Part 1 of 2

I have been advising my patients to exercise, keep active, and walk as long as they can in order to stay mobile and healthy. However, seniors often tell me activities that require prolonged walking are limited by knee pain from arthritis. They often ask, “What is arthritis of the knee?” How does it happen? What can I do about it? I will attempt to answer these questions, however, keep in mind that having knee joint arthritis is not a death sentence to an active lifestyle. Six years ago, I discussed this topic and used retired local physician, Dr. Joseph Andriole, as an example of someone who had severe osteoarthritis in his knees. He continued to be very active and enjoyed skiing and golfing during his retirement. However, he did go on to have his knees replaced a few years ago is doing very well and continues these activities. So, the next question is, how do I know when I am ready for a knee replacement? This will be the topic in Part II, Knee Arthritis.

Three Most Common Forms of Arthritis of the Knee

• Osteoarthritis – is also known as degenerative arthritis. It is the most common form of arthritis in the knee. It is usually a gradual, slow and progressive process of “wear and tear” to the cartilage in the knee joint which eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight bearing joints such as the hip, knee and ankle.
• Rheumatoid Arthritis – is a form of inflammatory arthritis in which many joints of the body can be affected. It is very destructive to the cartilage, joint and tissues surrounding the joint. It can occur at any age and usually affects both knees.
• Post-Traumatic Arthritis- is a form of arthritis that can occur following a trauma or injury to the knee. It is a form of osteoarthritis that is triggered years after a fracture, ligament or cartilage injury.

Symptoms of Arthritis

• Pain - usually occurs gradually. However, a sudden onset can occur, especially associated with a sudden twist or fall. Pain is often worse in the morning and improves with movement. Changes in the weather or barometric pressure can cause pain associated with arthritis.
• Swelling – can swell after increase activity at the end of the day.
• Stiffness – is more noticeable in the morning and improves with movement. However, overuse can create more pain and swelling and lead to stiffness also.
• Weakness – from disuse associated with pain and can lead to occasional buckling of the knee when walking or climbing steps.
• Loss of Function- is associated with pain, swelling, weakness and stiffness which limits walking, stair climbing etc.

Diagnosing Arthritis

Your family physician will examine your knee to determine if you have arthritis. In more advanced cases you may be referred to an orthopedic surgeon or rheumatologist for further examination and treatment. X-rays will show if the joint space between the bones in the knee is getting narrow from wear and tear arthritis. If rheumatoid arthritis is suspected, blood tests and an MRI may be ordered. The diagnosis will determine if you problem if minor, moderate or severe.

Treatment for Arthritis

Conservative Treatment for Arthritis

In the early stages your treatment will be a conservative, nonsurgical approach, which may include; anti-inflammatory medication, orthopedic physical therapy, exercise, activity modifications, supplements, bracing, etc. You and your family physician, orthopedic surgeon or rheumatologist will decide which choices are best.

• Anti-inflammatory Medications: such as aspirin, acetaminophen or ibuprofen to reduce pain and swelling in the joint.
• Orthopedic Physical Therapy: such as heat, cold, ultrasound, electrical stimulation, joint mobilization, range of motion exercises, strengthening exercises, partial weight bearing aerobic exercises.
• Activity Modifications: such as eat well and lose weight, doubles tennis instead of singles, sitting or lying leg exercises instead of standing, walk instead of run, soft bed treadmill instead of hard surfaces, avoid squatting, kneeling, and bending.
• Supportive Devices: such as knee sleeves, light bracing, use good running shoes for exercise and walking, use good quality supportive shoes for work/dress.

Conservative, But More Aggressive Treatment for Arthritis

• Corticosteroids: stronger anti-inflammatory medications than those above which are injected directly into the knee joint.
• Viscosupplementation: a type of synthetic fluid injected into the knee joint and designed to imitate the joint fluid of the knee to promoted healing and mobility.
• Glucosamine and Chondroitin: supplements taken orally to control the pain of osteoarthritis and promote healing.
• Rheumatoid Medications: specifically designed  for RA

Surgical Treatment for Arthritis

When conservative measures no longer succeed in controlling pain and deformity, improving strength and function then more aggressive treatment may be necessary.

• Arthroscopic Surgery: uses a scope to clean and repair damaged tissues inside the knee joint.
• Osteotomy Surgery: cuts one of the knee bones to realign the joint for less wear and tear
• Total or Partial Knee Replacement: replaces severely damage joint surfaces with metal or plastic.
• Cartilage Grafting: is performed on rare occasions, usually at teaching facilities, when young healthy cartilage with minor damage needs to be repaired.

SOURCES: Rothman Institute, Philadelphia, PA and American Academy of Orthopaedic Surgeons

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in the Scranton Times-Tribune.  Next Week – Part 2 on Knee Arthritis “How you know when you’re ready for a new knee.”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at The Commonwealth Medical College.