Osteoarthritis of the Knee Treatment in New Jersey

Anatomy & Background

The knee, as the body’s largest joint, is built for both mobility and stability. It’s a weight-bearing joint made up of three bones and three joints. The tibiofemoral joint, patella-femoral joint and tibiofibular joint are osseous joints in the knee.

Bones and Joints

To understand the joint complex in the knee, each joint and the bones that are connected within joints must be considered individually. These include:

• Tibio-femoral joint – This is a hinge joint situated between the tibia (the large bone in the lower leg) and the femur (the large bone in the upper leg and the largest bone in the body). There is a medial (closer to the middle) and lateral (closer to the outside) section of the joint;
• Patella-femoral joint – This joint is situated between the patella (“knee cap”) and the femur in the upper leg. The patella-femoral joint allows the patella to glide along a groove in the anterior distal section of the femur;
• Tibio-fibular joint – This joint is situated between two bones from the lower leg – the tibia (larger bone) and the fibula (smaller bone) – where they meet at the knee.

Joint articular cartilage covers the bone at the end of each bone that meets within the knee joints. This smooth and spongy substance is what allows the bones in the joints to move and slide freely over one another. Synovial fluid, a slippery fluid that helps limit friction, fills the joint.

Osteoarthritis

The most common form of knee arthritis, Osteoarthritis, is a gradual wearing and degeneration of the joint surfaces or articular cartilage. Osteoarthritis is most common in adults over the age of 50. Women are more likely to develop osteoarthritis, and it can affect one knee or both. Knee osteoarthritis is the most common cause of disability.

Causes

Common causes of knee osteoarthritis include:

• Genetics and family history can predispose individuals to develop osteoarthritis and joint degeneration;
• Ligament or meniscus damage can affect the knee joint’s stability and integrity, placing more stress on the joint or articular cartilage. The increased stress and force placed on the joint surfaces can lead to wear and tear on the joint;
• Repetitive strain injuries to the knee can damage and accelerate wear on joint surfaces;
• Obesity causes increased weight and pressure on the knee joints when performing everyday activities. This puts added stress on the knees, increasing forces on the joint cartilage;
• Diseases of the joint cartilage;
• Excessive use of steroids or steroid medication can result in degeneration of the joints and cartilage;
• Previous trauma to a joint can increase wear and tear and the likelihood of developing osteoarthritis.

To determine the precise underlying cause of your symptoms, your specialist will perform a thorough physical exam, review your personal and family medical history, and may order tests such as an MRI, CT imaging scan, or X-ray.

Symptoms of Osteoarthritis

Any of the following knee osteoarthritis symptoms may warrant a consultation with Dr. Eric Freeman, New Jersey’s best pain management doctor and leading pain relief specialist:

• Pain and achiness in the knee joint;
• Loss of motion during knee extension (straightening) and/or flexion (bending) of the knee;
• Noticeable swelling around the joint;
• Increased size or deformity of the joint;
• Weakness may be present, making it difficult to get out of a chair, squat, kneel, or climb stairs;
• Cracking, crunching, or joint noise called “crepitus” when moving the knee.

Other less common knee osteoarthritis symptoms include pain that increases with vigorous activity and significant warmth around the joint area.

Treatment of Osteoarthritis

When treating osteoarthritis of the knee, the severity of the condition, as well as other individual factors, such as age, physical condition, activity level, pain threshold, and overall health, are generally taken into account.

Different factors should be addressed in treatment, including acute pain and inflammation, joint protection, and maintaining or improving the joint’s range of motion and strength. RICE (rest, ice, compression, and elevation), range of motion (stretching) and strengthening exercises, and joint protection strategies like splinting, taping, strapping, or bracing are all common treatments. Medication may be necessary for the treatment of knee osteoarthritis, and patient education is essential in providing patients with the information necessary to prevent further joint damage.

Although Dr. Freeman, NJ pain specialist doctor’s ongoing or advanced treatment of knee osteoarthritis will depend on a variety of factors, general guidelines for treating knee arthritis at the onset of symptoms typically begin with the RICE method and other simple steps that an individual can do on their own. These are some of them:

• Rest – Kneeling, jumping, squatting, walking up and down the stairs, running, and any other activity that requires repetitive movement of the knee for long periods of time should be avoided.
• Ice – Swelling, inflammation, and pain can be reduced by applying ice to the affected joint for 20 minutes. Ice should not be applied to the skin directly and should not be used for more than 20 minutes at a time. If the knee joint is stiff, moist heat (such as a hot/warm washcloth) can help relieve stiffness, but it won’t help with swelling or inflammation.
• Compression – Light compression of the knee joint, in combination with ice, can help decrease swelling.
• Elevation – Elevating the leg can help decrease persistent swelling and pain.

