Degenerative or Post-Traumatic
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||Degeneration of the surface cartilage of
the knee that leads to spur formation and loss of range of motion.
and X-ray of a Normal Knee
||Osteoarthritis is a progressive disorder
of the knee that typically occurs in older patients. Degeneration of
the surface (articular) cartilage of the knee is the primary
problem. This cartilage destruction slowly leads to further
deformity of the knee and may result in complete loss of joint
||The exact cause of osteoarthritis is not
known. There is a genetic
component, meaning it can run in families. Obesity or trauma to the
knee such as a severe fracture
may lead to this form of arthritis.
||Osteoarthritis initially does not produce
many symptoms. As the disorder progresses, however, morning
stiffness, pain with activity and mild swelling occur. A dull
toothache like pain, especially with weather changes is common in
the intermediate stages. In the later stages, progressive disability
and moderate pain arise. The diagnosis is made by a history of these
symptoms and confirmed by a physical exam and plain x-rays. The
physical exam will show decreased motion in the knee and the x-rays
will reveal loss of space in the joint and spur formation.
of Normal and Osteoarthritic Knees
||Nonoperative: The goals of
treatment are to maintain function and decrease symptoms. This can
be done with anti-inflammatory medications, carefully planned
exercise programs, weight control and occasionally steroid
injections. Injections of some of the precursors of cartilage
(Hyaluronate) and oral supplements such as glucosamine sulfate and
chondrotin sulfate are other nonoperative therapies that have shown
promise in the treatment of knee osteoarthritis.
Anti-inflammatory medications especially the COX-2 type
inhibitors recently have been shown to cause an increased risk of
cardiovascular side effects in some patients. Exercise is a
neglected form of treatment. Typically, 30 minutes of riding
an exercise bike 3-4 times per week will increase leg strength and
mobility in patients with knee osteoarthritis.
(minimally invasive) removal of degenerated cartilage or loose
fragments may be useful in some patients. Realignment (osteotomy)
surgery may be helpful in patients with isolated compartment of
arthritis. Total Knee Replacement (TKR) surgery is the definitive
treatment for long term severe osteoarthritis. This last type of
surgery (TKR) usually requires a stay of 4-5 days in the hospital
and several months of rehabilitation. The implants used for
replacement surgery are made of plastic and metal.
Picture of an Arthritic Knee and a Total Knee Replacement
Newer Treatments: Cartilage transfer procedures are
becoming more common and have shown longer term benefits in certain
patient groups. Finally, various forms of biologic therapy are
being investigated and will likely result in effective treatments in
the near future.
Weight control and a consistent exercise program may help prevent
some forms of osteoarthritis.