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Understanding Osteoarthritis and Chronic Knee Pain
- 2. What is Osteoarthritis? Osteoarthritis is primarily a noninflammatory degenerative disorder of moveable joints characterized by an imbalance between the synthesis and degradation of the articular cartilage, leading to the classic pathologic changes and destruction of cartilage
- 3. Osteoarthritis Incidence • • • • Found in 80-87% of people over age 55 Found in over 95% of people of 65 Found in 40 million adults 20 million have hip or knee arthritis; 10 million treat it • 5 million have severe degenerative joint disorder • 400,000 TKRs and 160,000 total hips per year
- 4. Progression of Disease • First signs of disease (Mild OA) – Cartilage starts to wear down and thin out – May not have any pain or stiffness or be hindered in any activity unless it is prolonged
- 5. Progression of Disease • Moderate OA – Thinning cartilage causes bones to rub on each other, causing pain with weightbearing – Joint space narrows – Pain tends to worsen as day progresses and is present with most activity
- 6. Progression of Disease • Severe OA – Bone on bone contact creates inflammation, pain, swelling and development of osteophytes (bone spurs) – Pain is generally constant
- 7. Common Treatments • NSAIDs (non-steroidal anti-inflammatory drugs) • Physical Therapy • Hyaluronic Acid Injections • Bracing • BioniCare • Total Knee Replacement
- 8. NSAIDs • Non-steroidal antiinflammatory drugs – E.g. Tylenol®, Advil®, Aleve®, Celebrex®, Naprosyn® • Typically prescribed as a first line treatment; often tried by patients prior to physician visit
- 9. NSAIDs • Advantages – Easily to take, readily available • Disadvantages – Gastrointestinal, hepatic (liver) and renal (kidney) complications, especially when taken over long period of time – Does not slow down progression of disease (treats symptoms)
- 10. Physical Therapy • Typically consists of – Strengthening exercises – Non-impact aerobic activity to reduce weight – Balance, gait and posture exercises
- 11. Physical Therapy • Advantages – Focuses specifically on needs of patient – Individual attention by therapist • Disadvantages – Expensive
- 12. Hyaluronic Acid Injections • An injection into the knee that lubricates and cushions your joint • Made from a natural substance similar to healthy joint fluid – Brand names: Synvisc, Orthovisc, Hyalgan, Supartz
- 13. Hyaluronic Acid Injections • Advantages – One injection (or series of injections) can provide relief for several months • Disadvantages – Does not address the mechanical wear and tear during weight-bearing activities – Pain, swelling or infection possible at injection site
- 14. Bracing • A brace is applied to the leg which takes pressure off of the affected compartment (shares the load during weightbearing)
- 15. Bracing • Advantages – Non-invasive – Can reduce additional wear and tear • Disadvantages – Some braces may be cumbersome for patients
- 16. BioniCare • An electrical stimulation device that replicates the signal a healthy knee gives off during weight bearing to reduce pain and other symptoms.
- 17. BioniCare • Advantages – Non-invasive, very low risk – Studies show reduced pain, improved function and the effects of the device can be equal to a total knee replacement (2/3rds of patients deferred a TKA for 4 years after using the device) • Disadvantages – Must be worn for approximately 750 hours to receive significant benefits (about 3 months with daily use of 6 hours per day) – Applied with electrodes in a brace, which may be cumbersome for some
- 18. Total Knee Replacement • Typically recommended when patient has severe pain that prevents normal functioning, and other more conservative methods have failed • The ends of the femur (thigh bone) and the top of the tibia (shin) along with the patella are replaced with metal and plastic components
- 19. Total Knee Replacement • Advantages – Worn down surfaces are replaced – Outcomes (reduced pain, improved function) usually very good • Disadvantages – Invasive, inherent risks with surgery – Requires physical therapy and exercise postsurgical for optimal outcomes (may be several months)
- 20. • Questions?? • Thank you!
Editor's Notes
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