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Posts Tagged ‘osteoarthritis of the knee’

Knee pain from high impact activities like running is a common symptom of osteoarthritis.

There are many symptoms which can help your doctor diagnose osteoarthritis.  Osteoarthritis of the knee is typically observed after patients complain of knee pain, joint stiffness, joint swelling, and pain with exercise or high activities.  Early detection is very important because osteoarthritis includes degeneration of cartilage, a joint tissue that heals very slowly.  If osteoarthritis can be diagnosed earlier, it may be possible to improve treatment outcomes and to delay or avoid surgical intervention.

Recent research published in the Biophysical Journal suggests that there may be a new way to diagnose osteoarthritis even earlier.  Since cartilage includes a high fluid content, scientists may be able to detect damage to cartilage by diagnosing the flow of fluids in the joint space.  Researchers were also able to determine that cartilage deficits caused by osteoarthritis were most visible during rapid compression of the joint.  In other words, damage to your knee from osteoarthritis should be most visible in high speed high impact activities.

So if you experience knee pain that is worst when you run, talk to your doctor.  We all hope that the pain will go away on its own, but the longer you wait before consulting a physician, the more damage can occur to your knee.  Every day that you delay treatment may eventually cost you.  Why risk it?



OA and Weight Loss

March 22, 2013

Just as gaining weight can lead to osteoarthritis, losing weight may treat it.

It is well known that obesity is bad for your knees.  No one would be surprised to hear that high body weight speeds up joint degradation, or that it increases knee pain.  While it is well documented that weight loss decreases the stress on the knee, and so reduces knee pain, recent research has shown that weight loss can do much more.

In a paper published in the Journal of the American Academy of Orthopaedic Surgeons, Dr. Koonce found that weight loss could reduce the need for knee replacements in the USA by up to 50%.  This means that weight loss alone could protect you from osteoarthritis so that you don’t need to risk surgical or pharmaceutical treatments, and can avoid months of therapy.

This research suggests that weight loss may be effective as a primary treatment method for addressing osteoarthritis of the knee.  And while a doctor may help you with your diet, you can do it yourself for free.  So why not add dieting and excersize to your routine and watch your pain disappear?



Corticosteroids are often injected into arthritic joint spaces to reduce symptoms

Osteoarthritis of the knee often includes severe inflammation.  This inflammation and osteoarthritis related knee pain can be treated with an injection of corticosteroids.  These injections reduce inflammation and pain, and increase healthy function.  Unfortunately, these injections only alleviate pain for a short time, and subsequent injections are decreasingly effective.  This means that corticosteroid injections may be very useful in treating acute osteoarthritis, but are less helpful for people with chronic knee pain.

Recent developments by Flexion Theraputics inc. may reduce the limitations of steroid injections.  A new product, the FX006, offers sustained release of steroids after a single intra-articular injections.  This lets the FXoo6 reduce knee pain and inflammation for patients with osteoarthritis for much longer after each treatment.  The increased effectiveness of this injection makes it a reasonable treatment option, that should be considered alongside alternative therapies.

So if you suffer from osteoarthritis and are thinking about a knee injection, ask your doctor about the FX006.  Don’t settle for a standard treatment without discussing your options.  A sustained release injection can improve your function without any additional risk.



Some knee injuries may cause osteoarthritis later in life.

Osteoarthritis is far more common in individuals with a history of traumatic joint injury.  This is why athletes often develop osteoarthritis of the knee later in life.  It is important to distinguish between the normal wear of exercise and the accumulation of small injuries.  Healthy work-outs do not increase the risk of osteoarthritis, but those who push their joints beyond their limits may cause long-term injuries.

Recent work by Dr. Cruz of the University of Guelph examines the progression from a single traumatic event to the development of osteoarthritis.  Dr. Cruz specifically wanted to know if damage to cartilage, bone, or both, led to more severe symptoms after the immediate healing had been completed.  This research showed that even after a therapeutic exercise regimen, damage to cartilage and bone did not heal.  This means that severe, single-event injuries may have long-term effects, even after immediate treatment.

This is important because it means that some knee pain may not heal naturally.  Damage to cartilage and bone may kill the blood supply to an area and eliminate its potential for healing.  If you have a severe knee injury, it may not be enough to wait for the swelling and pain to subside.  Consult your physician and check if more serious treatment may be necessary.



OA and synovitis

November 13, 2012

Synovitis causes thickening of the joint capsule, and can worsen OA.

 

Osteoarthritis is often considered to be a degeneration of cartilage purely due to accumulated wear and tear.  This is not entirely accurate.  If wear and tear accelerated the deterioration of cartilage in the knee, then all exercise would be harmful.  In fact, exercise has been shown to be highly beneficial to individuals with osteoarthritis of the knee.

As explained by Dr. Hersh, Ph.D., M.D., osteoarthritis of the knee is more closely linked to synovitis (inflammation of the joint space).  The inflammation holds extra fluid in the joint space, which increases the pressure on the cartilage, and so greatly increases the friction of the joint.  Since friction leads to rapid degradation of the articular cartilage, this synovitis makes osteoarthritis much worse.  Understanding the role of synovitis in the progression of osteoarthritis is important for two reasons:

1:  Synovitis can be helped by exercise, which can drive fluid out of the joint space.

2:  Treating synovitis can effectively treat osteoarthritis.

