The treatment of knee arthritis, as in any arthritic condition, revolves around keeping the symptoms "livable." The early stages of arthritis may include mild discomfort or aching pain on an intermittent basis. As time passes, however, the symptoms may become more problematic and more difficult to manage. The early stages of treatment involve non-steroidal anti-inflammatory medications such as ibuprofen or naproxen. Acetaminophen may also be helpful, especially in the sustained-release forms, as well as some over-the-counter nutritional supplements.
As symptoms worsen, these methods may become ineffective. At this stage, injectable medications may prove useful. The first type of injection that is often used includes various steroid/cortisone preparations. These often do help but can be temporary in providing relief. These injections do not cure the arthritis, but are designed to hopefully get 6-12 months of symptomatic relief. If the injections do work, they can be repeated without any detrimental effects to joint cartilage.
When all of these efforts fail, the next option tends to be surgery. Arthroscopy is a simple outpatient procedure that can be useful for mild arthritis. It is particularly useful if there is evidence of either loose cartilage in the knee joint or a torn meniscus cartilage. This also does not cure arthritis but can relieve some more mechanical symptoms that result in pain and swelling of the knee. Whether or not this is a reasonable approach is on an individual case-by-case basis and should be discussed with the orthopedic surgeon.
The ultimate treatment for arthritis in the knee is joint replacement surgery. As I tell my patients, this is the next step when all other less invasive measures have failed and the symptoms of pain and/or decreased function are severe enough to affect their quality of life. At that point, the patient needs to decide whether the benefits of replacement outweigh the risks of surgery. Depending upon the extent of the arthritis, the individual may be a candidate for a partial knee replacement. This is a less invasive procedure with a decreased hospital stay and generally shorter rehabilitation. Unfortunately, not all patients are candidates for partial joint replacement. There are various disease processes as well as individual patient conditions that may not make this an option. If a partial replacement is not available, total joint replacement may be the ultimate answer. This is an excellent surgery when all three compartments of the knee joint are involved and the symptoms significantly affect quality of life.
In general, the treatment of osteoarthritis of the knee is a team approach between the patient, the patient's family, the family practitioner and the orthopedic surgeon. Usually, less invasive measures are used first and more aggressive measures are reserved as the disease process advances.
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