Osteoarthritis (OA) is the most frequent cause of disability in the United States, affecting 33% of Americans. The risk of developing OA substantially increases with each decade after the age of 45 years. Among reported upper and lower extremity sites, the most common region for OA to manifest is the medial compartment of the knee. Risk factors for developing arthritis include age, obesity, prior injury, family history of arthritis and occupations with repetitive joint loading or high physical demands.
Symptoms of arthritis include joint pain and stiffness. The stiffness typically improves within 30 minutes of getting up in the morning as a person becomes more active. The stiffness may set in again after prolonged periods of inactivity. Joint deformity, tenderness and bony enlargement are often seen in conjunction with arthritis. Some individuals lose range of motion as arthritis progresses.
Because knee cartilage thickens in the areas of greatest loading, the joint mechanics and loading patterns during walking have a significant influence on the development of joint cartilage. Disruption of normal gait patterns by trauma, injury, ligament laxity, weight gain, and improper footwear can shift the loading patterns during weight-bearing activity to cartilage regions not well adapted to accepting those loads.
Acetaminophen (Tylenol) is the first line of treatment for mild arthritis because of its effectiveness and relatively good side effect profile. The next medication use is typically an anti-inflammatory. This may be over-the-counter medication like ibuprofen or naproxen or prescription medications such as Celebrex or Mobic. Topical medications may also be helpful including prescription anti-inflammatories or over-the-counter capsaicin ointment.
Aerobic exercise is an important part of the rehabilitation process. Pool therapy has been shown to benefit patients with severe arthritis. Strength training is also important since muscle wasting is often seen around arthritic joints. For overweight individuals, weight loss is essential for reducing symptoms and taking pressure off of weight-bearing joints.
Gait modification has the potential to reduce pain and slow the progression of medial compartment knee OA. A medial unloader brace can take pressure off of the inside of the knee where arthritis tends to be seen most frequently.
For some individuals injections of the joint with a steroid reduces pain. Steroids have an anti-inflammatory effect. Ultrasound guidance can be used to more accurately place the medication within the arthritic joint. In appropriate patients, these injections may reduce pain for at least 3-4 months although in some cases the affect can last much longer. A second type of injection, called viscosupplementation, has been approved by the FDA only for knee joints. This type of injection replaces some of the naturally occurring cushioning fluid within the knee joint. These viscosupplementation injections can reduce pain and slow down the progression of the arthritis.
In patients who do not respond to conservative management with medications, physical therapy or injections, surgery may be necessary to relieve pain. In these cases, your physiatrist can give exercises to do beforehand that will speed up the recovery process after surgery. Postsurgical rehabilitation is also important for improving range of motion and strength.
