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Posts Tagged ‘knee osteoarthritis’

Stage 4 – Severe

The pain is severe.  Walking anywhere hurts.  This is the most advanced stage of knee osteoarthritis.  There’s not much cartilage left, if any.  There’s very little fluid remaining in the knee.  The joint space has narrowed to the point where an x-ray will show bone-on-bone.  The legs may be bowed or pigeon-toed depending on what side of the knee is most impacted.  The remaining treatment options all involve surgery.   Joint replacement is common.

 



Stage 3 Knee Osteoarthritis – Moderate

Daily activities are starting to hurt.  The arthritis has your attention.  Walking, bending down, running, kneeling can all cause your knee to hurt.

The knee will probably be inflamed and swollen.  Damage to the cartilage is obvious.  The joint space is narrowing.   The cartilage is thinning and eroding.  The bones begin expanding, becoming thicker, responding to the changes in cartilage.  Lumps on the bone form.  All this drama impacts the tissue lining the joint.  This is where the fluid and inflammation come from.

Treatments get a bit more serious.  We move into NSAID’s, cortisone, physical therapy, and supplement injections.



Stages of Knee OA

It takes many years to develop osteoarthritis of the knee – one step at a time.  The degradation of the cartilage can be tough to treat because the damage is usually done by the time it’s diagnosed.  Symptoms might only be experienced once the damage is irreversible.

There are progressive stages of knee osteoarthritis:

Stage 0 – A normal, healthy knee

The knee joint shows no sign of OA, and can move freely and without pain.

Stage 1 – Minor

Bone spurs may start to appear.  The cartilage may show some sign of wear.  There is no sign of joint space narrowing.  Pain or discomfort is rarely felt at this stage.

Your doctor may recommend exercise and weight loss, possibly some supplements.

 



Seated Leg Extension

To rest the arthritic knee or not to rest, that is the question.  Knee pain can be tricky to diagnose.  The knee joint slides, glides, and rotates.  There are ligaments, tendons, bones, cartilage….there’s a lot that can go wrong.  But for people with chronic knee osteoarthritis, they can usually tell if the knee pain is their “old friend” visiting or some new injury causing them to limp, shuffle, and creak as they walk.

If the knee pain is due to osteoarthritis, then don’t rest too much.  A healthy knee joint requires movement.  Bending the knee keeps the joint lubricated, and the surrounding musculature stretched and strong.  Resting is important for an acute injury, but for knee OA a low-impact exercise routine is important.

Inactivity can make knee pain worse because muscles become weak.  People with Knee OA need an exercise program that is safe for their knees.  And the exercise program needs to be consistent – a routine.  Your body needs to be used to moving.

Swimming, biking, and walking are great low-impact exercises that will get you sweating without beating on your knees.  Strengthen the muscles around your knee, keep them flexible, and your knee pain won’t be so bad.



OA and Plasma Therapy

February 26, 2013

Platelets used in plasma therapy speed up healing, and my be helpful in treating osteoarthritis.

Platelet-rich plasma (PRP) therapy has been used by high-profile athletes for high-profile treatments.  PRP therapy works by taking a blood sample, isolating the platelets in the blood, and then injecting them back into the patient.  Platelets are an important part of the natural healing process, producing growth factors and forming blood clots to help close open wounds.  PRP therapy can reduce knee pain and improve function for patients with athletic or osteoarthritic injuries.

Recent research at New York’s Hospital for Special Surgery supports the use of PRP therapy for patients with osteoarthritis.  In a study published in the Clinical Journal of Sports Medicine, Dr. Brian Halpern evaluated the effectiveness of PRP therapy by objectively measuring the quality of patient’s cartilage with PRP treatment.  They found that after a single injection, there was no further damage to cartilage for the subsequent year.  Over that same time period, patients reported that their pain dropped to half of pre-treatment levels.

PRP therapy is a relatively new treatment, and may not be appropriate for everyone, but it might be right for you.  If you suffer from knee osteoarthritis, and struggle with knee pain, ask your doctor about PRP treatment.  A single treatment might make the next year a whole lot easier.



OA and Housework

January 31, 2013

Some housework involves heavy lifting, and can cause osteoarthritis over time.

There is a well known connection between osteoarthritis and heavy physical exercise. While intense exercise does negatively effect joints and often causes knee pain, this does not mean that all exercise increases risk of osteoarthritis.  In fact, new evidence suggests that routine stresses lead to osteoarthritis more often than exercise does.  Many studies do connect exercise to osteoarthritis, but this connection is most visible in professional superstars, and is far less common for recreational athletes.

A recent study at the Women’s Hospital of Boston examined the stresses that housework can put on the knee.  They found that housework often involved squatting, kneeling, and stair climbing, and that these activities increased risk of osteoarthritis.  This same study shows that recreational sports and fitness are more helpful than they are harmful.  Most of the stress applied to the knees comes from carrying body-weight, and so weight loss can be helpful in reducing knee pain and slowing the progression of osteoarthritis.

So be aware of the damage that housework and manual labor can do.  Most knee osteoarthritis develops slowly over time and is made worse by obesity.  If you suffer from osteoarthritis of the knee, do not avoid exercise to avoid knee pain.  In the long run, weight loss will help you more than rest will.



Prosthetics like the preservation implant protect more healthy bone.  Not all procedures are equally invasive, and surgeries like the MAKOplasty may improve function and accelerate recovery.

