produce significant reduction in pain and improvement in physical function in older adults with knee OA
Local heat and ice
None can prevent the progression of joint damage due to OA, but they can improve pain and allow you to perform activities more comfortably.
Tylenol (acetaminophen): useful for mild to moderate pain, but less effective than NSAIDs.
NSAIDs: ibuprofen (advil, motrin), naproxen (aleve), and COX-2 inhibitors (e.g. celebrex).
Glucosamine sulfate is a sugar/protein molecule that serves as a building block for articular cartilage, the material of joint surfaces.
Neoprene knee sleeve
May improve pain, stiffness and physical function.
Step 2: More aggressive non-surgical treatments
Injections into the knee
G-2 Unloader knee brace
Stage 3: Surgical treatment
To maximize outcome and minimize complications, surgery should be performed before significant joint deformity and muscle atrophy occurs, and when patient will be able to participate in several months of rehabilitation.
Considered in select patients with mechanical symptoms; not helpful to all patients
Osteotomy (incision or cutting of bone)
Sometimes used in the treatment of young, active patients and may be particularly appropriate in combination with articular cartilage procedures
Total knee arthroplasty / replacement
Most definitive treatment available
Involves removing the diseased or damaged bony ends and replacing with manmade joint composed of metal and plastic
Leads to significant relief in pain and functional improvement