Understanding Osteoarthritis and Chronic Knee Pain

Osteoarthritis(OA)

Dr. Timothy Payne, MD

What is Osteoarthritis?

Osteoarthritis is primarily a non-inflammatory degenerative disorder of moveable joints characterized by an imbalance between the synthesis and degradation of the articular cartilage, leading to the classic pathologic changes and destruction of cartilage

Osteoarthritis Incidence

• Found in 80-87% of people over age 55• Found in over 95% of people of 65• Found in 40 million adults• 20 million have hip or knee arthritis; 10

million treat it• 5 million have severe degenerative joint

disorder• 400,000 TKRs and 160,000 total hips per

year

Progression of Disease

• First signs of disease (Mild OA)– Cartilage starts to

wear down and thin out

– May not have any pain or stiffness or be hindered in any activity unless it is prolonged

Progression of Disease

• Moderate OA– Thinning cartilage causes

bones to rub on each other, causing pain with weight-bearing

– Joint space narrows– Pain tends to worsen as day

progresses and is present with most activity

Progression of Disease

• Severe OA– Bone on bone contact creates inflammation,

pain, swelling and development of osteophytes (bone spurs)

– Pain is generally constant

Common Treatments

• NSAIDs (non-steroidal anti-inflammatory drugs)

• Physical Therapy

• Hyaluronic Acid Injections

• Bracing

• BioniCare

• Total Knee Replacement

NSAIDs

• Non-steroidal anti-inflammatory drugs– E.g. Tylenol, Advil,

Aleve, Celebrex, Naprosyn

• Typically prescribed as a first line treatment; often tried by patients prior to physician visit

NSAIDs

• Advantages– Easily to take, readily available

• Disadvantages– Gastrointestinal, hepatic (liver) and renal

(kidney) complications, especially when taken over long period of time

– Does not slow down progression of disease (treats symptoms)

Physical Therapy

• Typically consists of – Strengthening exercises– Non-impact aerobic activity to reduce weight– Balance, gait and posture exercises

Physical Therapy

• Advantages– Focuses specifically on needs of patient– Individual attention by therapist

• Disadvantages– Expensive

Hyaluronic Acid Injections

• An injection into the knee that lubricates and cushions your joint

• Made from a natural substance similar to healthy joint fluid – Brand names:

Synvisc, Orthovisc, Hyalgan, Supartz

Hyaluronic Acid Injections

• Advantages– One injection (or series of injections) can

provide relief for several months

• Disadvantages– Does not address the mechanical wear and

tear during weight-bearing activities– Pain, swelling or infection possible at injection

site

Bracing

• A brace is applied to the leg which takes pressure off of the affected compartment (shares the load during weight-bearing)

Bracing

• Advantages– Non-invasive– Can reduce additional wear and tear

• Disadvantages– Some braces may be cumbersome for

patients

BioniCare

• An electrical stimulation device that replicates the signal a healthy knee gives off during weight bearing to reduce pain and other symptoms.

BioniCare

• Advantages– Non-invasive, very low risk– Studies show reduced pain, improved function and

the effects of the device can be equal to a total knee replacement (2/3rds of patients deferred a TKA for 4 years after using the device)

• Disadvantages– Must be worn for approximately 750 hours to receive

significant benefits (about 3 months with daily use of 6 hours per day)

– Applied with electrodes in a brace, which may be cumbersome for some

Total Knee Replacement

• Typically recommended when patient has severe pain that prevents normal functioning, and other more conservative methods have failed

• The ends of the femur (thigh bone) and the top of the tibia (shin) along with the patella are replaced with metal and plastic components

Total Knee Replacement

• Advantages– Worn down surfaces are replaced– Outcomes (reduced pain, improved function)

usually very good

• Disadvantages– Invasive, inherent risks with surgery – Requires physical therapy and exercise post-

surgical for optimal outcomes (may be several months)

• Questions??

• Thank you!