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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Parkinson Disease and Your Pharmacist

The National Parkinson Foundation sponsors many Parkinson Disease (PD) support groups. (Most people refer to Parkinson as Parkinson’s, but that is incorrect). I had the opportunity to visit a support group in Northern Virginia and found them to be a very friendly, supportive group. No matter how mild the PD, a support group can be very uplifting. Additionally, the speakers for the meeting give valuable information.

Centreville Medical Arts PharmacyOn the day I visited, one speaker was Ernest Dixon, RPH, owner of Centreville Medical Arts Pharmacy. He explained that PD is a degenerative disease mostly of the aged. There are over 1 million people in the United States and 4 million people worldwide with the disease. It is characterized by tremors, rigidity with stiffness and slowness, and postural instability, all because the nerves in the brain become impaired when it stops producing dopamine.

Early treatment is best and Ernest recommended the following:

  1. Know yourself and your body.
  2. Know your medical provider and the medication prescribed, including side effects.
  3. Know your pharmacist. Build a relationship with the pharmacist.

Centreville Medical Arts Pharmacy is an independent pharmacy located in Northern Virginia. Ernest is a gregarious Ernest Dixonand friendly pharmacist who truly enjoys helping people. After his many years of experience with chain pharmacies, he decided he wanted to really work with people counseling them on their medication and not just filling prescriptions all day. In addition, the pharmacy is a “compounding pharmacy” meaning that they are able to “mix” drugs, such as changing the form of the medication from a pill to a liquid or to remove a non-essential ingredient that the patient might be allergic to.

Getting to know your pharmacist is a really good idea if you take many different kinds of prescription medication prescribed by different doctors so that the pharmacist can be on the lookout for any potential problems. Additionally, if you want to add over the counter medication to the mix, you need to talk to the pharmacist. Or, if you simply want to add high quality nutritional supplements such as vitamins, consult your pharmacist. A pharmacist like Ernest Dixon will be happy to give you professional advice. When we’re all surrounded by big chain pharmacies and pharmacies in supermarkets, it is refreshing to know that there are independent pharmacies with people like Ernest Dixon, RPH.

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