How is Knee Osteoarthritis (OA) managed?
Knee osteoarthritis is a degenerative joint disease of the knee caused by the destruction of the articular cartilage. Articular cartilage is the smooth white tissue covering the ends of the bones in joints, allowing the bones to glide smoothly. It is a living tissue made of cells called chondrocytes. Chondrocytes are normally quiescent cells. But in osteoarthritis, they undergo changes that make them active. They start fibrillation which is associated with necrosis in cell clusters in different zones of the knee. As the articular cartilage degrades, the bones rub against each other causing pain and inflammation.Risk factors for knee osteoarthritis include genetics, aging, and factors that add unusual stress or trauma to the knee such as injury or obesity. The disease is usually observed in individuals over the age of 45, with 55 being the median age of disease onset. The destruction of the cartilage is different in osteoarthritis than in usual aging.Common symptoms of knee osteoarthritis include gradually increasing knee pain, swelling, or stiffness that worsens with activity. The disease is progressive, and the pain generally becomes more severe and occurs more frequently over time. However, the rate of disease progression changes from person to person.
How is osteoarthritis managed long-term?Self-management strategies aim to empower the patient in managing their symptoms, maximizing function, and slowing down disease progression.They include:Educating the patient about knee osteoarthritis and its various treatments including physical therapy.Planning out a treatment.Reducing the burden on the knees in overweight patients through weight loss of 5-10% in six months, and avoiding walking while lifting heavy objects such as heavy bags.Increasing knee strength through physical therapist-approved exercises.Making small lifestyle changes such as wearing appropriate footwear or braces while walking, avoiding walking on bumpy trails, etc.Using a walking aid when necessary.Benefits of exercise for knee osteoarthritisExercise can benefit knee osteoarthritis in several ways. By improving metabolism and blood circulation, it provides nutrients to the joint fluid. By mildly straining the joint, it helps the cartilage absorb these nutrients. It strengthens muscles which can do some of the heavy lifting when doing demanding tasks such as climbing the stairs or walking up a hill.To gain benefits, it is recommended to exercise 2-3 times a week, each session lasting 45 minutes. Warm-up routines such as brisk walking are recommended before starting the exercise. Within the session, it is advisable to start with easier exercises gradually building up to harder ones. Some recommended exercises can include step-ups and getting up from a chair without help.However, all new exercises must be developed in collaboration with a physical therapist who can evaluate the extent of a patient’s pain and fitness and can recommend exercises and techniques that can be most helpful.In the U.S., most health insurance companies and Medicare cover about 12 sessions of physical therapy over a month if they are deemed medically necessary and are prescribed by a medical care provider.
What if self-management strategies fail?The patient may be prescribed pain-relieving medications or surgery if the pain persists. Surgical treatment for knee osteoarthritis involves the removal of the damaged bone and cartilage and its replacement with long-lasting prosthetics.The most successful surgery for knee osteoarthritis is total knee replacement. In this treatment, surgeons remove the ends of the knee bones and replace them with an artificial knee made of metal and plastic. The metal parts are made from strong biocompatible materials such as titanium, or cobalt with chromium. The plastic parts are generally made from medical-grade polyethylene. The design fits inside the knee and simulates the working of a real knee joint. There are over 150 designs available in the market, and surgeons can often closely match the design to the patient.This procedure is considered the current gold standard. It provides pain relief 90-95% of the time and has complications 1-2% of the time. Even two decades after the surgery, 90% of artificial knees are satisfactory.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
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