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Okay. Just remember
Osteoarthritis of the knee is more common in the elderly but it is not an inevitable part of aging.
Younger people may develop OA, especially as a result of previous injury.
There is no known cure for osteoarthritis and no clearly effective medication to prevent it from getting worse; while surgery is the definitive treatment for severe OA, a number of medications and other treatments may provide significant relief for milder forms.
There are a number of causes and treatments of osteoarthritis; if properly treated, it's unusual to become crippled from this form of arthritis.
Okay. When the arthritis is severe enough and more conservative options have not worked well, surgery may be the only option that's likely to provide much relief. If you are otherwise in good health and are a good candidate for surgery, this may be an option worth pursuing.
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I'd like more general information about OA.
Okay, that's important to know. Sometimes, if the osteoarthritis is severe and these other treatments do not work, surgery may be the only option that is likely to help much. You may choose not to pursue surgical therapies, but that could mean having to tolerate a fair amount of discomfort, reduced function or the side effects of more powerful pain medicines.
Review all your options with your doctors. If they've all been failed and surgery would not be considered, combinations of treatments or alternative therapy (such as acupuncture or chiropractic care) may help.
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I'd like more general information about OA.
A cortisone injection or a series of hyaluronic acid injections (such as Synvisc or Hyalgan) can be helpful, at least temporarily, for osteoarthritis of the knee. Some doctors reserve these for people who have knee swelling and do not offer them to people whose knees have no swelling or signs of inflammation. Neither type of injection can be repeated often. For example, a steroid injection can be safely repeated two or three times per year, while repeated courses of hyaluronic acid injections are not officially approved at all (and some health insurers will not cover repeated courses). If you have tried these and they did not help, other treatment options might work better.
Would you consider having orthopedic surgery?
Yes, I would consider having orthopedic surgery.
No, I would not consider having orthopedic surgery.
A cortisone injection or a series of hyaluronic acid injections (such as Synvisc or Hyalgan) can be helpful, at least temporarily, for osteoarthritis of the knee. Some doctors reserve these for people who have knee swelling and do not offer them to people whose knees have no swelling or signs of inflammation. Neither type of injection can be repeated often. For example, a steroid injection can be safely repeated two or three times per year, while repeated series of hyaluronic acid injections is not officially approved at all. If you have tried these and they did not help, other treatment options might work better.
Would you consider having orthopedic surgery?
Yes, I would consider having orthopedic surgery.
No, I would not consider having orthopedic surgery.
Okay, if it works well for you, this type of medicine taken regularly or as needed might be the only treatment you need. On the other hand, if you have ulcers or significant kidney disease, these medicines, whether taken over-the-counter or by prescription, might be hazardous. There may be safer pain medicines or anti-inflammatory drugs. Talk with your doctor about whether the anti-inflammatory drugs (including the newer agents, such as celecoxib) or other pain medicines (such as tramadol) are right for you. Also, ask about monitoring - for people taking NSAIDs on a daily basis, blood tests for anemia, kidney and liver function should be checked periodically. Glucosamine is another medicine that may reduce pain (though claims about its ability to heal cartilage are controversial and not widely accepted by most physicians).
Have you tried knee injections?
No, I have not received injections.
Okay. This type of medicine taken regularly or as needed might be the only treatment you need. On the other hand, if you have ulcers or significant kidney disease, these medicines, whether purchased over-the-counter or by prescription, might be hazardous. There may be safer pain medicines or anti-inflammatory drugs. Talk with your doctor about whether the anti-inflammatory drugs (including the newer agents, such as celecoxib) or other pain medicines (such as tramadol) are right for you. Also, ask about monitoring -- for people taking NSAIDs on a daily basis, blood tests for anemia, kidney and liver function should be checked periodically.
Have you tried knee injections?
No, I have not received injections.
Okay. If you take less than the maximum recommended dosage (see the medication label) and it works well for you, that may be all you need to do for now. (It's generally a good idea not to take the maximum recommended dose long-term; and you should definitely not go above the recommended dosage). Ask your doctor about the safety and advisability of acetaminophen in your particular situation.
Have you tried a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen?
You might want to give it a try (unless your doctor has suggested you avoid it). If you take less than the maximum recommended dosage (see the medication label) and it works well for you, that may be all you need to do for now. Ask your doctor about the safety and advisability of acetaminophen in your particular situation.
Have you tried a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen?
