Knee Arthritis and the Treatment of Pain

Osteoarthritis, or degenerative joint disease, is the most common form of arthritis and results in the loss of the articular joint cartilage (the cartilage coating the ends of bones). The loss of articular joint cartilage or cartilage cells is most commonly due to ones genetic make up. Old trauma or injury is another cause of degenerative joint disease and along with genetics contributes to early development of disabling arthritis. For a movie description click on movie.

knee_partial_arthritis.jpgknee_total_arthritis.jpgknee_healthy.jpgArticular cartilage cushions the joint during activities and provides smooth, pain free motion of the joint. The loss of the cartilage (via the death of cartilage cells) leaves areas of the bone uncovered leading to bone on bone contact. This contact and pressure changes results in inflammation, which leads to pain, swelling, and stiffness. We are currently working on ways to prevent cartilage cell death and ways to restore articular cartilage through stem cell and genetic research. Unfortunately, we are many decades away from effective treatments and hip replacement or resurfacing remains the treatment of choice for end stage arthritis. Note the severe arthritis or the loss of the “cartilage cushion” on the end of the bone in the xray. When you stand and take an xray the bones touch - this loss of the cartilabe that coats the bone is arthritis.

Other causes of articular cartilage destruction or joint disease include avascular necrosis (loss of the blood supply of the underlying bone), post traumatic degenerative joint disease, and inflammatory conditions (including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis).

partialkneexray1-1.jpgThe initial treatment of arthritis is though medications designed to decrease pain and inflammation. These medications include acetaminophen (tylenol), aspirin, ibuprophen (motrin), Naproxen (Naprosyn), Diclofenac (Voltaren), and cox 2 inhibitors (Celebrex). Other early treatments include injections such as corticosteroids and viscosupplamentation injections such as synvisc. Once these treatments are exhausted and the patient has significant activity limiting pain, surgical treatments can be considered.

Several surgical options exist in the treatment of arthritis of the knee. These include total knee replacement, knee resurfacing, bicompartmental knee replacement, and partial knee replacement. A lengthy conversation with your surgeon after a thorough examination and history is important to understand which procedure is appropriate for you.