As explained in the prior installment, arthritis is deterioration of the cartilage surface on the ends of the bones. So, when one develops arthritis of the knee, the cartilage deteriorates and at times deteriorates completely so that bone is touching bone which is painful when moved. Understanding what arthritis means is important in the treatment options afforded patients as it helps to understand the goal of various modalities of treatment
The first thing to understand about arthritis is once one has worn down the cartilage in the knee, there is no treatment option that is available in modern medicine to give back the cartilage that has been lost. So, when talking about treatment options there are basically two categories of care. The first is what doctors term “conservative management” meaning non-surgical and the second is surgical replacement of the knee.
There are numerous options that fall within the nonsurgical category of care, but the goal of all of them is to decrease the amount of pain that one has, but will not change the fact that he or she has arthritis or deterioration of the cartilage. There is no bringing it back. Options within this category that are fairly predictable include weight loss (which is one of the most effective and predictable conservative options), activity modification, oral anti-inflammatory medication (Advil type medications), and injections of medicine into the joint. Other options that are less predictable are bracing, physical therapy, and topical creams. All of these treatment options are available and may help in relieving pain, but all of them will wear off or stop working when discontinued and are therefore, temporary. There is not a very predictable way to tell which one of these option will work, or for how long. A common question I get is how long will the injection or medicine last, and the answer is, honestly, I don’t know. The injection may work very well for multiple months (6+) or it may work for 6 hours and then wear off. The medicine may work well initially and then stop being as effective, or it may be that the only treatment necessary is an occasional prescription dose Advil. The bottom line with all of these options of care is that beyond weight loss, all of them are an option that will likely improve your pain, but for how long and how much will only be known by trying it and seeing what happens. As long as this is understood, conservative care is a great choice for those patients that aren’t quite ready for a joint replacement.
The only permanent option for symptomatic arthritis is a joint replacement. While joint replacement may not be the first or best choice of care for every patient, for those that are seeking a permanent relief of pain from arthritis and have not done well with conservative options, it is a very successful and safe surgery with a very low risk profile. Briefly, what is done in a joint replacement is the ends of the bones of the arthritic joint are surgically removed and replaced with implants most often made of metal alloys, medical grade plastic polymers, or occasionally ceramic compounds. The pain relief provided from this surgery is typically permanent as there is no more bone grinding on bone.
Tailoring treatment options to individual patients is important as what is right for one, may not be right for the other. But, I have found that simply knowing the available options and expectations that accompany them is half the battle.