Knee pain or ways to treat knee Arthritis
The cartilage of the knee is complex. It is made of elastic compressive structure with normal articular cartilage. Commonly called hyaline cartilage. It provides a smooth delighting surface to help in the motion of the joint. There is about 2cc Synovial fluid inside the knee that helps in the motion and lubrication of the joint. Between the hyaline cartilage which is called the articular cartilage, there are the meniscus, the lateral meniscus and the medial meniscus. The meniscus is a shock absorbing cartilage. It’s a cushion between the articular cartilage.
The hyaline cartilage has four layers, the superficial, the middle, the deep and the calcified. After the calcified layer you’ll find the bone. These cartilage cells live forever. Good cartridge cells are sterile. They cannot make more cartilage if these cartilage cells are destroyed. If the cartilage is subjected to excessive wear, excessive trauma, injury overuse, excessive weight or improper alignment, the cartilage will wear away leaving bone to rub against bone. The cartilage does not have the ability to heal itself by hyaline cartilage. However, small affected area can sometimes heal itself by inferior type of cartridge called fibrocartilage.
So what is the treatment of arthritis of the knee? There a number of treatment options that will help the patient.
The doctor will choose is a medication. People respond differently to medication. The doctor usually selected a type and the dosage and duration of the treatment. The medication got to be safe and effective. Ask the doctor a question about the side effect of this medication. There are several medications, one of them is nonsteroidal anti-inflammatory drugs. The selection of this medication will be based on the physician preference and the patient susceptibility. The duration will be based on the effectiveness and the side effect of the medication and the medical history of the patient. This medication can have side effects. The physician will ask the patient if the patient have the gastritis or stomach problem.
If you had renal failure or renal issues. Sometimes this medication also interferes with fracture healing. Cox-2 inhibitors such as Celebrex and Mobit can cause less GI side-effects but it can cause other side effects. Another medication that’s recommended is tramadol Ultram. It is used for symptomatic osteoarthritis. Another medication is Acetaminophen Tylenol. Some people prefer tramadol and Tylenol, they think is more effective than tramadol alone. This medication treatment is a core treatment is very important and recommended.
You got to have weight loss. The normal BMI is between eighteen point five to twenty-four point nine. The overweight is between twenty-five to twenty-nine point nine. The Obese is 30 BMI or more. Diet control and exercises is important. You need to lose about five percent of the body weight especially if your BMI is above twenty-five. So we’re going to give the patient nutritional consult. How about the metabolic syndrome? How we deal with that? This patient will have syndrome which is abdominal obesity, and you will have high blood pressure, and you will have elevated fasting glucose level and Dyslipidemia. This patient has the metabolic syndrome and there are complex patients. The automatic surgeon will need support for multiple medical consultant.
Low-impact physiotherapy is a low-impact activity like swimming or cycling is usually better and it would add less stress underneath. While jogging and running and tennis is a high impact activity which will put more stress on your knees. You will need to decrease activity that aggravate the condition. Lifestyle modification is needed to protect the knee with the slowing the progress of having arthritis. There is a strong evidence that physiotherapy helps the patient.
The physiotherapy will decrease the pain will improve the function, increase the strength, the range of motion and flexibility of the knee. The physiotherapy should be catered with a program that meets the patient needs. It is important to suits their lifestyle and the expectation. The patient will do aerobic exercises, education wellness home program. The patient should continue to do the therapy even if they feel better because the benefit can be lost if the patient stopped the exercises.
There are a number of treatment that can help the patient. The initial treat of patient is normally no-surgical. The physician will also use intra-articular injection of steroids, Viscosupplementation or hyaluronic acid. It will relieve the patient pain and disability. The Steroid injection can give about 3 to 4 injection per year. The relief is usually temporary.
The Viscosupplementation will improve the quality of the joint fluid. The problem with Hyaluronic acid and Viscosupplementation is that the studies that are published did not meet the minimum clinically important improvement threshold. This is clearly a group of patients which this injection can help them. However, the industry is more interested in competing against each other rather than finding which group of patient that will get benefit from this heroic acid or Viscosupplementation injection. Other methods of injection can be a gene therapy, or PRP, or growth factors or stem cells. It’s logical to pursue the efficacy of stem cells in cartilage regeneration.
Other knee Arthritis Treatment options like, acupuncture massage, glucosamine, chondroitin sulfate, Valgus directing brace, wedges in the foot and arthroscopy lavage , did not show a clinical effective response so the evidence is inconclusive.
Assistant devices such as a cane, shock absorbing shoes, shoe inserts knee sleeves or support brace can help.
Arthroscopy should not be done in artritis unless there is a loose body or meniscal tear causing mechanical symptoms of recurring locking, catching, swelling and pain. There are some guidelines which are very good from the American academy of orthopaedic surgeon. Decision on treatments can reference on these guidelines. However patient’s treatment of arthritis should be deal separately. Treatments will be based on, Doctor clinical judgment, the patient clinical situation and benefit, published tested evidence. It’s really a combination of all of these factors in order to prescribe a proper treatment.
Knee replacement will be done when patient experience severe arthritis is severe the most predictable option for treatment is to do a knee replacement. You got to reduce the pain and improve the function of the knee. The modulus of elasticity of the cartilage is reduced because of the Collagen is disorganized and the proteoglycan concentration and synthesis is decreased. The doctor will remove all the damaged cartilage and bone and insert a new knee. There are some potential risks and complications with every surgery. There is no cure for arthritis. Injection of Hyaluronic acid may help but only temporary.