by: Jon Thatcher, MD
Secondary to arthritis, knee pain is becoming the most current common condition seen by the general orthopedist. As people are living finger and staying more active, wearing out of the articular cartilage – bearing surface of the knee – has become very common. Symptoms generally begin with a deep, subtle ache in the knee – usually on the medial side (the inside of the knee) – and this is usually after taxing it with, for instance, hard court tennis, gardening, or a daily run. At first the pain will resolve with a few days of rest, but gradually the symptoms do not go away.
If the wear of the articular cartilage is minimal, x-rays would be normal. However, as more surface cartilage abrades, x-rays will eventually reveal subtle changes consistent with early or moderate arthritis. Fortunately there are several treatment options available that do not involve surgery.
The old standard is aspirin – the original and still one of the best anti-inflammatory medications. Motrin and Naprosyn (Advil and Aleve) have been around for thirty years and are cheap, effective, and do not require a doctor’s prescription.
The above-mentioned medications block the inflammation to reduce the swelling of the lining of the arthritic knee and thus reduce pain, but they do not help the cartilage at all. And, if taken long-term or in excess, they can have untoward side effects, such as bleeding ulcers. The good news is there are also many natural anti-inflammatories such as ginger, tumeric, and Zyflamend that can be helpful and are safer.
Another oral treatment is glucosamine and chondroitin sulfate, the main building blocks of articular cartilage. This pill is considered a supplement and is commonly found in pharmacies or health food stores. It was originally used by veterinarians to treat hip arthritis in dogs, and eventually found its way into traditional medicine. The Orthopedic Academy, after reviewing favorable outcomes and double blind scientific studies for human use, now supports its use for arthritis of any joint. Its effect of improving the function of the cells which make the cartilage are subtle and often unnoticeable. The only adverse effect is on your wallet. Tylenol is a commonly used, non narcotic pain reliever that works in the brain and is not an anti-inflammatory.
There are two types of injections currently available for knee arthritis. The most common is cortisone, the supreme anti-inflammatory medication. When you take a pill like Motrin it is distributed throughout your body, whereas the injection into the joint puts all of the medicine where it belongs. Its benefit is often dramatic, but always temporary. It is not a cure, although it may feel that way for a while. In fact, it is caustic to the articular cartilage and its excessive use, i.e. more than three or four injections over several years can actually damage the cartilage.
Synvisc is a relatively new injectable that lubricates and nourishes the damaged articular cartilage. This is normal, good quality synovial fluid which is an important component to a healthy joint. It really is an oil change or grease job. The fluid is harvested from the crowns of chickens (I figured Frank Perdue could not stand throwing out any part). It comes in three syringes injected over three weeks. The benefits last up to a year and can be repeated annually without any adverse effects.
Activity modification, such as avoiding knee flexion greater than 50 degrees while weight bearing, will reduce loads across the knee and thus reduce stress to the aging cartilage. Strengthening the thigh with sit down exercises, such as cycling also help reduce stress across the cartilage. There are various braces that can be used during vigorous activity to alter loads and protect the damaged area in the knee.
Should you develop an arthritic knee, I encourage you to try these options to find out what works for you and then play on, but play smart. Know your limits. If you push too hard and all else fails, you may end up with surgery.