Osteoarthritis, by far the most common form of arthritis, is more than simple “wear and tear.” It does involve wearing away of the cartilage, the smooth “cushions” that cover the ends of the bones. It also involves the bone itself and the synovium, the lining of the joint.
Obesity is a risk factor for osteoarthritis of the knees and hips, but recreational running is not – it may even be protective. Both sedentary lifestyle and very high volume competitive running do increase the risk.
If you have it, what can you do to decrease your pain and be more active?
Rule number 1 is to stay active. Exercise such as walking lubricates the knees and lessens stiffness. If you enjoy running, keep at it. You may find that running on grass is easier than pavement, and be sure to experiment with different shoes.
In addition to aerobic exercise, strengthen your quads. Exercises such as straight leg raises with ankle weights and squats will build up the muscles that support the knee.
Tai chi has also been found to decrease pain and increase quality of life.
Weight loss, however you achieve it, helps.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can be very helpful, but have side effects on the stomach, kidneys and heart. If you use them, use the lowest dose that works for as short a time as possible.
If you find yourself needing NSAIDs daily, ask your doctor for a prescription for a topical (gel or cream) NSAID, which is much safer. The only one available in the U.S. is diclofenac.
If these measures are not adequate, injection of cortisone-type drugs into the knee will usually give quite a bit of relief. The problem with “cortisone shots” is that the relief is temporary, rarely lasting more than 2-3 months, and repeated injections contribute to worsening of the underlying arthritis.
Hyaluronic acid injections are controversial. There are many trials comparing it to placebo injections and while the majority show benefit, many show no advantage of hyaluronic acid. Insurance companies may cite lack of proven benefit and refuse to pay for these injections. It does appear to be safe should you opt to try this.
If nothing works and you are willing to have surgery, knee replacement is the ultimate choice. This has good results for most people, but not all. Before opting for surgery, it is critical that you are willing to commit to a vigorous physical therapy program. The surgery is the start, but not the end.
To get the optimal benefit from a “total knee” (or a partial one), expect to spend 4 to 6 months of demanding PT; if you are half-hearted with your exercise program, you will be left with a so-so result. You will still probably have less pain than pre-surgery, but you will not have full knee motion.
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Thank you for a wonderfully succinct explanation of what contributes to this sad condition of the knees and how to at least delay the onset and then respond. I especially applaud your warnings about the need for huge and long effort with PT if a knee replacement is chosen.
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