Department of Orthopaedic Surgery

The Department of Orthopaedic Surgery offers services and programs through the following Divisions. Use these links to directly access all our Department sites.

 

Sports Medicine

Arthritis of the Knee

Overview

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.

Causes

  • 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.

  • Genetics

Symptoms

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.

Treatment

Stepwise Approach to Treatment of Osteoarthritis of the Knee

Step 1: Conservative non-surgical treatments
Lifestyle modification

  • Weight loss

  • Modification of exacerbating activities

  • Avoid high impact exercises, such as running and stair climbing; avoid prolonged standing, kneeling or squatting

Exercise programs

  • 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

Pain Medications

  • 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.

Arthroscopic debridement
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