Osteoarthritis is a chronic and irreversible disease that is characterized by pain and stiffness in the joints. It is caused by damage to the articular cartilage that serves as a cushion between the joint bones.
Although it can affect any joint, osteoarthritis is more common in weight-bearing joints of the hips, knees, and feet. It is also one of the most common forms of arthritis, which occurs most often in the elderly population of 50 years and older. In osteoarthritis, the cartilage of the knee joint gradually wears away. As the cartilage wears away, it becomes rough and frayed, and the protection space between the bones decreases. This can result in bone rubbing on bone and produce painful bone spurs.
Osteoarthritis Conservative Treatment Approaches
Similar to several other arthritic diseases, osteoarthritis too can be managed in its early stages with conservative approaches. Depending on the severity and chronic nature of pain, your doctor may recommend certain diagnostic tests such as an X-Ray and MRI to assess the extent of damage caused by Osteoarthritis. Accordingly, a treatment approach may be recommended.
Changes in your lifestyle can protect your knee and slow the progression of arthritis.
- Lower weight reduces stress on the knee joint, resulting in less pain and increased function.
- Limiting activities such as climbing stairs, that aggravate the condition can help.
- Replace high-impact activities (such as jogging or tennis) to low impact activities (such as swimming or biking).
Specific exercises can help increase the range of motion and flexibility, as well as help strengthen leg muscles. Physiotherapists are trained to evaluate patient’s unique medical condition and suggest an individualized exercise program as per the condition, age and lifestyle of the patient.
The main objectives of physiotherapy for knee arthritis are:
- Reduce knee pain and inflammation.
- Normalize range of knee joint motion.
- Strengthen the knee quadriceps and hamstrings.
- Strengthen your lower extremity: calf muscles, hip, pelvis
- Improve your (kneecap) alignment and function of the patella femoral.
- Normalize muscle lengths.
- Improve your proprioception, agility and balance.
- Improve your technique and function, such as walking, squatting.
Several types of drugs are useful in treating arthritis of the knee. No drug works the same way for every patient when it comes to pain relief. As our bodies respond differently, it becomes important to find the drugs that are most acceptable to your body.
Drug therapy is usually the next step and focuses on pain relief. Drug therapy typically includes acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase (COX-2) inhibitors, and opiates. Each of these drugs can be beneficial in some patients. Though some of these drugs may be available without a prescription, it is best not to take any of these without consulting with a specialist.
Hyaluronic acid supplements – Although technically these are not medicines, these substances are injected into knee joints to complement naturally occurring Hyaluronic acid. In healthy joints, Hyaluronic acid acts as a shock absorber and lubricant, allowing the joints to move smoothly over each other.
Intra-articular glucocorticoid injections are another potential component of treatment OA. These may be useful for patients who still have one or a few painful joints despite the use of NSAIDs and patients with one or a few affected joints in which NSAIDs are contra-indicated. Doctors sometimes may inject corticosteroids directly into the knee joint for quick relief from pain and inflammation. Benefits can last from a few days to more than six months.
Surgical Treatment Options
Your doctor may recommend surgery if your arthritis pain causes disability and pain. The benefits of the suggested surgery should outweigh the risks that almost all surgeries entail. It is important that as a patient, you obtain all information about the various surgical options and post-surgery complications, as well as the post-surgery rehabilitation plan. A second or third opinion is highly advised when surgery is suggested as a treatment option.
During arthroscopy, doctors use small incisions to insert instruments that help in viewing the joint problems as well as performing minor procedures such as removing bone spurs or smoothening rough edges of bones that lead to inflammation and pain. Arthroscopic surgery is not used very often to treat arthritis of the knee. However, when a degenerative meniscal tear accompanies osteoarthritis, arthroscopic surgery may be recommended to treat torn meniscus.
Synovectomy surgery is performed to remove the inflamed joint tissue (synovium) causing unacceptable pain or is limiting their ability to function and range of motion. This again is more common for a different form of arthritis called Rheumatoid Arthritis, which typically affects the synovial tissue.
Normal healthy cartilage tissue, taken from another part of the knee or a tissue bank, is used to fill a hole in the articular cartilage. This procedure is usually only considered for younger patients with small areas of cartilage damage.
In a knee osteotomy both the tibia (shin bone) and the femur (thigh bone) is cut and then reformed to ease the pressure on the knee joint. Knee osteotomy is performed when a patient has early-stage osteoarthritis with damage to only one side of the knee joint. Osteotomy helps with changing the weight on the damaged portion of the joint, which helps to gain better motion and relief from pain.
Uni-compartment surgery refers to the replacement of only those components in a knee joint that have suffered damage due to Osteoarthritis. In this process, only the affected part of the knee joint is fixed, leaving the rest of the knee joint as it is.
Total Knee replacement surgery
Total Knee replacement surgery often abbreviated as TKR, and also known as Knee Arthroplasty, is the most advanced treatment option to help patients suffering from severe disability and chronic pain. During knee replacement, a surgeon cuts away damaged parts such as cartilage of the femur and tibia bones, and knee cap. Implants or artificial components made of metal alloys, high-quality plastics and polymers are then affixed.
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