Osteoarthritis of the knee is the most common joint affected but arthritis. Painful knee arthritis is present in up to 10% of men and 13% of women over the age of 60. Factors that increase the risk for osteoarthritis include old age, obesity, prior knee injury, repetitive use of knees, muscle weakness, and joint laxity. |  |
SYMPTOMS:
Symptomatic knee osteoarthritis begins with pain. Pain will be present with certain activities such as running, climbing stairs, and walking. Pain at night, joint swelling, knee stiffness, and locking/catching are other symptoms of knee osteoarthritis.
Symptomatic knee osteoarthritis begins with pain. Pain will be present with certain activities such as running, climbing stairs, and walking. Pain at night, joint swelling, knee stiffness, and locking/catching are other symptoms of knee osteoarthritis.
 BruceBlaus, via wikimedia (CC BY-SA 4.0) | PATHOPHYSIOLOGY: During osteoarthritis the articular cartilage degenerates, the lining of the joint (synovium) becomes inflamed, and the subchondral bone remodels and forms osteophytes and bone cysts. Some of the known factors that play a role in this are proteolytic enzymes. Matrix metalloproteases (MMPs) are responsible for breaking down cartilage. Tissue inhibitors of MMPS (TIMPs) play a role by inhibiting these enzymes. When there is an imbalance of MMPs and TIMPs the degenerative arthritis process proceeds. Inflammatory cytokines, like IL-1, IL-6, and TNF-alpha, also play a role by increasing creation of MMPs. |
| DIAGNOSIS: The diagnosis is often made by careful questioning and physical exam by a healthcare practitioner then confirmed with imaging including x-rays and possibly MRI. On X-rays we can see joint space narrowing, osteophytes, and subchondral bone cysts and sclerosis. The MRI will show detailed degenerative changes in the cartilage and bone. |  James Heilman MD, via wikimedia (CC BY-SA 3.0) |
TREATMENT:
Conservative management for knee osteoarthritis includes ice/heat, non-steroidal anti-inflammatories (ibuprofen or naproxen), bracing, weight loss, and physical therapy. Often when conservative treatment fails, physicians will often move on to corticosteroid injections which can help decrease pain and improve function temporarily. When symptoms and severity of arthritis become severe enough physicians will often refer to orthopedic surgery for possible joint replacement. Corticosteroid injection combined with anesthetics can be toxic to chondrocytes, the cells that produce cartilage, and joint replacement comes with the risk of a major surgical procedure. According to the American Academy of Orthopedic Surgery (AAOS), complication rate is around 5% and the chance of dying within 30 days of surgery is 1 out of 400.
Conservative management for knee osteoarthritis includes ice/heat, non-steroidal anti-inflammatories (ibuprofen or naproxen), bracing, weight loss, and physical therapy. Often when conservative treatment fails, physicians will often move on to corticosteroid injections which can help decrease pain and improve function temporarily. When symptoms and severity of arthritis become severe enough physicians will often refer to orthopedic surgery for possible joint replacement. Corticosteroid injection combined with anesthetics can be toxic to chondrocytes, the cells that produce cartilage, and joint replacement comes with the risk of a major surgical procedure. According to the American Academy of Orthopedic Surgery (AAOS), complication rate is around 5% and the chance of dying within 30 days of surgery is 1 out of 400.
Alice Pien MD, via wikimedia (CC BY-SA 4.0)
Orthobiologics, also known as regenerative medicine, is a new area of medicine that harnesses the healing ability of our own tissues. These regenerative cells, often called stem cells, have the ability to decrease pain, improve function, and slow the degenerative process. Platelet rich plasma (PRP), mesenchymal stem cells from bone marrow aspirate concentrate (BMAC), adipose derived stem cells, and amniotic/placental tissue have all been used knee osteoarthritis.
References:
Brown GA. J Am Acad Orthop Surg. 2013. Sep;21(9):577-9.
Centeno C, Pitts J, Al-Sayegh H, Freeman M. Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft. Biomed Res Int. 2014;2014:370621.
Freeley BT, Gallo RA, Sherman S, Williams RJ. J Am Acad Orthop Surg. 2010 Jul;18(7):406-16.
Wang M, Shen J, Jin H, Im HJ, Sandy J, Chen D. Ann N Y Acad Sci. 2011 Dec;1240:61-9.
Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69.
Brown GA. J Am Acad Orthop Surg. 2013. Sep;21(9):577-9.
Centeno C, Pitts J, Al-Sayegh H, Freeman M. Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft. Biomed Res Int. 2014;2014:370621.
Freeley BT, Gallo RA, Sherman S, Williams RJ. J Am Acad Orthop Surg. 2010 Jul;18(7):406-16.
Wang M, Shen J, Jin H, Im HJ, Sandy J, Chen D. Ann N Y Acad Sci. 2011 Dec;1240:61-9.
Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010;26(3):355-69.
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