That's good! Exercise can help you maintain optimal body weight and that puts less stress on your knees; it will also help you maintain the range of motion you have, and it will help strengthen muscles (to help take stress off your joints). A physical therapist can help design an exercise program that is good for your knees. Other non-medication options include acupuncture, using a cane, losing excess weight, changing footwear, wearing splints or braces, and massage. Although many of these are unproven as treatments specifically for knee osteoarthritis, future research could prove their benefit.
Have you tried acetaminophen (example: Tylenol)?
Yes, I have tried acetaminophen.
No, I haven't tried acetaminophen.
Yes, you probably should. In general, moving is better than not moving. Of course, it's important no to overdo it.
Exercise can help you maintain optimal body weight and that puts less stress on your knees; it will also help you maintain the range of motion you have, and it will help strengthen muscles (to help take stress off your joints). A physical therapist can help design an exercise program that is good for your knees.
Other non-medication options include acupuncture, changing footwear, wearing splints or braces, and massage. Although many of these are unproven for osteoarthritis, future research could prove their benefit.
Have you tried taking acetaminophen (example: Tylenol) for your osteoarthritis?
Yes, I have tried acetaminophen.
No, I haven't tried acetaminophen.
Okay. Swelling in the knee can occur with OA (though many people with OA notice no knee swelling) and that could mean there is more fluid than is normal. Other types of arthritis can also cause knee swelling, so it might be a good idea to have some of the fluid removed for testing.
The presence of fluid may also mean that you are more likely to respond to a medication that is injected directly into the knee; there's more information about that coming up.
Are you already exercising?
Nope, not exercising -- should I?
Good. That's usually the case with osteoarthritis.
Just a few more questions:
Are you already exercising?
Nope, not exercising -- should I?
Okay. Your symptoms suggest that you may have a torn piece of cartilage (a torn meniscus) or torn ligament. These are problems that may require surgery, though the surgery may be minor (called arthroscopic surgery) or, if symptoms are mild, you may be able to put up with them even without surgery. Talk with your doctors about whether surgery may be necessary for your problem.
Do you have knee swelling?
Good. If you did, it would raise the possibility that you have a torn piece of cartilage (a torn meniscus) or torn ligament. These are problems that may require surgery, so it's good you have none of these.
Do you have knee swelling?
The presence of night pain, constant pain, including pain at rest and/or reduced function over time that are due to OA suggest that it is severe. The cartilage may be completely worn away and now bone is moving on bone. If that's the case, treatments other than surgery may help a little, but they are unlikely to help a lot. It may be worth reviewing the situation with an orthopedic surgeon, to discuss what joint replacement surgery or other types of surgery have to offer.
Do you have locking or giving way of the joint?
This question is an attempt to identify a torn or damaged ligament (such as the anterior cruciate ligament) or cartilage (called a meniscus).
Yes, I have locking and/or giving way.
No, I have no locking or giving way.
Good. The presence of night pain, constant pain, including pain at rest and/or reduced function over time that are due to OA suggest that it is severe and that you might be headed for surgery, so it's better not to have end-stage symptoms such as these.
Do you have locking or giving way of the joint?
This question is an attempt to identify a torn or damaged ligament (such as the anterior cruciate ligament) or cartilage (called a meniscus).
Yes, I have locking and/or giving way.
No, I have no locking or giving way.
Okay. The following questions are to determine whether your arthritis is severe (also called "end-stage") -- in which case you may need joint replacement surgery to make a big impact -- or whether there might be other conditions complicating your situation for which specific treatment might be effective. Prior therapy is also important to know; if you've already failed a particular medicine, it probably makes sense to suggest something else. Finally, your preferences matter; the goal of treatment is to reduce pain and maintain function, so knowing how this condition affects you and how you feel about the risks and benefits of treatment are very important.
Do you have any of the following?
night pain
constant pain, including pain at rest
reduced function over time due to joint pain.
Yes, I have one or more of those symptoms.
Currently, research is looking into the notion that abnormal enzymes released by cartilage cells may lead to cartilage breakdown and joint destruction. Another theory is that some people are born with defective cartilage or slight defects in the way joints fit, and as these people age, they are more likely to experience cartilage breakdown in the joint. Researchers hope that understanding the cause or causes of OA will lead to innovative (and more effective) ways to treat it.
A number of exciting new therapies are under consideration for osteoarthritis of the knee. Among other approaches, researchers are looking at the potential for cartilage transplant and antibiotics, glucosamine and/or chondroitin to repair or restore the damaged cartilage in OA.
Studies are under way to assess the benefits of acupuncture, chiropractic care, massage and other alternative therapies in the treatment of OA. While some swear by these methods now, they are considered unproven. Of course, if the results of research studies are positive, that could change.