The most severe cases of knee osteoarthritis are treated with a total knee replacement.  This highly invasive surgery involves removing large portions of bone in order to attach metallic prosthetic substitutes.  The surgery is highly traumatic and requires a lengthy recovery.  This makes a total knee replacement a difficult option for older or infirm patients because slow healing may make full recovery difficult or impossible.  Total knee replacements are also problematic for very young and very healthy people because the implants typically last only 5-10 years.  When the original prosthetic implant is replaced, even more bone must be removed to anchor the new, larger implant.  This means that a 50 year old man with severe knee osteoarthritis who has a total knee replacement can expect more highly traumatic surgeries every 5-10 years for the rest of his life.   As he ages and his healing slows down, the recoveries for each surgery will be longer as well.

Fortunately, a total knee replacement is not the only surgical option, even for the most severe patients.  Osteoarthritis affecting only one side of the knee has been effectively treated with partial knee replacements for many years.  Robotic technology has vast surgical applications, and has recently been employed in a new procedure called a MAKOplasty.  The MAKOplasty uses robotic arms to trim away only the damaged bone, and to create and implant a unique prosthetic that complements the healthy tissue.  This means that healthy, well vascularized bone is not removed, and so there is much less trauma and a faster recovery.

This procedure may not be appropriate for everyone but the MAKOplasty and other partial replacements could be a more conservative surgical treatment.  If your doctor recommends joint replacement surgery, ask about your options.  You may not need a total joint replacement to get the best results.



OA and Dysfunction

January 18, 2013

Inactivity can make knee osteoarthritis and pain much worse.

The word “dysfunction” refers to abnormal or impaired function, usually of a physiological system or social group.  With regard to osteoarthritis, generic dysfunction of an individual describes a present state below that individual’s potential; living a life of suffering and hardship when a better life is within your grasp.  Anatomical dysfunction such as severe knee deformities and knee pain can be a tremendous obstacle, but it is not insurmountable.  In the moment that your osteoarthritis prevents you from engaging in an activity, you face a broader and more damaging form of dysfunction.

A recent study at Northwestern university examined over one thousand patients with knee osteoarthritis.  Patients with severe knee dysfunction were roughly half as active as those without anatomical deficits.  While this may not seem extreme for individuals with severe deformities, what is frightening is that overweight individuals had the same levels of inactivity.  Obese patients showed even greater inactivity, at about a quarter of the activity level of lighter individuals still suffering from knee osteoarthritis.  Unfortunately, inactivity makes weight issues worse, and can propagate a cycle of inactivity and obesity that gets worse and worse.

But there is a silver lining:

Adjusting your activity level dramatically improves function.  An inactive (“dysfunctional”) individual can regain function and health by increasing their activity level.  If you are categorized as overweight or obese, you need not remain there.  Your ability to overcome obesity is limited only by your control over diet and exercise, because your knee pain and anatomical dysfunction will decrease with your weight.

So add some fiber to your diet.  Add a walk to your daily schedule.  And remember that slow, incremental change will keep you on the path to your goals.



Many. drugs are often employed to treat OA symptoms, but few address the disease directly

Knee osteoarthritis is commonly treated by medications, diets, exercise, braces, and surgery (among other things).  Most medications for osteoarthritis reduce pain and inflammation.  This can indirectly slow the progression of the disease by reducing the fluid in the joint-space (and thereby reducing the pressure on the cartilage).  A new drug, strontium ranelate, delays progression of osteoarthritis by as much as 40%, without employing anti-inflammatories.  This is important because it could potentially be taken in combination with more conventional medications for even more effective treatment.

A recent study presented at the American College of Rheumatology examined the progression of osteoarthritis in more than 1300 seniors over 3 years.  They found that those taking strontium ranelate were 30-40% less likely to require surgery for their osteoarthritis than people taking a placebo.

Strontium ranelate has been approved in Europe, but has not yet been accepted by the FDA.  If the results of this recent study are validated by other papers, US approval should be on the horizon.  So keep your ears open, and when strontium ranelate hits American markets ask your doctor if it could help you.



Artificial cartilage is often grown on lattices that weave collagen into a supportive tissue.

The 2012 Nobel Prize in Physiology or Medicine was awarded to researchers who developed induced pluripotent stem-cells (IPS-cells).  IPS-cells do not carry the ethical stigma of embryonic stem cells, since they can be created by coaxing mature skin cells (from consenting adults) into their developmentally flexible states.  Most importantly, they offer the opportunity to externally grow healthy living tissue as needed.  So far, IPS-cells can be grown into relatively simplistic cells (like cartilage and bone), and not into more complex tissues like livers or kidneys.

Researchers at Duke University have recently developed a new technique to grow IPS-cells into cartilage.  This technique could permit a limitless production of cartilage for researching drug treatment.  Short term (within the next 3-5 years), cartilage from IPS-cells might be sophisticated enough for implantation.  This could delay a knee replacement by several years, and dramatically improve quality of life.

Understanding the relevance of things like IPS-cells matters because it reminds us of the importance of scientific development.  One of the recipients of this Nobel Prize earned it by turning a frog back into a tadpole.  While this may seem far from the daily knee pain felt by those suffering from knee osteoarthritis, it is his research that will lead us to the artificial cartilage that may cure them.