Sports Medicine and Exercise Information  

Dr. Allan Mishra | Knee Pain Diagnosis



Diagnosis

OSTEOARTHRITIS

Degenerative or Post-Traumatic Arthritis


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Definition Degeneration of the surface cartilage of the knee that leads to spur formation and loss of range of motion.

Model and X-ray of a Normal Knee
Details Osteoarthritis is a progressive disorder of the knee that typically occurs in older patients. Degeneration of the surface (articular) cartilage of the knee is the primary problem. This cartilage destruction slowly leads to further deformity of the knee and may result in complete loss of joint function.
Causes The exact cause of osteoarthritis is not known. There is a genetic
component, meaning it can run in families. Obesity or trauma to the knee such as a severe fracture may lead to this form of arthritis.
Diagnosis Osteoarthritis initially does not produce many symptoms. As the disorder progresses, however, morning stiffness, pain with activity and mild swelling occur. A dull toothache like pain, especially with weather changes is common in the intermediate stages. In the later stages, progressive disability and moderate pain arise. The diagnosis is made by a history of these symptoms and confirmed by a physical exam and plain x-rays. The physical exam will show decreased motion in the knee and the x-rays will reveal loss of space in the joint and spur formation.

X-rays of Normal and Osteoarthritic Knees
Treatment Nonoperative: The goals of treatment are to maintain function and decrease symptoms. This can be done with anti-inflammatory medications, carefully planned exercise programs, weight control and occasionally steroid injections.  Injections of some of the precursors of cartilage (Hyaluronate) and oral supplements such as glucosamine sulfate and chondrotin sulfate are other nonoperative therapies that have shown promise in the treatment of knee osteoarthritis.

Anti-inflammatory medications especially the COX-2 type inhibitors recently have been shown to cause an increased risk of cardiovascular side effects in some patients.  Exercise is a neglected form of treatment.  Typically, 30 minutes of riding an exercise bike 3-4 times per week will increase leg strength and mobility in patients with knee osteoarthritis.

Operative: Arthroscopic (minimally invasive) removal of degenerated cartilage or loose fragments may be useful in some patients. Realignment (osteotomy) surgery may be helpful in patients with isolated compartment of arthritis. Total Knee Replacement (TKR) surgery is the definitive treatment for long term severe osteoarthritis. This last type of surgery (TKR) usually requires a stay of 4-5 days in the hospital and several months of rehabilitation. The implants used for replacement surgery are made of plastic and metal.

X-ray Picture of an Arthritic Knee and a Total Knee Replacement

Newer Treatments:
Cartilage transfer procedures are becoming more common and have shown longer term benefits in certain patient groups.  Finally, various forms of biologic therapy are being investigated and will likely result in effective treatments in the near future.

Prevention

Weight control and a consistent exercise program may help prevent some forms of osteoarthritis.


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