Although the RICE method effectively alleviates swelling, pain, and inflammation, it is only one step in the treatment of knee arthritis. It’s important to distinguish between resting and the tendency to avoid using the joint at all. Although a brief period of rest may be required to alleviate pain and inflammation, and you should avoid certain motions during arthritis flare-ups, it is best to keep moving the joint as much as possible. Range of motion (stretching) and strengthening exercises are essential for maintaining joint function and preventing further loss of motion.

Managing Your Pain

Pain management intervention at an NJ pain center can help you manage both acute and chronic pain if you have persistent or chronic knee arthritis. The first line of treatment is to avoid the activities that cause or worsen pain, as well as to use at-home methods like RICE (rest-ice-compression-elevation) and temporary immobilization techniques like bracing, taping, strapping or splinting.

Additional pain-relieving measures may include:

• Medication – Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain, swelling, and inflammation. If rheumatoid arthritis is the culprit behind your knee arthritis, you may benefit from the use of disease-modifying anti-rheumatic drugs (DMARDs);
• Steroid injections – Injections of low-dose steroids into the knee joint can help decrease inflammation;
• Synvisc or Suparz injections – Joint injections of hyaluronic acid preparations such as Synvisc or Suparz help speed up cartilage repair and regeneration;
• Physical therapy – Following a thorough examination of the affected joint, which includes determining the level of inflammation, flexibility, strength, balance, and gait, a series of stretching and strengthening exercises may be used to improve the knee joint’s strength and flexibility. Changes in gait can also reduce joint stress, and other pain-relieving techniques such as manual therapy, ultrasound, electrical stimulation, cold therapy, and ice may be used;
• Surgery – Surgery is only used as a last resort to treat chronic and severe pain caused by knee arthritis. In some cases, arthroscopic surgery can be used to debride (clean out) the affected joint surfaces and synovial lining in order to reduce swelling and inflammation. Your doctor can recommend partial or total knee replacement if severe joint degeneration has occurred and other pain management methods have failed.

Contact one of our offices or use our convenient online scheduling system to learn more about osteoarthritis of the knee treatment options offered at Redefine Healthcare.

Prognosis

The type of arthritis causing symptoms (osteoarthritis, rheumatoid arthritis, traumatic arthritis), the severity of joint damage and cartilage degeneration, the strength and flexibility of the joint, and other factors such as the individual’s age, weight, level of physical fitness, and overall health will all influence the prognosis for people with arthritis of the knee. The timing and type of treatment used will also have an impact on the outcome of arthritis treatment.

• Mild Cases – When flare-ups occur, patients with mild forms of arthritis in the knee, with minimal degeneration and damage, usually respond well to short-term, conservative treatment. At the onset of pain, the RICE method (rest-ice-compression-elevation), along with non-steroidal anti-inflammatory medication (NSAIDs) if necessary, and a program of mild stretching and strengthening exercises is usually all that is required to see improvement. Within 4–6 weeks, most patients can expect reduced or eliminated pain and improved function.
• Moderate Cases – To see a significant improvement in symptoms, patients with moderate degeneration due to arthritis may require more than just rest, medication, and exercises. The patient may experience more pain, weakness, and loss of mobility and function as a result of increased degeneration or damage caused by more serious or chronic arthritis. Steroid injections or hyaluronic acid preparation injections, for example, can help to reduce inflammation and repair or regenerate cartilage in the knee joint. Debridement (cleaning out) of the knee joint may necessitate arthroscopic surgery. The recovery time for this procedure is 6–9 weeks, and it should be followed by an exercise or physical therapy program aimed at restoring strength, range of motion, and function.
• Severe Cases – Traditional treatments for mild to moderate knee arthritis may not be sufficient for patients who have severe joint damage and degeneration caused by knee arthritis that results in significant pain, swelling, and stiffness, as well as loss of strength, motion, and function. Conservative treatments are usually tried first before attempting a more invasive technique, but if the cartilage is severely eroded and the joint has bone-on-bone contact, a partial or total knee replacement is usually the best option. Joint replacement surgery is usually followed by three to four months of physical therapy, though recovery can take up to a year. Most patients who undergo joint replacement surgery experience significant improvements in knee function, pain relief, and the ability to return to a higher quality of life. However, the artificial joint will feel and function differently than a natural joint, which may result in some limitations.

Depending on the severity of the condition, it is usually best to discuss outcomes and prognosis with the best pain management doctors in New Jersey. This could be the most important factor in determining the treatment’s success.