How to manage knee osteoarthritis?
Welcome to the One Care Medical Center, my name is Dr. Abdul Salam, I am a full-time orthopedic consultant and I practices at OCMC, which is among the best ortho hospital in coimbatore. In this post, lets quickly discuss osteoarthritis management
The first thing that comes to mind when treating knee osteoarthritis is probably surgery. However, this is the last resort option. Before thinking of the most extreme solutions, know that there are many other ways to manage osteoarthritis that you’ll learn in this article.
Let’s get started.
You can detect osteoarthritis from noticing discomfort or pain in your knees. For example, when you wake up in the morning, you might feel that your knees are too stiff, or even swollen.
When you begin moving them around, you may feel pain or tenderness in the knee area. More than 60 percent of women older than 60 years old are affected by some stage of osteoarthritis, so this is the likely cause of your bad knees.
But what exactly happens in osteoarthritis? The cartilage of your knee begins to deteriorate such that your bones end up closer together than they should be. Severe osteoarthritis may even cause your bones to rub together. When treating osteoarthritis, you should aim to regain mobility and reduce pain, as well as slow down the deterioration of your joints.
In the USA, 1 in 20 women older than 50 have experienced knee replacement. This type of surgery is the extreme treatment for very severe cases of osteoarthritis, wherein the pain is intolerable and the condition causes disability. Within the last decade, the frequency of the surgery has increased by 200 percent.
There are several reasons for this. One is that the surgery is effective and has a high rate of satisfaction; another is that the less extreme treatments for knee osteoarthritis were not maximized and did not give the intended results. These are proper diet, exercise, and losing weight.
Losing weight: Reducing strain on your knee
Whenever you walk, the knee joints take on up to 5 times your full body weight. That is how much force affects your knee regularly. When you are suffering from osteoarthritis, even a difference of 5 pounds will have a significant positive impact on the pain caused.
Research has found obese adults to reduce the pain from their osteoarthritis by around 4 pounds per 1 pound. Being overweight adds extra pain to your osteoarthritis, but it also hastens how fast your knee cartilage deteriorates. Losing that extra weight can do a lot for your knee.
It is not very well known just how much weight and osteoarthritis are related. If you are obese or overweight and have osteoarthritis, it is highly recommended that you lose a minimum of 5 percent of your weight.
The natural weakening of your body due to age can be compounded by genetics, biochemical conditions, and physical conditions that will lead to osteoarthritis. This slow diminishing of cartilage exposes the bone ends to each other. In the case of the knee, your tibia and femur will end up knocking together.
Exercise and Physical Therapy
It may seem counterintuitive to expose your osteoarthritic knee to more physical movement, but exercise is important in maintaining strength and resistance.
Not exercising can lead to faster degradation of your knee joints. So although there is pain, you have to get into the habit of light exercise to prevent your condition from worsening. According to Dr. Jeffrey Katze of Harvard Medical School, exercise as a treatment for osteoarthritis is surprisingly being underused.
Practice exercising with light or moderate intensity regularly. You can estimate this by exerting enough effort that you sweat a little, but not so much that you cannot carry a conversation easily.
This light kind of exercise should not leave you prone to injury and can help with the pain. For building a regimen, you can ask a physical therapist or clinician. Here is an example of a routine for osteoarthritis in the knee:
Low-impact aerobics: An elliptical machine allows you the motion of climbing stairs but remains easy on the joints. Light swimming, cycling, or walking can also work. Start doing this with short periods and eventually extend the amount of time spent on it. One fun way of accomplishing this is by having physical activity during your daily routine, such as walking around the area or using stairs sometimes in place of an elevator.
Wall sit: Simply stand back against the wall. Slowly lower your body by bending your knees into a sitting position. Try to hold this for 20 seconds, and repeat.
Balance: As your knee deteriorates, it can also impair your sense of balance and body space awareness. There are plenty of exercises and therapeutic activities like tai chi that can help you maintain your sense of balance.
Straight-leg raise: This exercise requires you to lie down on your back and slowly raise your leg with your knee straightened. You only need to lift your leg for about 10 seconds at a few inches off the ground. You can repeat this exercise until you feel fatigued in your thighs.
Quadriceps conditioning: Your quadriceps are your thigh muscles, and increasing their strength will take the strain away from your knee. You may also lookup “knee-strengthening” exercises for this one. These can also help for badly-aligned joints and overstretched ligaments.
Flexibility: This will help you increase your mobility and motion range in the knee. Keeping your joints too stiff will cause even more pain.