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Osteoarthritis is generally a chronic condition. It usually progresses quite slowly over time. However, when treated properly, osteoarthritis is rarely crippling. Because it cannot yet be cured, it usually requires ongoing care and reconsideration of the various treatment options over time.
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I'd like to learn more about my particular situation.
The first step is to have an evaluation with your health care provider so that the diagnosis of osteoarthritis can be established. For the most part, health care providers diagnose osteoarthritis on the basis of symptoms that are evident during an office visit and on physical examination. Once the diagnosis is clear, a number of treatments can be considered, depending on the severity of symptoms, other medical problems and your preferences.
Drug Treatment
Mild pain relievers (oral analgesics). The stiffness and pain of osteoarthritis are often relieved by an over-the-counter pain reliever, such as acetaminophen (Tylenol). Because acetaminophen is considered safe and potentially effective, most health care providers suggest that treatment begin with this drug.
Anti-inflammatory drugs and other pain relievers. If an over-the-counter pain reliever fails to relieve your symptoms, your health care provider may suggest a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn and others). You should only use NSAIDs, especially if you use them regularly, under the supervision of your health care provider. Do not combine them with other drugs without talking with your health care provider first. Stomach problems, including ulcers, are the most common side effects. Newer NSAIDs, such as celecoxib, may be safer for people who are at risk of stomach ulcers, including those who have had ulcers in the past.
Stronger pain medications, such as tramadol or even narcotics such as codeine, are sometimes suggested if over-the-counter pain relievers and NSAIDs fail to relieve osteoarthritic symptoms.
Topical pain relievers (topical analgesics). Topical pain relievers can be applied to the skin over the affected joint as an alternative to, or in addition to, oral pain relievers. Topical pain relievers include methyl salicylate and capsaicin cream. Capsaicin, a substance obtained from hot chilies, may cause mild skin irritation or a burning sensation when applied to the skin.
Corticosteroid injections. When osteoarthritis is accompanied by inflammation, as indicated by warmth and an accumulation of fluid in the joint, your health care provider may recommend that some joint fluid be removed. After fluid is removed, a corticosteroid drug can be injected into the joint. This procedure usually has short-term effects and is used almost exclusively for acute (sudden) and severe symptoms, especially for osteoarthritis of the knee. It is important to recognize that overuse of this procedure has risks, including an increased risk of infection, thinning of the skin and tendon rupture. Because of these potential dangers, your health care provider will recommend this treatment infrequently -- and only when absolutely necessary.
Dietary supplements. The dietary supplements glucosamine sulfate and chondroitin sulfate are over-the-counter agents currently under investigation for the treatment of osteoarthritis. Recent research suggests that these agents may safely provide some benefit for people with osteoarthritis in the knee. The results of more definitive, ongoing studies will show whether these agents act as mild pain relievers or whether they also help heal the damaged joint.
Hyaluronate. Hyaluronate is a newer treatment for osteoarthritis that may provide mild relief of symptoms in some people. This chemical ordinarily provides the joint with lubrication and nutrition. Synthesized forms can be injected directly into an osteoarthritic knee once a week for three to five weeks; it is not clear whether repeated courses are effective. Some health care providers do not believe the modest benefits are worth the risk and discomfort of the injections.
Surgical Treatment
Joint reconstruction or replacement. Health care providers recommend orthopedic surgery in cases of severe osteoarthritis in which there has been significant deterioration of the joint. Surgery can be used to correct joint deformity, to reconstruct a diseased joint or to completely replace a diseased joint with a prosthetic device. This surgery is most often recommended for osteoarthritis of the hip or knee, because severe disease of these joints can impede movement. Joint replacement is definitive treatment for severe osteoarthritis, and hip replacement and knee replacement are among the most common surgeries performed in the United States. A replaced joint will last an average of ten to 15 years (or even longer, because these estimates are based on operations performed at least ten years ago).
Arthroscopy. Arthroscopy is another surgical treatment option for osteoarthritis. But in contrast to joint reconstruction or replacement, arthroscopy is considered minor surgery in that it generally does not require an overnight stay in the hospital. An arthroscope is an instrument with a tiny light, a camera and a variety of surgical attachments. The instrument is inserted into the joint to perform minor surgery using the attachments. Ragged joint edges, debris and loose material can be visualized and either smoothed over or removed. Depending on the condition of the joint, this can result in mild to moderate improvement that may last several months or perhaps a few years; however, for someone with severe osteoarthritis, this approach is unlikely to offer much benefit.
