Arthritis of the knee is a condition that affects millions of people every year. While causes are many, the end results are the same: painful, stiff knee joints with difficult mobility and significant activity restriction.
Many different treatments exist for knee joint arthritis, some of which are specific for certain types, such as rheumatoid arthritis or psoriatic arthritis, however the majority of treatment options are widely used in all types.
Medications
In the milder forms of arthritis, oral medication therapy may be adequate to relieve the symptoms. Types of medications can include simple over-the-counter analgesics, prescription narcotic pain relievers or anti-inflammatory drugs. Over-the-counter varieties can include non-prescription strength acetaminophen and low dose ibuprofen, while more powerful pain relievers, such as codeine, can relieve symptoms of more severe degenerative arthritis.
Steroid Injections
When the arthritic process becomes severe enough that oral pain medication and anti-inflammatory agents aren't enough to quell symptoms, treatment can include the use of injectible steroids, commonly known as cortisone.
The body normally produces its own cortisone by way of the adrenal glands, but rarely in the concentrations needed to treat the ill effects of arthritis. Injections of cortisone directly into the knee joint place the drug where it is needed most---inside the joint. In addition to the benefits of direct injection into the joint, absorption is slower in the knee compared to intra-muscular injections or oral administration where vascularity is greater, which translates into a longer lasting effect, with little systemic effect on the rest of the body.
Hyaluronic Acid Gel Injections
Products other than cortisone are now available that can be injected directly into the knee joint. They are commonly referred to by the general public as "gel injections." These gel injections are comprised of a material called hyaluronic acid, which is a normal component of joint fluid. Some of the injectibles are made from biologic sources such as rooster combs, while others are made synthetically. Some brands require injections to be administered over several weeks, while others are single injection treatments.
These non-steroidal, hypo-allergenic injections help lubricate arthritic joints, in part, by enabling the joint cartilage to retain more water, making it less likely to crack and flake, as well as coating rough areas of the joint surfaces, thus decreasing friction between these surfaces.
Immuno-suppressive Therapy
For the more troublesome and hereditary versions of arthritis, such as rheumatoid arthritis, more conservative forms of treatment (non-steroidal anti-inflammatory drugs, over-the-counter analgesics and gel injections) are often inadequate.
Because rheumatoid arthritis is an auto-immune disease, one in which the body literally attacks itself, drugs that are specific to the disease condition are used to suppress the body's response to the inflammatory and the invasive nature of the disease.
These medications are not specifically designed to treat the knee joint locally, but the systemic suppression of the auto-immune response by the body plays an important role in reducing more localized symptoms.
Partial Knee Replacement
Joint replacement can be confusing to many people who think that the knee joint is actually removed and replaced by an entirely new, artificial joint. Actually, the procedure is similar to capping a tooth--only the arthritic surfaces of the joint are removed and re-surfaced with artificial components, not the entire joint.
In some cases where arthritic damage is limited to local areas of the knee joint, partial replacement surgery has proved very beneficial. In these procedures, only the damaged portions of the knee are re-surfaced, typically on only one side of the knee. An example of this would be to replace/resurface one femoral condyle (knuckle), and one side of the tibia (shin bone).
The indications, however, are fairly limited to people whose arthritis is very focal, such as is seen in post-traumatic or post-surgical arthritis where only one side of the knee is affected.
Additionally, this type of surgery has been typically used in the younger population because of the higher demand on knees and the somewhat limited lifespan of total replacement components (15 to 20 years). The younger the patient, the higher the odds of having to undergo some kind of revision procedure at a younger age, so it may not be necessary to perform a complete replacement procedure if only one part of the knee is damaged.
Total Knee Replacement
For end stage arthritis, (debilitating, painful arthritis that has failed all forms of conservative management), total knee replacement is the benchmark treatment.
This procedure involves the re-surfacing of all the articular surfaces of the knee: the femoral (thigh bone) condyles (knuckles), tibial surface (shin bone) and the under-surface of the patella (knee cap).
Total knee replacement components are typically made of metal ( Cobalt Chrome or Titanium) and space-age plastic. They can be cemented into place or press-fitted (fitted tightly to the bone surfaces without the use of cement) and typically have a life span of 15 to 20 years.
