Arthritis of the knee is a progressive and debilitating condition that can ultimately lead to a lifestyle of minimal mobility. This can occur due to injuries occurring many years prior to the development of arthritis. Certainly, wear and tear and a physically taxing lifestyle can contribute to the development of arthritis. Ultimately, genetics plays a large role in whether or not an individual will develop knee arthritis.
Early stage arthritis may involve just some mild clicking and pain but by no means are these symptoms exclusive to arthritis. Meniscus damage and loose cartilage can cause similar problems or can, in some cases, be a result of early arthritis. Weight loss, physical therapy and transitioning to lower impact activities are quite effective at treating early stage arthritis. Oral anti-inflammatory medications on a judicious basis are effective in treating arthritic pain. Injections of cortisone into the knee can be very effective in limiting pain and swelling for typically several months, but their long-term chronic use is discouraged.
A healthy diet can be helpful in weight loss and this takes particular importance in patients with arthritis whose capacity for more intense cardiovascular exercise may be limited by the arthritic dysfunction. Recommendations include low calorie intake and avoidance of processed foods.
Viscosupplementation involves an injection of a substance called hyaluronan into the knee. Hyaluronan is an important lubricating component of normal joint fluid and some studies have shown noticeable pain relief with injection of these supplements into the arthritic knee. Conversely, there are also studies that demonstrate minimal improvement with these injections. However, the risk profile of these injections is so low, they are a reasonable consideration where other modalities have failed a patient with knee osteoarthritis. Platelet-rich plasma (PRP) shows promise in providing months of symptomatic relief in the arthritic knee. While PRP also is considered a regenerative modality, research is unclear as to whether its injection actually provides any beneficial regenerative effect on osteoarthritis as a disease process. Finally, stem cell injections also hold some promise but, outside of some pain relief, studies have yet to prove regeneration of healthy cartilage cells in the arthritic joint. (See regenerative medicine). Knee arthroscopy has not been shown to make a significant difference in the treatment of isolated knee osteoarthritis and is only recommended in the setting of symptomatic loose bodies and/or symptomatic meniscus tears which can occur in conjunction with arthritis.
Knee replacement refers to either partial knee replacement or, more commonly, total knee replacement. This involved replacement of the worn bone and cartilage in an arthritic knee joint with metal and polyethylene surfaces that are implanted directly into the joint. These surgical procedures can be done as an outpatient in appropriately screened patients but more typically involve an overnight stay in a medical center. Physical therapy is vital to full recovery and begins the afternoon of your surgical day. Several months of therapy are often necessary and full weight bearing occurs on day 1 after knee replacement surgery. Most people have significant recovery by 3 months out of the surgery and the longevity of these prosthetic joints on average is about 10-15 years.