ARTHRITIS OF THE KNEE

WHAT IS ARTHRITIS?

Arthritis is inflammation of the joints. Pain, swelling, and stiffness are the primary symptoms. The disease may affect any joint in the body, but it is particularly more common in the knee. Knee arthritis can cause difficulties in daily activities, such as walking, running or climbing stairs.

Although there is no cure for arthritis, there are many treatment options available to help manage pain and keep people staying active.

Anatomy
The bone structure of the knee joint is: femur (thighbone), tibia (shinbone) and patella (kneecap). Three bones where they touch are covered with articular cartilage. Between femur and tibia there are two menisci (medial and lateral) which act as shock absorbers. In addition, there are four main ligaments (ACL, PCL, MCL, and LCL) within and around the knee.

Inside the knee, a thin lining called the synovial membrane surrounds the joint. This membrane releases a fluid that feeds the cartilage, some part of menisci and reduces friction.

Description
The major types of arthritis that affect the knee are osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

Osteoarthritis
Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative, "wear-and-tear" type of arthritis that occurs most often in people 50 years of age and older. In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs. Osteoarthritis develops slowly and the pain it causes worsens over time.

Rheumatoid Arthritis
Rheumatoid arthritis is a chronic autoimmune disease (immune system attacks its own tissues) that attacks multiple joints throughout the body. The immune system damages normal tissue (such as cartilage and ligaments) and softens the bone.

Posttraumatic Arthritis
Posttraumatic arthritis develops after an injury. For example, a broken bone of the tibia, the femur or the patella may damage the joint surface and lead to arthritis years after the injury. In addition, the torn meniscus and ligament injuries can cause instability and additional wear on the knee joint, which over time can result in arthritis.

Symptoms
Pain, stiffness or limited range of motion, swelling, locking and weakness are the most common symptoms of arthritis.

Diagnose

The doctor will talk with the patient about the symptoms and medical history, and then he/she will check the knee by physical examination and possibly order diagnostic tests, such as x-rays or blood tests.

Treatment

There is no cure for arthritis but there are a number of treatments that may help relieve the pain and disability it can cause.

Nonsurgical Treatment

In early stage of arthritic conditions, initial treatment of arthritis of the knee is not surgical. There are some other treatment options for the patients.
Lifestyle modifications: The patient should change daily activities to slow the progress of arthritis.

• Minimize activities that aggravate the pain and swelling.
• Avoid from high impact activities like jogging or tennis
• Prefer lower impact activities like swimming or cycling
• Losing weight will reduce stress on the knee join and help to feel less pain

Physical therapy: Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in the leg.
Assistive devices: Using devices such as a cane, wearing shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. Applying heat or ice, using pain-relieving ointments or creams, or wearing elastic bandages to provide support to the knee may provide some relief from pain.
Medications: Several types of drugs are useful in treating arthritis of the knee.

• NSAIDs (ibuprofen and naproxen)
• A COX-2 inhibitors (celecoxib and meloxicam)
• Corticosteroids (cortisone)
• Disease-modifying anti-rheumatic drugs (DMARDs-methotrexate, sulfasalazine and hydroxychloroquine
• Viscosupplementation involves injecting substances into the joint to improve the quality of the joint fluid.
• Glucosamine and chondroitin sulfate, substances found naturally in joint cartilage, can be taken to relieve the pain.

Surgical Treatment

The doctor may recommend surgery if the patient's pain from arthritis causes disability and is not relieved with nonsurgical treatment.

Arthroscopy: During arthroscopy, doctors use small incisions and thin instruments to diagnose and treat joint problems. Arthroscopic surgery is often used to treat arthritis of the knee.It is also used in cases where osteoarthritis is accompanied by a degenerative meniscal tear and synovitis to reduce the pain.
Osteotomy: In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when the patient has early-stage osteoarthritis that has damaged just one side of the knee joint.
Total or partial knee replacement (arthroplasty): The doctor will remove the damaged cartilage and bone, and then position new metal or plastic joint surfaces to restore the function of the knee.

Recovery

Recovery time depends on the type of surgery performed. The patient may need physical therapy or may need to use crutches or a cane for a time. Mostly surgery helps to relieve the pain and makes the patients possible to perform the daily activities easily.