Therapy and treatment

Dr. Hartmut Stinus talks about osteoarthritis of the knee

Pain, pain go away

Conservative treatment options are often chosen as a first step in treating knee osteoarthritis. The goal is to relieve pain, improve mobility, and delay the progression of the condition. Several conservative treatment options exist:

  • A balanced diet
  • Low-impact exercises
  • Orthotic devices (braces and supports)
  • Pain medication

Healthy knees start with a healthy diet and exercise program. To help prevent osteoarthritis and aid in the treatment of osteoarthritis, adopt new healthy habits – do it for the sake of your knees!

Take a load off

Take a load off

Orthotic devices for osteoarthritis of the knee normally refer to braces and supports. These are applied externally, usually to the knee.

Indirect approach

The Agilium Freestep uses an ankle-foot device to shift the weight bearing line to a healthy area of cartilage for pain relief.

The role of an Orthotist

Proper fitting of orthotic devices by an Orthotist can help ensure you get the most out of your osteoarthritis orthotic device and achieve maximum pain relief. An Orthotist is a medical professional uniquely trained in the fitting of orthotic devices to treat knee osteoarthritis like the Agilium Freestep. Orthotists work with your physician to ensure you achieve the best possible fit and outcome.

A hard pill to swallow

A hard pill to swallow

Osteoarthritis patients can consume as many as 2,000 pain relieving pills per year costing between $500 and $5,000. Both over-the-counter and prescription pain relievers are available for the treatment of osteoarthritis. But these non-invasive options can include side effects.

Over-the-counter pain killers

Several over-the-counter pain relievers exist including analgesics like Tylenol which contain acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil, Aleeve, Anacin, Aspirin, Bayer, and Motrin. Common side effects of NSAIDs include stomach irritation, gastrointestinal bleeding, heart attack, and stroke.

Prescription drugs

There are several prescription NSAIDs available as well including Clinoril, Disalcid, Feldene, Indocin, Lodine, Mobic, and Relafen. The Food and Drug Administration (FDA) requires warning labels on these prescription drugs to include risks like gastrointestinal bleeding, heart attack, and stroke. Cox-2 Inhibitors were developed as an alternative to traditional NSAIDs; however, the FDA still requires warning labels on these products to include risk of cardiovascular side effects and gastrointestinal bleeding. The only Cox-2 Inhibitor on the market for the treatment of osteoarthritis is Celebrex.

Last resort – invasive options

For some, invasive options including injections and surgical intervention are needed. Surgical intervention should not be taken lightly and you should discuss the risks and benefits with your doctor. Invasive options include joint preservation and joint replacement.


Joint Preservation

Hyaluronic acid treatment

Hyaluronic acid is a gel-like fluid injected into the knee joint to improve the consistency of the synovial fluid that naturally lubricates the knee joint and thereby relieving the cartilage.

Joint cleaning (lavage)

In a lavage or joint cleaning procedure, a saline solution is injected into the knee using a hollow needle. It breaks up agglutination and flushes abraded cartilage out of the joint.

Shaving

Shaving means removing frayed cartilage and smoothing the cartilage margin. A lavage usually follows any shaving procedure.

Corrective osteotomy

A corrective osteotomy corrects faulty alignment of the bones and the resulting stress in the knee joint. It involves separating misaligned bones and relocating them to the correct position.


Joint Replacement

As a final step, joint replacement surgery may be recommended.

Partial knee replacement

Patients whose osteoarthritis is limited to a single compartment may be candidates for a partial knee replacement where only a portion of the knee is replaced with an artificial joint. The incision is smaller and the recovery time is shorter. Approximately 12% of knee joint replacement candidates receive a partial knee replacement. Your physician will determine if you are a candidate for a partial knee replacement.

The recovery time varies from patient to patient but typically lasts between 1-3 days after the procedure. Patients also follow a pain management regiment while you heal, at-home wound care, and physical therapy. Most people recover in about 6 weeks.

Complications include:

  • Infection at the surgical site
  • Life threatening blood clots in the lower leg
  • Continued pain and the need for additional surgery

Total knee replacement

Patients whose osteoarthritis has progressed beyond conservative treatment options may be candidates for a total knee replacement. In this procedure, an artificial joint replaces the natural knee joint. An Orthopedic Surgeon will remove the cartilage along with some of the thigh and lower leg bones. Then, the physician will fit and cement a metal components to the thigh bone and lower leg bone and insert a spacer to act as the artificial cartilage.

The recovery time varies from patient to patient. The surgical procedure is followed by a hospital stay lasting several days and including a pain management regiment while you heal. This is followed by at-home care and physical therapy. Most people can drive again 4-6 weeks after surgery.

Complications include:

  • Infection at the surgical site
  • Life threatening blood clots in the lower leg
  • Implant problems including loosening and limited range of motion