Overview • Osteoarthritis of the Knee • Treatment Options

Lifestyle Changes
The object of any treatment is to reduce the pain, as there is no known way to reduce or halt the destruction of the cartilage. Generally doctors will recommend lifestyle changes to reduce the stress on the joint. Weight reduction is a primary tactic. A change in exercise regimens that substitute running / jumping with swimming / cycling.

Drug treatment
If lifestyle changes are unsuccessful then non steroidal anti inflammatory drugs (NSAIDs) will be prescribed to reduce inflammation and pain. These will range from ASA to the new Cox2 drugs. Traditionally long-term use of NSAIDs is not successful due to the gastric side effects of these drugs and a loss of analgesic properties. The Cox2 inhibitors promise to be gastric-sparing due to their unique mechanism of action. Glucosamine and chondrotin have also been shown to be effective in some cases.

Steroid Injections
The next course of therapy would be a steroid injection into the intra-articular space. Steroids are used to reduce inflammation thereby reducing the pain and increasing immobility. Again long-term steroid use is not advocated because of the systemic side effects associated with their use.

ViscoSupplementation
Viscosupplementation is the addition of hyaluronic acid to the lubricating (synovial) fluid of the knee, that has been damaged due to the disease. Hyaluronic acid (HA) is a natural component of healthy synovial fluid and is responsible for lubricating and cushioning the knee joint. In OA the viscosity of the indigenous HA is diminished. The HA is injected into the intra-articular space 3 times over a two week period. The effect is to reduce friction between the bones and it has also been shown that HA has anti inflammatory and analgesic effects. The injections usually begin to work within 3 weeks and the effect can last as long 6 months or more.


Surgery
Arthroscopy allows the surgeon to look directly at the articular cartilage and assess how advanced the damage is. It also allows them to debride the knee joint by removing debris and loose bone spurs. Badly worn surfaces can be roughened up to promote fibrocartilage that is similar to scar tissue and acts as a cushion between the bone faces.

Proximal Tibial Osteotomy is a surgical procedure designed to shift the weight-bearing angle of the tibia. Usually the medial surfaces take a disproportionate amount of the weight, but in OA this promotes faster degradation of the articular surfaces. This procedure reduces the pain temporarily, 5 – 7 years, but these patients generally will require a total knee replacement.

Total Knee Replacement is the ultimate surgical solution for OA. Both joint surfaces are replaced with an artificial knee. This procedure is done primarily in older patients as the operation lasts for about 12 years after which time it would need to be replaced. The "revision" procedure to replace the artificial joint is complicated and less likely to be as successful as the original procedure.