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Treating the Osteoarthritic Knee
Presently, because there is no known cure for osteoarthritis, the major focus in regards to treatment is symptom relief. Fortunately, with conventional treatment, osteoarthritis associated joint pain and stiffness can be diminished, and joint function and mobility preserved.
Usually, the normal aging process or genetic predisposition are the source of cartilage decay. Under normal circumstances, cartilage, which is a living tissue, can maintain a decay and repair process at an equal rate with the help a cell called the “chondrocyte” and a surrounding substance of water, collagen and proteoglycans.
However, excessive biomechanical stress, such as obesity or overuse, can cause an imbalance in the decay and repair process. Because of this imbalance, the cartilage becomes damaged and cracked, develops tiny fissures, and loses its elasticity, thus the start of osteoarthritis of the hands, neck, back, hips, or knees.
The first steps in managing osteoarthritis of the knees are to lose weight and to exercise in order to reduce the amount of stress placed on the affected joint. Walking, swimming, or cycling regularly can not only help increase muscle strength, but also improve joint flexibility and decrease pain.
Drug therapy such as topical or oral pain relievers and non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to reduce joint pain and stiffness.
For patients who respond poorly to drug therapy, particularly if the knee is inflamed and swollen, intra-articular corticosteroid injections, given nor more than every three months, are quite helpful.
On average, a healthy knee joint contains less than 2ml of synovial fluid, consisting of hyaluronic acid. The elastic properties of the hyaluronic lubricant act like a shock absorber to the knee joint to prevent damage during activity. With osteoarthritis, the synovial fluid loses its viscosity (thickness) which decreases its ability to adequately lubricate and cushion the joint.
“Viscosupplementation” therapy, known as “Synvisc”, “Hyalgan”, or “Orthovisc” works well by injecting a hyaluronic acid into the knee in order to rejuvenate the protective, lubricating, and shock absorbing effects of the synovial fluid. Synvisc, Hyalgan, and Orthovisc injections are administered three times over a 15-day period and are especially beneficial to patients with mild to moderate knee osteoarthritis, and who are not obese.
Additionally, several studies have shown that Glucosamine may stimulate chondrocyte production of proteoglycans and collagen. Even though this ability has made Glucosamine an appealing treatment, more convincing studies are needed to make it a treatment of choice and not of trial.
At this point, while there is no particular drug available that can modify the process of osteoarthritis of the knee, maintaining an ideal weight, exercising regularly and receiving the right treatment, can help minimize your pain and preserve joint function.
By Dr. Yong H. Tsai
Published in The Daytona Beach News-Journal
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