This means that exercise can treat osteoarthritis in two ways:

1:  By helping you to lose weight, which reduces the pressure felt by the cartilage of your joints.

2:  By reducing your synovitis, which reduces both pressure and friction in the joint space.

So get out there and exercise.  Your discomfort today will save you far more pain tomorrow.



OA and the Quadriceps

September 14, 2012

Quadriceps Musculature

The quadriceps is a muscle group in the front of the thigh.  It is composed of the vastus lateralis, vastus intermedius, vastus medialis, and the rectus femoris muscles.  The vastii connect the thigh bone to the knee-cap and shin bone.  The rectus femoris stretches from the pelvis to the shin.  The primary function of the quadriceps is to straighten the knee, but because of the rectus femoris’s origin on the pelvis, it can also bend the leg at the hip.  The quadriceps are often used with the foot on the ground but can fire when the leg kicks.  When the foot is on the ground the quadriceps will contract to control knee bending and leg straitening.  This means that the quadriceps are important in activities like climbing and descending stairs, and sitting down and getting up from a chair.

Because the quadriceps muscles cross the knee, when they contract, they increase forces on the joint.  This extra pressure can increase friction, which can put stress on cartilage.  This means that using the quadriceps can increase pain for individuals with osteoarthritis of the knee.  Tension in or spastic firing of the quadriceps can put prolonged stress on the inflamed joint.  Individuals with weak quadriceps hyper-extend their knees when they walk.  This promotes stability but is damaging to knee ligaments and the hamstring muscles.  This also dramatically increases the stress on the cartilage and bone in the front of the knee.

Excessive tension in the quadriceps may be treated with slow stretching.  Spasticity and quadriceps weakness have more rigorous treatments, often including bracing.  For quadriceps weakness, bracing is often implemented to support the knee and prevent hyper-extension.  More sophisticated braces provide that support only when the leg is supporting body weight, while other braces may lock the knee full-time.  Quadriceps strengthening exercises are often recommended for individuals with osteoarthritis of the knee in order to avoid the pathological gait associated with quadriceps weakness.

 

 



 

A recent study shows that smokers have a harder time with knee replacement surgery than non-smokers.  That’s not a surprise.  But what is surprising is that the research said there was no difference between current smokers and patients that had quit.

Dr. Michael Mont, director of the Center for Joint Preservation and Replacement said, “It could be that the damage was already done.  When you smoke and stop, you improve your health, but you still have build-up in your system. That may be why we didn’t see a difference.”

The study, which was presented at the annual Academy of Orthopedic Surgeons in San Francisco, examined 600 knee replacements in 60 – 65 year old patients.  About 20% of the patients were smokers.  Problems related to surgery like failing kidneys, blood clots, and abnormal heart rhythms affected 21% of the smokers compared to 12% of the non-smokers.  Smokers were ten times more likely to have a revision surgery to fix things that went wrong than non-smokers.

One of the last treatment options for osteoarthritis of the knee is knee replacement surgery.

 



Who do people with osteoarthritis of the knee get bowlegged?

A person suffering from osteoarthritis of the knee will begin to walk differently over time.  If the arthritis is affecting the inside of a person’s knee that person is likely to start walking on the outside of their feet.  This is a gradual progression, so gradual the person may not recognize they are shifting their body weight when they walk.

This transference of body weight from the middle of their feet towards the outside of their feet causes a knee joint to bow.  Over time and thousands of steps the knee’s anatomy changes  to accommodate the change in gait.

If a person has osteoarthritis of the knee that affects the outside or lateral compartment of the knee, that person is likely to transfer their body weight towards the inside of their feet.  The resulting change in knee anatomy is the opposite of bowlegged.  This person will become pigeon toed.



Lateral Heel Wedge

Lateral Heel Wedge

A study published in International Orthopaedics treated sixty-two patients with medial compartmental osteoarthritis of the knee with lateral heel wedges.  These patients were followed for twelve years.  The study, authored by H. Tohyama, showed that patients treated with lateral heel wedges had a greater improvement in pain and walking ability.  Tohyama concluded that lateral heel wedges are useful for patients with early onset of medial compartment osteoarthritis as long as patients are provided with an understanding of the indications and orthotic limitations.



Quadriceps_Osteoarthritis

Quadriceps

The quadriceps is a large group of muscles located on the front of the thigh.  They are responsible for extending the leg and they’re strongest muscles in the body.

The quadriceps is divided into four sections.  All four parts attach to the knee cap through the patella tendon.

Rectus Femoris – Located in the middle of the thigh, this section of the quadriceps covers most of the other three sections of muscle (listed below).  Along with knee extension, this muscle also helps flex the hip.  It is attached to the ilium, or the top of the hip.

Vastus Lateralis – Located under the rectus femoris, this section of the quadriceps is attached to the femur and lies on the outside (lateral side) of the thigh.

Vastus Medialis – Located under the rectus femoris, this section of the quadriceps is attached to the femur and lies on the inside (medial side) of the thigh.

Vastus Intermedius – Located under the rectus femoris, this section of the quadriceps is attached to the femur and lies between the vastus medialis and vastus lateralis.

Since all four sections of the quadriceps attach themselves to the knee cap, these muscles play an important role in how the knee slides and glides.  Injury of weakness can lead to or affect osteoarthritis of the knee.