Osteoarthritis of the Knee
Osteoarthritis of the knee affects many middle aged and elderly people. Symptoms of arthritis including knee pain, swelling and joint stiffness afflict millions of men and women around the world, prompting many consultations and increasing health care cost.
Degeneration of the cartilage which acts as a shock absorber between the thigh bone and the leg bone during ordinary and high impact activities like walking and running is the main cause of osteoarthritis of the knee. These progressive changes are often the cause of chronic pain which is usually worse in the morning or after a period of inactivity and also after walking, climbing stairs, and kneeling.
Knee Osteoarthritis Pain Relief
There are several modes by which pain relief may be obtained for knee arthritis, depending on a person’s age, level of activity, body weight, knee mechanics (alignment of bones) and degree of damage to the knee cartilage. These factors affect how the knees are used and often times overused, and pain relief methods must be adequately chosen to suit one’s needs.
A. Conservative Measures
- Rest from activities that cause knee pain.
- Use alternate cold and heat therapy to decrease inflammation and swelling.
- Minimize activities that aggravate the condition. Avoid jumping, running and climbing stairs.
- Reduce body weight to decrease the stress on the knee joint which causes pain.
B. Physical Therapy
Exercises to mobilize the joint and increase its range of motion are helpful but must be done under a doctor’s advice or with the help of a physical therapist. These exercises also aid in strengthening the muscles, increasing one’s function and in losing weight.
C. Supportive Devices
The use of knee braces to support the knee is found to be helpful in most patients who have problems in knee mechanics, such that the weight bearing function is not in the center but towards the inner side of one or both knees. Knee braces can help assist with stability and function of the knee and delay or avoid the need for surgery.
A walking cane is also a simple supportive device that can help in stabilization and support for a weak knee.
Using supportive devices help in decreasing the stress on the cartilage and joint, thereby decreasing pain.
D. Pain Medications
Pain medications help decrease swelling and pain, although tolerance to these drugs may develop over time. Side effects may also occur such as gastric irritation and bleeding. There is a wide range of oral pain medications that can be used either prescribed by a doctor or obtained over the counter. These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like paracetamol, ibuprofen and naproxen
- COX-2 inhibitors like Celebrex – has less gastrointestinal side-effects
- Glucosamine and chondroitin sulfate – natural supplements that help decrease inflammation in the early stages
E. Knee Injections
Local injection of corticosteroids to decrease moderate to severe local inflammation and pain is often helpful and avoids the systemic effects of oral medications. However steroids do not correct the degenerative changes and joint mechanics so pain may recur and repeat injections may have to be given.
Hyaluronic acid may also be injected into the joint space to improve the quality of the joint, a procedure called viscosupplementation. This substance is a viscous fluid which increases lubrication of the bones and cartilage enabling these to glide smoothly against each other. It is injected as a single dose or given weekly for a few weeks, after which it gives pain relief for several months. However, patients who are allergic to eggs are not advised to have these injections because severe reactions may occur.
Some forms of arthritis also benefit from gold salt injections.
The injection of Botox, stem cells and growth factors have been done experimentally on the knees, but more evidences have to be shown to prove their effectiveness and safety and to gain FDA approval.
F. Alternative Treatments
Other modes of treatment that have been tried for knee pain are: acupuncture, magnetic pulse therapy, and other dietary supplements like methylsulfonylmethane (MSM). Further research is needed to prove their effectiveness and safety for long term use.
G. Knee Surgery
For patients who do not experience pain relief with medical and conservative measures, there are different options for knee surgery depending on the indication and degree of joint damage:
- Arthroscopic surgery – to repair damaged joint with the use of endoscopic techniques
- Osteotomy - to improve the alignment of the knee joint the leg and thigh bones may be reshaped
- Total or partial knee arthroplasty – knee replacement with a prosthetic device
- Cartilage grafting – to replace lost or damaged cartilage
After surgery rehabilitation exercises have to be implemented to mobilize the joint, improve stability and strengthen the muscles.
To be able to choose and plan for appropriate knee osteoarthritis pain relief, medical consultation must be done. Coordination with a pain specialist and a physical therapist may also be needed in the therapeutic plan. When conservative measures do not relieve chronic pain due to severe degenerative changes surgical consultation with an orthopedic surgeon may be the next best option.
American Academy of Orthopaedic Surgeons, “Arthritis of the Knee” accessed 1/27/11
Mayo Clinic, “Arthritis” accessed 1/27/11