By Mark Jenkins, D.O.
Osteoarthritis of the knee is a leading cause of disability in the United States. More than 5 million American adults complain of symptoms related to knee arthritis as pain, stiffness, and swelling, leading to millions of visits to doctors’ offices and missed work days. Osteoarthritis of the knee typically is a slowly progressive degenerative process during which the bearing surface of the knee, the articular cartilage, wears down. Avoiding the development of arthritis of the knee, or minimizing its impact, is an important concern for many adults in this country. This is especially true for those older than 65, as they make up the majority of patients with knee osteoarthritis.
Unfortunately, eliminating the risk of developing osteoarthritis of the knee is impossible. There is no single “cause” or risk factor for the development of this condition, and some of these risk factors simply cannot be avoided. For example, increasing age increases one’s risk for the development of arthritis in the knee, as the healing capacity of the joint bearing surface diminishes. Gender also plays a role, as older women have a higher incidence of osteoarthritis of the knee than older men. Although these factors are worth mentioning, they are of secondary importance since they cannot be changed. One factor that increases the risk of osteoarthritis of the knee that can be controlled is body weight. Increased body weight increases the stress on the cartilage of the knee, and obesity has been demonstrated in numerous studies to significantly increase the risk of knee osteoarthritis. This problem is often compounded when the overweight patient develops knee pain, swelling and stiffness, as these symptoms make aerobic exercise and weight loss activities such as walking, biking and running dramatically more difficult. Knee arthritis is just one of many medical conditions whose risk can be decreased by maintaining a healthy body weight.
Another well known risk factor for the development of knee osteoarthritis is injury. Damage to the ligaments and cartilage of the knee joint can occur in a variety of ways including sports injuries, car accidents, falls, etc. Although our ability to treat these injuries with or without surgery has improved, we are unable to prevent the development of arthritis in all cases. Wearing protective knee braces during sporting activities probably does not lower your risk of knee injury. Your best insurance is achieving good leg strength and stamina before undertaking high risk activities such as snow skiing, and avoiding play under dangerous conditions such as wet tennis courts. What about less risky, but more repetitive impact activities, such as running? Do they increase your risk of developing arthritis? That answer is not as clear. Years of long distance running may increase the risk of developing osteoarthritis in the knee, but the benefit of lower body weight offsets this risk in the recreational runner.
Treatment options vary based on the radiographic degree of arthritis, age of the patient, and the severity of the symptoms. Anti-inflammatory medications are indicated for pain relief. Cortisone and Hyaluoronic acid injections may also alleviate pain for an unpredictable period of time. Arthroscopic clean up of the worn cartilage may also afford some temporary relief. Total knee replacements are indicated when the above conservative treatments are not controlling the pain enough to allow the patients to function during their usual daily activities.
Dr. Jenkins can be contacted at Chatham Orthopedics, 4425 Paulsen Street, Savannah, GA 31405; 912-355-6615