The term arthritis has been widely used in today’s society to explain knee pain, and most people do not have a clear understanding of what is actually occurring in the joint. There are multiple types of arthritis, with the common element of each being degeneration of the articulating surfaces. These surfaces are covered in hyaline cartilage – a specialised tissue that creates a smooth surface to allow movement whilst at the same time having properties to allow for shock absorption. The capacity for this layer to heal is quite limited, with any damage creating roughness or fraying of the surfaces. Once this occurs, further joint movement slowly erodes the damaged area further until pain or stiffness prevent further movement. Everyone will develop some wearing of the cartilage in their joints as they age, but not many become symptomatic with it to the point of requiring orthopaedics intervention. Arthritis is when the worn joints begin to cause pain and/or functional impairment.
Inflammatory arthritis has multiple causes, with the final common pathway being destruction of the joint surface by inflammatory tissue. The most common causes are rheumatoid arthritis, psoriatic arthritis, and infection.
Osteoarthritis can be though of most simply as simple wear and tear. The tyre analogy is a good one – you are born with tyres with a nice thick tread on them, but with use and damage, this tread will thin. Your joints are no different – a thick healthy layer of hyaline cartilage covers the joint surfaces of children, but this slowly degenerates and frays as we age and accrue injuries. Not all people will be bothered by it, and most can learn to live around the pain or stiffness and maintain an adequate quality of life. For those where the symptoms are severe, such as pain that wakes you at night, inability to perform daily chores, and inability to work or perform desired recreational hobbies, non-operative and operative treatment options are available.
The more weight you carry, the more work your joints need to do. Thus weight lifting at a gym or work, or carrying extra body weight, will put an increased load on your joint surfaces and lead to accelerated arthritis. Weight loss is always a part of a balanced treatment plan for symptomatic arthritis.
Simple analgesic medications such as paracetamol and non-steroidal anti-inflammatories (NSAIDs) can help you deal with the symptoms, and potentially delay the need for more invasive interventions. Commonly available NSAIDs include neurofen, voltaren and mobic. Such medications should only be taken regularly following consultation with your regular GP. Opiate based medications such as panadeine forte, endone and morphine should only ever be short term solutions to increased pain.
Physical therapy is vital. Though moving causes pain, failing to move causes stiffness and pain, and severely reduces the effectiveness of surgical interventions. A physiotherapist can assist you by showing you an exercise program to maintain joint mobility and muscle strength.
Supplements are worth a try, but not always as good as adds can make out. More well known supplements such as glucosamine, chondroitin and fish oil have literature supporting their use, but results are not guaranteed. Dr Host suggests trialling such medications for a few months, then ceasing to assess whether a positive effect is being achieved. Other alternative therapies can be trialled, but one should always have a healthy skepticism, and seek further information from your GP or Dr Host if you are concerned.
Injections of the knee are frequently reported in the media, and do have some clinical applications. Cortisone or similar steroid injections of the joint can help by decreasing inflammation, but as most arthritis is due to general wear and tear, the result is not predictable. Such steroid injections can only be performed a few times each year, and cannot be performed if surgery is being considered in the short term. Other injections are designed to act as lubricants for the joint, the most commonly available being Synvisc. It contains hyaluronic acid, a compound found in normal joint fluid, and can yield improved function with decreased pain in some individuals for up to a year. The results are not reliable however, and at around $600 each injection, the treatment is generally reserved for younger patients trying to delay joint replacement surgery.
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Various walking aides and braces exist that can help with joint pain. These range in quality and effectiveness, and it is recommended you seek the assistance of a physiotherapist when choosing the device that is right for you.
Surgical procedures for joints fall into two main categories – joint preserving or joint sacrificing. Dr Host offers all of these procedures, and will tailor the treatment to suit your individual needs.
Joint preserving surgeries include knee arthroscopy, ligament reconstructive surgery, and bony realignment procedures such as a high tibial osteotomy (HTO).
Joint sacrificing surgeries are unicondylar knee arthroplasty (UKR or a ‘half’ knee replacement) or a total knee replacement (TKR or full knee replacement).