Osteoarthritis patients may choose to take medication, although these are primarily to alleviate pain instead of curing your osteoarthritis. They can be useful supplements to helping you continue your exercise regimen.
The American Academy of Orthopaedic Surgeons has a recommended routine of medications: Tylenol in up to 4 grams a day; NSAIDs or nonsteroidal anti-inflammatory drugs to relieve the swelling, but this must be accompanied by medicine for strengthening the stomach lining; topical NSAIDs like Voltaren Gel; and cyclooxygenase-2 or COX-2 inhibitors. These will help reduce the side effects of the other anti-inflammatory medications.
There are other non-oral options for pain medication. One is a direct injection of a corticosteroid. This is meant to relieve the inflammation and bring back some mobility in the joint. A single injection has an effect that can last several weeks, but these injections are only recommended for once every four months at most.
Yet another medicine that can be directly injected is a method called viscosupplementation. This will involve direct injection of a joint lubricant, hyaluronic acid. There are different formulas of the medication available.
Although the theory exists, AAOS has yet to establish exactly how effective the viscosupplementation is in alleviating pain.
Supportive devices and aids
If your osteoarthritis is severe and requires mechanical support, luckily there are already options available.
The mildest form of mechanical support is therapeutic knee taping. This uses a special medical tape to realign your knee and reduce the pain. This improved alignment also helps the stress on your knee get redistributed to the surrounding tissues and areas so that more of your leg is properly maximized. Most patients have their physical therapists apply the knee tape first and learn how to eventually do it for the succeeding times.
AAOS recommends using knee tape because of the well-researched positive effects of the treatment.
Although there are mechanical knee braces that are available, AAOS has not yet recommended the use of this device due to the lack of research. Some braces fully support the knee, and others simply redirect the weight away from the knee. There also exist specially-made shoe inserts that alter how your knee takes stress and force, but research is lacking in this area as well.
Canes are a common aid for as long as we can remember, but recent research finally showed significant positive effects of using a cane.
In a study done in February 2012 over two months, cane users were compared to non-cane users in their mobility and pain. According to the study, those who used canes significantly felt reduced pain and were able to walk longer and farther. The study also considered that a month was spent adjusting the cane users to walking with their canes.
Alternative treatments and therapies
Alternative therapies have gained more traction over the last decade despite the lack of concrete research that there are helpful. Although there is not much formal research regarding the effectiveness of these alternative treatments, they may still work for you.
Here are a few things you may want to try out to address your knee osteoarthritis:
Acupuncture: Research has not shown much evidence in pain reduction from acupuncture, but a few people did report feeling some improvements. Overall, however, acupuncture has not shown to be significantly helpful even when coupled with exercise.
Chondroitin and glucosamine: These are supplements that are naturally produced by your body to strengthen your cartilage. However, even as a medication, there is not enough formal study to say that these supplements are completely effective in reducing pain and increasing mobility.
These supplements could take several months to take effect, but patients should also not stay long on them. There may be long term side effects to your other organs. The AAOS does not particularly recommend this supplement for your osteoarthritis, but you can still consult your doctor regarding them.
Intense and late-stage osteoarthritis may require surgery to alleviate. There are a few surgical procedures that are available to you depending on the condition of your osteoarthritis. If only a specific part of your knee joint has sustained damage, an osteotomy is likely to be recommended.
This involves the surgeon removing that part of the joint and aligning the bones to redirect weight onto the strong areas of your joint.
Another option to consider is partial knee replacement. This is self-explanatory, wherein the surgeon will remove the arthritic section of your joint cartilage and replace it with an artificial section made out of plastic metal. This will leave the rest of your knee intact.
The more extreme version of this is a knee replacement. In this procedure, the entire cartilage is removed, along with bits of the connecting bone from the tibia and femur, or the shin and thigh bone respectively.
The artificial replacement will then be inserted, along with an implement that can allow the artificial joint to move easily. This does not mean that you should not exercise and lose weight. Exercising and reducing your body weight will still help your weakened joints in the long run, and can even hasten recovery from knee replacement surgery.
If you are feeling symptoms of osteoarthritis, it is best to contact a medical professional as soon as possible.
Then you will be able to come up with the best regimens and strategies to prevent your condition from worsening. Hopefully, you will also be able to strengthen your joints, bones, and body overall.
If you do not have a primary care provider in contact, you may visit a physical therapist, rheumatologist, or even a surgeon specialized in orthopedics.