Knee arthritis is a very common problem. It occurs when there is wear on the articular surface of the knee joint, either on the femur, tibia or patella. It can involve one of these surfaces or a combination of them. Joint surfaces are normally smooth and move freely, lubricated with joint fluid. When there is an injury or too much load occurs across the joint then the articular surface can be injured. This will result in breakdown of the articular cartilage. Arthritis is time related and gradually the smooth cartilage becomes worn and rough. This produces inflammation and pain. As the arthritis progresses the meniscus may become torn. The entire process is progressive and unless something is done will continue to cause the knee to deteriorate. Obesity is a major factor in arthritis. It produces extra load on the knee joint causing wear and tear.
There are several options in treating arthritis of the knee. Most patients start off with an anti-inflammatory medication such as Ibuprofen or Aleve. These work by blocking the production of the cells that cause inflammation. Weight loss for overweight patients is essential. Unfortunately it is usually a Catch 22 and it is difficult to lose weight by exercise when the knee is painful. Physical therapy is used to help increase the knee mobility as well as to build strength. When the muscles surrounding the knee become stronger then there is less stress across the joint. Often a cortisone injection is used to try and get some immediate relief. This works by reducing the pain caused by inflammation. It may last, but it does not change the damage to the articular cartilage. Viscosupplementation is used to treat arthritis of the knee. When someone has arthritis the synovial fluid in the knee becomes thinner thus there is less cushioning provided. Viscosupplementation is a gel-like material that is injected into the joint in a series of three, each a week apart. It is a cumulative effect so by the third injection most patients have much less pain and increased mobility.
PRP or platelet rich plasma is newest treatment for osteoarthritis. It works by taking the patients blood, spinning down the cells and injecting the platelet rich plasma. The PRP contains stem cells which have been found to reduce the pain and inflammation and delay the progress of the arthritis. A recent study done at Hospital for Special Surgery showed a 73% improvement in those patients with arthritis who underwent PRP injections. This procedure can be done in the office and it does not require any anesthesia. The patient can walk out of the office.
In severe or what we call end stage osteoarthritis a total knee replacement may be the only solution. When pain and function limit the activities of daily living and there is bone on bone a knee replacement is usually recommended. The arthritis in the knee joint is removed during surgery and a knee implant is inserted. This is composed of two metal components with a plastic tray that sits on the tibia. The surgeon restores the knee alignment so that any prior bowing is corrected. Patients often remark: "why did I wait so long". It is standard procedure and usually will last the patient's entire life.