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: or

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

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Fitness: Strong Quadriceps

Clip Art Graphic of a Red Guy CharacterOne of the exercises I was taught by my physical therapist was a quadriceps (quads) muscle strengthener. With my feet about 1.5 feet from the wall, I put a small ball (16″) between my knees and I slide down the wall until I am almost in a seated position, making sure that my knees do not go over my toes. I then hold for a few seconds while squeezing the ball between my knees, then slowly slide back up. You don’t necessarily need a ball for this exercise, but it gives my knees greater support.

According to Prevention (11/2008), lower body strength translates into good balance, flexibility, and endurance. As you get older, those are the key attributes to reducing your risk of falls and injuries, particularly hip fractures, which often quickly lead to declining health. They state that up to 20% of hip fracture patients die within one year because of complications from the trauma. I know I would not want to be part of that statistic.

According to Robert N. Butler, MD, president of the International Longevity Center-USA, “Having weak thigh muscles is the number one predictor of frailty in old age.” What a great piece of information to know. I believe most of us want to remain independent until we depart this life.

For quicker recovery from sore muscles and joint support, consider a regimen of glucosamine/chondroitan. There are many over-the-counter brands, some with an additional ingredient, MSM, which some believe helps pain and inflammation. As in all dietary supplements, know your source and remember, this is not medication. Do not expect instant results. Your body needs time to absorb over a period ot time. Here is one to check out which I take called Naturflex. Here’s to strong quads!

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