Treatment Options for Knee Arthritis

Last month I attended a lecture titled, “State-of-the-art Treatment Options for Knee Arthritis” given by orthopedic surgeon, M. Mike Malek, MD at the Inova Fairfax Hospital. If you suffer from chronic knee pain or osteoarthritis of the knee, then this lecture provided pertinent information.

Dr. Malek first explained that this did not include rheumatoid arthritis which is a systemic disease. Osteoarthritis is a joint problem and a wear and tear problem. It is a degenerative problem that becomes arthritis. Part of osteoarthritis could be genetic and part of it is acquired. The knee is the least protected joint in the body and the most commonly injured.

As a wear and tear problem, the surfaces of the knee become pitted, eroded, uneven, and painful. This has to go on for 18 to 24 months before showing any changes on an x-ray.

Osteoarthritis symptoms include:

  • Pain
  • Loss of range of movement
    • Going up and down stairs
    • Unable to get off the toilet seat or couch
    • Night pain and stiffness
    • All day and night pain and stiffness

Causes include the following:

  • Excessive wear — weight is a major problem
  • Sport injury
  • Age
  • Obesity
  • Deformity — bow leggedness makes it worse
  • Work-related injury
  • Major trauma
  • Weak quadriceps
  • Lack of vitamin D

There is no laboratory test for osteoarthritis. There are 208 joints in the body and any joint can be affected, but the knee is the most common.

What are your treatment options?

  • Activity modification (One person said he’s a runner and he has knee problems. Dr. Malek said to find something else).
  • Physical therapy
  • Anti-inflammatories (NSAID) (Everything has side effects).
  • Cortisone injections
  • Visco supplementation (Joint fluid therapy — hyaluronic acid — something your knee produces).
    • There are five companies in the US that use rooster combs
    • Euflexxa is the only one that’s synthetic
  • PRP (protein-rich plasma)
    • Your own blood is taken and the Growth Factor is injected back
    • Athletes get on a regular basis
    • Makes healing faster
  • Bracing — customized about $1,200
  • Arthroscopy with or without HTO (High Tibial Osteotomy)
  • Arthroplasty — open surgery

With a knee replacement you will never have the full range of motion. Unicondylar knee replacement is a possibility for bowed legs. Only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement.

The bottom line is your age, activity, use, and abuse of your knee will determine the length of how long your knee will last. However, you have a variety of treatment options for knee arthritis. Remember that nothing will last forever, not even knee replacement surgery. For more information, check out Dr. Malek’s Web site: http://kneesurgeryfairfax.com or http://kneeman.com.

See also a post I wrote last month about arthroscopic knee surgery.

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Arthroscopic Knee Surgery

A couple of weeks ago, I had arthroscopic knee surgery because of a fall more than a dozen years ago. It was partially exploratory to determine the next step as well as to “clean it up.” The next two weeks will determine my options, but total knee replacement is not necessary.

In order to go through this surgery, I had to get a second opinion and while the second doctor determined that surgery is necessary, it was his opinion that a total knee replacement should be considered “just in case” I might need one down the road. On the other hand, my world-renowned knee specialist said you never replace anything that’s in good condition and basically, other than my knee cap, my knee is in very good condition. But the most important lesson in this is to prevent falls in the first place and to prevent arthritis from creeping in.

Fitness expert Sonia Gow, in a previous post, shared her expertise about why people fall. She mentioned that falls are not a normal part of aging.

Did you know that falls are a leading cause of hospital admissions for people over 65? For those over 65, one in three will experience a fall each year. According to the Centers for Disease Control and Prevention, 20 to 30 percent of the falls result in injuries such as lacerations, hip fractures, and head traumas with hospital bills averaging nearly $18,000 per patient.

According to Mary Tinetti, M.D., professor of internal medicine at the Yale School of Medicine, the more chronic health conditions you have, the more likely you are to suffer a fall.

  • Diabetes can worsen vision and desensitize nerves in the feet.
  • Depression can increase risk of falling.
  • Many medications cause dizziness and affect balance, especially sleep aids.

Other diseases causing a higher rate of falls include:

  • Circulatory disease
  • Chronic obstructive pulmonary disease
  • Arthritis

Yoga and tai chi which has slow, rhythmic movements can help you with your balance. Don’t forget to strengthen your arms too since you can use them to steady yourself. Find a personal trainer or borrow/buy a DVD to help you.

Anti-inflammatory Turmeric

turmericMany issues faced by seniors such as heart problems, arthritis, and even Alzheimer’s disease are said to be a result of inflammation. Turmeric comes from the root of the Curcuma longa plant and is a member of the ginger family. It has been used in the Ayurvedic (Indian) and Chinese medicine for ages. After processing and being ground into a powder, turmeric is better known to those of us in the west as curry. Today we are realizing more and more health benefits.

According to www.whfoods.com, (The World’s Healthiest Foods and The George Mateljan Foundation, a not-for-profit foundation with no commercial interests, is a new force for change to help make a healthier you and a healthier world), their food rating system shows the following nutrients in turmeric:

Turmeric, powder
2.00 tsp
4.52 grams
16.04 calories

Nutrient

Amount

DV
(%)

Nutrient
Density

World’s Healthiest
Foods Rating

manganese

0.36 mg

18.0

20.2

excellent

iron

1.88 mg

10.4

11.7

excellent

vitamin B6 (pyridoxine)

0.08 mg

4.0

4.5

good

dietary fiber

0.96 g

3.8

4.3

good

potassium

114.48 mg

3.3

3.7

good

DV = Daily Value

World’s Healthiest
Foods Rating

Rule

excellent

DV>=75%

OR

Density>=7.6

AND

DV>=10%

very good

DV>=50%

OR

Density>=3.4

AND

DV>=5%

good

DV>=25%

OR

Density>=1.5

AND

DV>=2.5%

According to The World’s Healthiest Foods, the volatile oil fraction of turmeric has demonstrated significant anti-inflammatory activity in a variety of experimental models. Even more potent than its volatile oil is the yellow or orange pigment of turmeric, which is called curcumin. Curcumin is thought to be the primary pharmacological agent in turmeric. In numerous studies, curcumin’s anti-inflammatory effects have been shown to be comparable to the potent drugs hydrocortisone and phenylbutazone as well as over-the-counter anti-inflammatory agents such as Motrin. Unlike the drugs, which are associated with significant toxic effects (ulcer formation, decreased white blood cell count, intestinal bleeding), curcumin produces no toxicity.

Ezine articles author Henri K. Junttila also writes about the benefits of turmeric in “Discover the Incredible Health Benefits of Turmeric Spice.” She says, “The best way to take advantage of the benefits of this herb is to take it in the form of multi-vitamin supplements.  Studies reveal that the substance is digested and ingested in the bloodstream better in combination with other beneficial substances. It is important however, to check which of the other complementing substances and ingredients work best with turmeric spice.”

There are nutritional supplements available. The supplements that I have taken contain turmeric as part of another supplement. For example, Immunotec has an Omega-3 product with turmeric. Vitamark International puts it in their Naturflex product and includes ginger root in their vitamin, VitaChe, specifically for heart health. My favorite, VitaOne, Vitamark’s multi-nutrition pack, contains 100 mg of turmeric. Does your favorite multi-vitamin contain turmeric?

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