Most knee problems are caused by osteoarthritis (OA). In fact, OA of the knee is one of the five leading causes of disability among elderly men and women. The risk for disability of the knee is as great as that from cardiovascular disease. I use to work for orthopaedic surgeons and I’m quite familiar with this common disease. Osteoarthritis is actually wear-and-tear arthritis that is marked by the breakdown of cartilage (through connective tissue) between joints. As the articular cartilage is lost, the joint space between the bone narrows. This early symptom can easily be seen on X-rays.
Sudden onset is possible with OA of the knee, although generally, the pain associated with this disease develops gradually. The joint might become stiff and swollen, making it difficult to bend or straighten the knee. Pain and swelling are worse in the morning or after a period of inactivity. Pain can increase after activities such as walking, stair climbing or kneeling. Most patients say they have a feeling of weakness in the knee, resulting in a “locking” or “buckling.” Some people report that changes in the weather also affect the degree of pain from arthritis.
More often than not, OA occurs in knees that have experienced trauma, infection or injury. Further, the female gender above the age of 50 is more likely to develop OA than men. Women have smaller, weaker leg muscles leaving more weight for knees to absorb. In addition, women’s pelvises tend to be wider, causing thigh muscles to pull kneecaps out of line and destabilize knees. As the disease progresses, the cartilage thins, becoming grooved and fragmented. The surrounding bones react by becoming thicker. Over a period of years, the joint slowly changes. In severe cases the thickened bone ends rub against each other and wear away. This results in a deformity of the joint and normal activity becomes difficult and painful.
We already know that women have an increased risk of developing OA of the knee, but there are several other factors that could lead to the disease. These include heredity, weight, age, trauma, repetitive stress injuries, high impact sports and certain metabolic disorders. Some additional risk factors are being investigated, such as the impact of vitamins C and D, poor posture or bone alignment, poor aerobic fitness and muscle weakness.
In the early stages of the disease, osteoarthritis of the knee is treated with nonsurgical measures. These measures include lifestyle modifications, exercise, supportive devices and drug treatment. Other methods include the application of heat or ice, liniments, elastic bandages or water exercises. In more severe cases, intra-articular treatments (corticosteroid injections or injections of hyaluronic acid) might be used in combination with alternative treatments such as acupuncture, magnetic pulse therapy or vitamin regimes. Finally, surgery is a final option, including arthroscopy, osteotomy and arthroplasty (joint replacement). The effectiveness of these different treatments will vary from patient to patient, so the choice of treatment should be a joint decision between the ailing individual and the physician. The purpose of any treatment is to reduce pain, increase function and to lessen symptoms associated with the disease.
Healthy Living, MediZine’s, fall 2009, Joint Efforts. Keeping Your Knees Strong and Supple.