Knee Arthritis

Three basic types of arthritis may affect the knee joint.

1. Osteoarthritis (OA) is the most common form of knee arthritis. OA is usually a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people.



2. Rheumatoid arthritis (RA) is an inflammatory type of arthritis that can destroy the joint cartilage. RA can occur at any age. RA generally affects both knees.



3. Post-traumatic arthritis can develop after an injury to the knee. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, ligament injury or meniscus tear.

Symptoms of arthritis

Generally, the pain associated with arthritis develops gradually, although sudden onset is also possible. The joint may become stiff and swollen, making it difficult to bend or straighten the knee. Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing or kneeling. The pain may often cause a feeling of weakness in the knee, resulting in a "locking" or "buckling." Many people report that changes in the weather also affect the degree of pain from arthritis.

Making the diagnosis

Your doctor will perform a physical examination that focuses on your walk, the range of motion in the limb, and joint swelling or tenderness. X-rays typically show a loss of joint space in the affected knee. Blood and other special imaging tests such as an MRI may be needed to diagnose RA.

Treatment options

In its early stages, arthritis of the knee is treated with conservative, nonsurgical measures.

• Lifestyle modifications can include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities such as climbing stairs that aggravate the condition.
• Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg.
• Using supportive devices such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful.
• Other measures may include applications of heat or ice, water exercises, liniments or elastic bandages.
• Several types of drugs can be used in treating arthritis of the knee. Because every patient is different, and because not all people respond the same to medications, your orthopaedic surgeon will develop a program for your specific condition.
• Anti-inflammatory medications can include aspirin, acetaminophen or ibuprofen to help reduce swelling in the joint.
• Glucosamine and chondroitin (kon-dro’-i-tin) sulfate are oral supplements may relieve the pain of osteoarthritis.
• Corticosteroids are powerful anti-inflammatory agents that can be injected into the joint.
• Hyaluronate (hi-a-lou’-ron-ate) therapy consists of a series of injections designed to change the character of the joint fluid.
• Special medical treatments for RA include gold salt injections and other disease-modifying drugs.

Surgical Treatment

If your arthritis does not respond to these nonoperative treatments, you may need to have surgery.

• Arthroscopic surgery uses fiber optic technology to enable the surgeon to see inside the joint and clean it of debris or repair torn cartilage.
• An osteotomy cuts the shinbone (tibia) or the thighbone (femur) to improve the alignment of the knee joint.
• A total or partial knee arthroplasty replaces the severely damaged knee joint cartilage with metal and plastic.
• Cartilage grafting is possible for some knees with limited or contained cartilage loss from trauma or arthritis.
• Orthopaedic surgeons are continuing to search for new ways to treat arthritis of the knee. Current research is focusing on new drugs as well as on cartilage transplants and other ways to help slow the progress of arthritis.

Hip Arthritis

Like other joints that carry your weight, your hips may be at risk for "wear and tear" arthritis (osteoarthritis), the most common form of the disease. The smooth and glistening covering (articular cartilage) on the ends of your bones that helps your hip joint glide may wear thin. Your first sign may be a bit of discomfort and stiffness in your groin, buttock or thigh when you wake up in the morning. The pain flares when you’re active and gets better when you rest.

If you don’t get treatment for osteoarthritis of the hip, the condition keeps getting worse until resting no longer relieves your pain. The hip joint gets stiff and inflamed. Bone spurs might build up at the edges of the joint. When the cartilage wears away completely, bones rub directly against each other. This makes it very painful for you to move. You may lose the ability to rotate, flex or extend your hip. If you become less active to avoid the pain the muscles controlling your joint get weak, and you may start to limp.

About 10 million Americans reported having been diagnosed with osteoarthritis. You’re more likely to get it if you have a family history of the disease. You’re also at risk if you are elderly, obese or have an injury that puts stress on your hip cartilage. You can get osteoarthritis if you don’t have any risk factors. See your doctor as soon as possible if you think you may have it.

Evaluation

While you cannot reverse the effects of osteoarthritis, early non-surgical treatment may help you avoid a lot of pain and disability and slow progression of the disease. Surgery can help you if your condition is already severe. You doctor will determine how much the disease has progressed. Describe your symptoms and when they began. Your doctor may rotate, flex and extend your hips to check for pain. He or she may want you to walk or stand on one leg to see how your hips line up. Both hips will probably be X-rayed to check if hip joint space has changed, and if you have developed bone spurs or other abnormalities.

Nonsurgical treatment

If you have early stages of osteoarthritis of the hip, the first treatment may be:

• Rest your hip from overuse.
• Follow a physical therapy program of gentle, regular exercise like swimming, water aerobics or cycling to keep your joint functioning and improve its strength and range of motion.
• Use nonsteroidal anti-inflammatory medications like ibuprofen for pain.
• Get enough sleep each night.
• You may need to lose weight if you are overweight. As the disease progresses, you may need to use a cane.

Total hip replacement surgery

If you have later stages of osteoarthritis, your hip joint hurts when you rest at night and/or your hip is severely deformed, your doctor may recommend total hip replacement surgery (arthroplasty). You will get a two-piece ball and socket replacement for your hip joint. This will cure your pain and improve your ability to walk. You may need crutches or a walker for awhile after surgery. Rehabilitation is important to restore your hip’s flexibility and work your muscles back into shape.

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