“Oh, my aching knee!” is a common cry among the more than four million people affected with osteoarthritis (OA) of the knee. Osteoarthritis is the leading cause of disability in the United States with approximately one in three adults with arthritis reporting limitation in their usual activities. The problem will be compounded with the aging of the Baby Boomer population and the projected increase in life expectancy.
Joint pain during and/or after activity is the most common symptom of this degenerative disorder, which affects the cartilage and bone of primarily large weight-bearing joints. Other joint symptoms include swelling, a grating or crackling sound or feeling, and restricted motion. Genetic predisposition, obesity, advancing age and physically demanding occupations contribute to the development of osteoarthritis.
What are the treatment options?
Pharmacological intervention is an important and often early component in the management of OA. Acetaminophen or nonsteroidal anti-inflammatory medications (NSAIDs) are frequently prescribed as the first-line treatment for mild to moderate OA symptoms. Due to potentially dangerous side effects, caution should be taken when using any medication.
There is some evidence that physical therapy and a standardized exercise program can improve self perceptions of pain, stiffness and function in OA sufferers. One study showed that physical therapy and exercise delayed the need for total knee replacement one year after treatment.
Intra-articular corticosteroid injections also have an anti-inflammatory effect and may often provide short-term pain relief. Steroid injections carry the potential for complications, however, and frequent administration is somewhat controversial.
Hyaluronic acid, a component of cartilage and the fluid which cushions the knee, is another intra-articular injection option which can provide longer-lasting relief. These products, available in four different preparations, are designed to improve the shock absorption and lubrication of the joint and are generally provided in a series of three to five injections.
There is significant disagreement in the published literature about the effectiveness of arthroscopic surgery as a treatment option for knee OA. Arthroscopy is a minimally invasive procedure which focuses on the surgical removal of torn or damaged cartilage.
Total knee arthroplasty is the final procedure used to restore joint function by replacing damaged surfaces of the knee joint with artificial surfaces. Advances in biotechnology are revolutionizing knee replacements. Newer products can bend and rotate and can last 30 years or longer. This option is reserved for severely affected joints. To discuss this or any of the treatment options for OA of the knee, contact a rheumatology or orthopedic specialist.
Martin Memorial’s research department is currently enrolling volunteers in a clinical trial designed to test an investigational knee injection to treat osteoarthritis of the knee. For more information about the trial please contact me at (772) 223-5945, ext. 3739.
--Judith Johansen, RN, BSN, CCRP
Clinical Research Coordinator
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