Jan. 24, 2000 (Atlanta) -- There's a broad range of surgical and nonsurgical options to treat osteoarthritis of the knee, according to a report in a recent issue of the Journal ofthe American Academy of Orthopaedic Surgeons. Doctors say seeking treatment in the early stages of the disease helps prevent joint degeneration.
"Primary osteoarthritis is the most common type of arthritis, though its cause is unknown," says lead author Brian Cole, MD, director of cartilage restoration at Rush-Presbyterian-St. Luke's Medical Center and assistant professor of orthopaedic surgery at Rush Medical College in Chicago. "It's a process of wear and tear that results in damage to joint cartilage. Once it's damaged, cartilage no longer provides a smooth and resilient surface for adjoining bones. And this leads to pain, swelling, and stiffness." Cole tells WebMD that 85% of people older than age 65 have osteoarthritis.
"Diagnosing degenerative arthritis of the knee begins with a physical examination while lying flat, standing, and walking," says Cole. "Imaging studies are also used to compare the knees. And if plain X-rays are negative, bone scans may be needed." After diagnosis, Cole says that treatment of osteoarthritis should begin with lifestyle modification.
"Nonsurgical treatment, that combines lifestyle changes and drug therapy, should usually be tried first," says Cole, "because weight loss, low-impact exercise, and acetaminophen often provide effective pain relief. Many doctors also prescribe nonsteroidal anti-inflammatory drugs [NSAIDs, such as ibuprofen (Advil) or naproxen sodium (Aleve)] as first-line therapy for swollen and painful knees. If NSAIDs fail, corticosteroid injections are also an option." According to Cole, over-the-counter supplements may help stimulate cartilage production.
"Glucosamine and chondroitin sulfate, both contained in animal cartilage, have a heightened effect when taken together," says Cole. "And they seem to increase the amount of normal cartilage without toxicity or side effects." Cole tells WebMD that two new injectables, known as hyaluronate therapy or viscosupplementation, are available to help lubricate arthritic joints.
"As the disease progresses, surgical intervention may become necessary for effective symptom control. Arthroscopic lavage, a noninvasive technique, cleanses the joint of inflammatory debris with pain relief [lasting] from several months to several years," says Cole. "And osteotomy, for young or obese patients, helps reduce joint load with improved comfort and function for up to 10 years." Cole says that arthroplasty, or knee replacement, is an excellent option for older adults with moderate to severe arthritis.
"The majority of patients report excellent results for up to 10 years, but patient selection is critical. Active adults are good candidates, but only if they're willing to limit activity to low-impact exercise like cycling, swimming, golf, and walking," says Cole. "After putting surgery off, arthritis patients often describe knee replacement as a new lease on life."
Doctors tell WebMD that postoperative rehabilitation is improved with preoperative conditioning. "Good physical condition prior to surgery is a critical factor in recovery," says Nicholas DiNubile, MD, clinical assistant professor of orthopaedic surgery at the University of Pennsylvania. "It's often called 'prehabilitation,' and it means weight loss in combination with strength training. Sometimes, patients are so debilitated that physical therapists have to be creative, but just practicing with crutches can improve the outcome."
Severe disability from osteoarthritis is often preventable. "A recent study showed that roughly half of those with arthritis believe nothing can be done," says John Klippel, MD, medical director of the Arthritis Foundation and clinical professor of medicine at Georgetown University. "And yet it's clear that early treatment helps prevent further degeneration. That's why we encourage people with joint pain and swelling to see their doctor. Arthritis is not an inevitable and untreatable aspect of aging."
Klippel tells WebMD that wide consumer use of oral supplements to rebuild cartilage has led the National Institutes of Health (NIH) to evaluate their effectiveness. "As the placebo-controlled NIH trial gets underway, patients using glucosamine and chondroitin sulfate should certainly tell their doctor," says Klippel. "Even though they're available without a prescription, the supplements are biologically active and can interact with prescribed medications or diminish their therapeutic value." The FDA also makes the same recommendation.