Managing Arthritis in Active Adults

All painful knees are not necessarily arthritic.  The knee is a complex joint with several moving parts which is frequently challenged during regular and recreational activities.  It is not uncommon for one part or another to start showing signs of strain or regular wear and tear of the joint surface, which is also known as articular cartilage.  This surface has the appearance of a resilient plastic that is well constructed to absorb the repetitive loads during walking and running.

The joint surface may start to show signs of wear and tear with or without apparent injury.  This wear and tear of the joint surface is also known as degenerative arthritis. 

If the pain is produced by strains of parts other than the joint surface, the condition is not arthritic.  Smoking, overweight, trauma, repetitive loading and misalignments of the joint contribute to the development and continuation of the knee arthritis.

The knee has three main compartments or moving sections, which absorb the body loads during physical activities.  The arthritic condition may involve one, two or all three compartments of the joint.  It is important for the patients to have this knowledge, since the treatment may differ depending upon the involvement of a particular compartment.

Arthritis can be easily treated. Consult your physician for more information!

Pain and stiffness are two of the most common symptoms of arthritis.  At times, this may be accompanied by swelling, popping, clicking and sensations of giving out.  It is important to know that non-arthritic conditions of the knee can also produce similar symptoms that closely mimic arthritis.

A history of symptoms, clinical examination and standing X- rays are usually sufficient to make a correct diagnosis of degenerative arthritis. On rare occasions, additional testing such as CT scan or MRI scans may be necessary to arrive at a diagnosis.  These additional tests are unnecessary and redundant in more than 90% of patients.  The X- rays might show joint space narrowing, small bone overgrowths such as bone spurs or deposits of calcium. At times the X- rays look completely normal and further investigations become necessary in face of continuing symptoms.

Treatment for Knee Arthritis

In the knee, arthritis treatment can take several forms. Selection of treatment takes several factors into consideration and these may include but are not limited to, severity of pain and disability, response to previous treatments, number and extent of the compartments that are involved in the disease process, general health of the patient and circulation of the extremity.

Treatment could be as simple as modification of the physical activities and periodic utilization of ordinary pain medications. Non-impact activities such as cycling and swimming can provide excellent cardiovascular and aerobic advantage while the joint is undergoing other medical treatments. For mild misalignments, heel wedges and balancing shoe inserts come in handy to alleviate pain and improve function. Non-steroidal anti-inflammatory medications do provide symptomatic relief without reversing the arthritis. Food supplements such as Glucosamine and Chondriotin sulfate also provides symptomatic relief and do not delay the progression of the arthritis. These products are still under active research and their mode of action remains unknown.

Myriad of injections are also utilized to provide symptomatic relief. Among these injectable steroids and lubricating type of injections are most popular. These injections if effective, may provide relief for several months. Injectable steroids are safe and effective for nasty and painful flares; however, their utilization should be limited and never applied as a long-term management strategy.

Surgical alternatives may be explored for resilient arthritic knees. Surgery is an elective choice and never an absolute necessity. For arthritis induced loose bodies and related mechanical problems a relatively simple outpatient procedure of arthroscopy can alleviate the immediate problem without reversing the arthritis itself. Removal of loose bodies can extend the life of the joint and postpone the need for major invasive procedures.

In relatively younger adults, a portion of the joint can be replaced if the disease is localized to a single compartment. Such a procedure is known as uni-compartmental knee replacement. If more than one compartment is involved, it may become necessary to replace the entire joint through a standard total knee replacement. Contrary to common misconception, a total knee replacement doesn’t entail removal of the entire knee; instead the procedure replaces the uneven arthritic surface with synthetic materials and preserves the bulk of the original bones that produce the natural shape of the knee joint.

Before any surgical procedures patients must familiarize themselves with the exact nature of surgery, alternate approaches and risks that may accompany such procedures. No one should jump into surgical options without acquiring sufficient knowledge about the operation. For further information about arthritic knee please visit our patient information website at: www.caoortho.com

Shaheer Yousaf, M.D., FACS