Treatment of Knee Pain

Osteoarthritis and knee pain

Do you have knee pain? Is it possible that you have knee pain due to arthritis? How can you tell if you have osteoarthritis:

If you have knee pain and you are above age 40, reading the following information can assist you in determining next steps.

What is osteoarthritis: Osteoarthritis is the most common form of arthritis. It describes a process where the cartilage in the joints is wearing away causing the bones to be closer, otherwise known as narrowing of the joint spaces.  The joint spaces are maintained not only by the cartilage, which is softer than bone, but also by the synovial fluid in the joint.  The synovial fluid is a thick fluid which is present to help with smooth movement of the joint as well as to serve as a shock absorber for the joint. As we age, we have less lubrication in the joint, again causing a narrowing of the joint space.

Although the knee is not the only joint affected by arthritis, it is one that affects mobility and general function. 

How does it present itself?

The main complaint of persons with osteoarthritis is pain with walking, stair climbing and after prolonged sitting.  Many individuals also report hearing a clicking sound and at advance stages, there is a report of decreased ability to bend or straighten out the knees.  If you are an athlete involved in jumping sports such as basketball, you may develop osteoarthritis of the knee as early as mid to late twenties.

How is it diagnosed?

Osteoarthritis is diagnosed primarily by a doctor based on the history given by the patient. The doctor also examines patients in order to look for signs of osteoarthritis such as crepitation (a grinding sound or feel when moving he knee joint).  Another sign may be swelling and a feel of effusion (increased inflammatory fluid collection) in the knee.

Radiology studies such as x-rays can determine the presence of joint line narrowing, as well as osteophytes, (abnormal bony overgrowth due to the reaction of the wearing away of cartilage and decrease in synovial fluid.

Evaluation of the feet which are the foundation of the body can help to determine a cause of knee pain.  Specifically flat feet and hyperpronation of the foot (turning in of the foot /ankle joint) can cause increased stress and therefore pain in the knees.  Pain due to malalignment of the foot and ankle is often confused with osteoarthritis.
The use of custom molded orthotics or pronation-control athletic shoes often off load the pressure on the knee and may allow for pain relief in these cases.

Common treatments of osteoarthritis.

Many patients are treated with Non steroidal Anti-inflammatory medications (prescription strength Naproxen sodium or Ibuprofen, Celocoxib, Meloxicam, Diclofenac)  as well as other similar medications. Most of these are in pill form, however the FDA recently approved topical anti-inflammatory Diclofenac, which can be rubbed directly onto the knee.  For persons who suffer from gastrointestinal ulcers, analgesic (pain killing) medications such as Acetaminophen and the topical analgesic ointment, Capsacin are recommended.

Physical therapy is key in treating the symptoms of osteoarthritis of the knee.  Patients are treated with modalities such as ice, heat electric stimulation, and Range of Motion exercises.  In addition, specific exercises such as quadriceps strengthening exercises, wall sits and judicious use of the stationary bicycle are an integral part of the physical therapy program. Acupuncture and Massage therapy have been found to be helpful in decreasing the symptoms of knee osteoarthritis.  Swimming as well as aqua- therapy has a positive effect on the range of motion of the knee it also can decrease pain.

Further treatment:

Should the above treatments fail to alleviate the pain, the patients can be treated with Steroid injections or the more natural Hyaluronate injection.  Hyaluronate is a base product of cartilage which increases lubrication of the join as well as decreases pain thus potentionally avoiding surgical intervention.  These injections are given once a week for 3-5 weeks regimen with the impact lasting between 6-12 months. The process can be repeated between six months to one year.

Surgical options:

Often times arthroscopic surgery is recommended if the arthritis affects primarily the space between the knee cap (patella) and the thigh bone, which is known as patello-femoral syndrome. Arthroscopic is usually a same day surgery with a 4-6 week recuperative phase.

If the space between the Leg bone (Tibia) and the thigh bone Femur) is significantly narrowed, a total knee replacement is recommended. This includes placement of artificial materials to replace cartilage, causing increased mobility of the joint and decreased pain. Post surgical physical therapy is highly recommended to ensure a successful functional outcome of the surgery. The patient is hospitalized for 3-7 days post surgery and receives sub-acute rehabilitation if a skilled nursing facility or in home therapy.

For more information, feel free to contact Dr. Carol V.R. De Costa at www.remass.org Or Call (718) 852-6949.