How to Feel Better
You and you doctor can individualize your treatment to find what worksIf you have OA of the knee, there are many ways to ease discomfort and provide relieffrom the time-tested use of over-the-counter (OTC) pain relievers such as ibuprofen to total knee replacement.
"Twenty years ago we thought that osteoarthritis was the inevitable result of wear and tear on your bones," says Joanne M. Jordan, M.D., M.P.H., director of the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill. "But clearly not everyone gets osteoarthritis, and, although there are risk factors such as obesity, genetics or injury, a lot of folks develop OA without having any. So we are looking at the role inflammation plays, as well as other factors."
While it appears to be intermittent and at a different level of intensity than in rheumatoid arthritis (RA), the inflammation is there and, says Dr. Jordan, very relevant. "Understanding this opens up the possibility that disease-modifying drugs, or even biologics, [such as those used to treat RA] may be useful in treating or stopping the progression of OA," she explains. "Some people feel that for osteoarthritis, as opposed to RA, it's not justified to incur the risk of side effects that is associated with these drugs. But I think OA causes a lot of difficulty and trying these medicines may be worth the risks, particularly with multi-joint OA. Just because OA isn't rheumatoid arthritis doesn't mean it isn't associated with significant disability."
Although using disease-modifying drugs for OA is still in the future, treatments are changing in other ways. "Structurally, we're not just focusing on cartilage in the knee," says Dr. Jordan. "We are looking at the role of the meniscusthe cartilage pad between the thighbone and the shinas well all the bone itself and supporting structures that contribute to OA."
Lifestyle interventions have been found to be effective in easing the pain associated with OA of the knee. "Several studies have shown that being physically active and walking, as well as weight loss for those who are overweight, can help relieve symptoms," says Dr. Jordan. "What we don't know is if these programs do anything to alter or slow down the course of the disease.
"But at least the days of saying, 'Oh well, it's just arthritis,' are over. There are many treatment choices we can use quite effectively."
If you need medical intervention to ease the discomfort that OA of the knee is causing you, here are the options to discuss with your doctor.
OTC pain relievers such as acetaminophen and nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, can be very effective in easing discomfort. If they're not, prescription strength NSAIDs may be prescribed, including Cox-2 inhibitors such as Celebrex.
Corticosteroids are powerful anti-inflammatory agents that can be injected into the joint. They remove pain but may not improve joint function. Although there is concern that they may increase inflammation, Australian researchers looking at 28 trials of the drug in treating OA of the knee found "the short-term benefit of injections of corticosteroids in treatment of knee OA is well established."
However, a newer type of injectable therapy, viscosupplementation, can be useful in cases in which corticosteroids are not effective or to avoid their negative side effects. Viscosupplementation is an injection into the knee joint of hyaluronic acid, a naturally occurring substance found in synovial (joint) fluid. Once in the joint, it cushions and lubricates so that the bones do not catch, grind or touch.
Depending on the product, treatment is given as a one-time shot or in three to five injections at weekly intervals. Relief can come quickly or take a month to be felt; it can last for several months. Repeated injections are thought to be effective and safe.
According to the AAOS: "It has been shown to relieve pain in many patients who can't get relief from nonmedicinal measures or analgesic drugs." It is most effective for mild to moderate arthritis.
More than half a million knee replacements are done every year in the U.S., and the results are usually positive, although the degree of success can depend on a person's overall health and how conscientiously he or she adheres to physical therapy afterwards.
"Studies show many people put off knee replacement because they have misconceptions about recuperation and results," explains Dr. Jordan. But serious complications, such as a knee joint infection, occur in fewer than 2% of patients. And according to the NIH Consensus Development Conference on Total Knee Replacement, 90% of people receiving total knee replacement report a rapid and substantial improvement in pain, mobility and overall health-related quality of life. And this level of satisfaction lasts over time.
There are various types of knee replacement surgeries. Total knee replacement is recommended when you can no longer find relief from pain using other therapies, and your knee problems are curtailing your quality of life. There are two common forms: standard total knee replacement and the newer minimally invasive knee replacement. Many designs and components are used in these surgeries, but generally they consist of a metal femoral (thigh) component, a durable plastic tibial (shinbone) component and a plastic patellar (knee cap) component.
Alternatives to Knee Replacement
Alternatives to total knee replacement do exist. They include:
- OsteotomyIt is used to improve the knee's alignment by reshaping the thighbone or the shinbone. Healthy bone and cartilage can then take over the work being done by damaged parts of the knee. The AAOS says it is recommended for those 60 or younger, who are active or overweight, when there is "uneven damage to the joint, correctable deformity and no inflammation."
- Unicompartmental knee replacement This procedure replaces one of two compartments of the knee: the medial (inner) compartment or the lateral (outer) compartment. The third compartment of the knee (the kneecap) is not replaced. The surgery is recommended for those 60 or older, who are not obese and are relatively sedentary.