Cartilage transplant. Cartilage transplant is a method to replace damaged cartilage with healthy cartilage transplanted from elsewhere in the body or from a person who has died and donated their organs. Cartilage cells may be removed from a joint or some other area and grown outside the body to form a "patch." The patch is then inserted in an area of damaged or missing cartilage with an arthroscope. So far, these approaches have been used primarily in young people with sports-related injuries limited to the knee. But many experts believe that the time is soon coming when cartilage transplant will become a more common treatment for osteoarthritis.
Treatments Other Than Drugs or Surgery
Education. Top on the list of nondrug and nonsurgical approaches to osteoarthritis is patient education. You can learn about your disease and various ways to manage it from your health care provider. Or search the library or reliable sites on the Internet. In addition, there are arthritis self-help courses available in many communities, hospitals and clinics.
Weight loss. Obesity is a known risk factor for osteoarthritis. Weight loss may help decrease the odds of developing symptoms of osteoarthritis. Researchers are investigating whether weight loss slows the progression of the disease and whether it can help to relieve symptoms. For these reasons, many health care providers recommend that overweight patients with osteoarthritis participate in weight-management programs that include dietary counseling and exercise. This may be particularly important for patients who may need surgery, because significant obesity may increase the risk of complications.
Rehabilitation services. Several forms of rehabilitation services are available to people with osteoarthritis. These include physical therapy, occupational therapy and podiatry. A rehabilitation service may help you relieve your pain and improve your ability to function with the use of a cane, a splint, specific exercises, joint protection maneuvers, education, shock-absorbing shoes or orthotics (shoe inserts).
Exercise. Exercise can be helpful for people with some forms of osteoarthritis, such as arthritis of the knee. For example, walking programs and water aerobics may help improve functioning and relieve pain.
Application of heat or cold. A heating pad or ice pack sometimes provides comfort and relieves pain. If you use these methods, be sure to protect your skin from exposure to extreme temperatures.
Complementary and alternative medicine. There are several other safe and potentially effective ways to treat osteoarthritis without drugs or surgery that are generally considered "alternative" or "complementary" to more traditional options. These include:
Chiropractic care. This form of therapy attempts to decrease pain and restore normal function by manipulating the structures of the body, primarily the spinal column. Manipulation of the neck, however, should be performed with caution if at all because nerve or spinal cord injury may rarely complicate such therapy.
Acupuncture. Fine needles are inserted into the skin at certain points of the body in an attempt to relieve pain and promote well-being.
Massage. The muscles of the body are kneaded in an effort to relieve pain.
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Okay. The information will be presented in the following categories:
Causes -- who gets OA and why
Treatments -- therapies that may be helpful
Course/prognosis -- what to expect
Future directions -- what may lie ahead for the treatment of OA.
Let's start with the causes of OA.
Osteoarthritis is particularly common among older people, but it is not an inevitable part of aging and age does not cause OA. In other words, it is not "normal" for an elderly person to have joint pain. Anyone who has bothersome joint pain, elderly or not, should be thoroughly evaluated by a health care provider. There are many causes of joint pain and many types of arthritis; appropriate treatments vary accordingly. It is never a good idea to assume that joint pain is "just due to aging."
There probably is no single cause of osteoarthritis, and, for most people, no cause can be identified. Factors other than age seem to contribute to osteoarthritis. People who sustain injuries or small repetitive injuries as a consequence of repeated movements on the job or those with sports-related injuries may be at increased risk of developing osteoarthritis; this may occur at any age. There may be a genetic component involved, especially in the development of osteoarthritis in the hands. Obesity seems to be a factor in osteoarthritis of the knees. Other recognized risk factors for osteoarthritis include
repeated episodes of bleeding into the joint, as may occur in hemophilia or related bleeding disorders
repeated episodes of gout or pseudogout in which episodes of inflammation follow the deposition of uric acid or calcium crystals into the joint
avascular necrosis (AVN), a condition in which the blood supply to the bone near the joint is interrupted, leading to bone death and eventually joint damage. The hip is the most commonly affected joint, but the knee can also develop AVN
chronic inflammation caused by previous rheumatic illness, such as rheumatoid arthritis
metabolic disorders, such as hemochromatosis, in which a genetic abnormality leads to too much iron in the joints and other parts of the body
previous joint infection.
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Click here to read about treatment.
Welcome to this guide regarding osteoarthritis (OA, or degenerative joint disease) of the knee.
This Decision Guide is designed for persons who have learned that they have OA and would like to find out more about this condition and what they might be able to do about it.
Please keep in mind that this information cannot replace a face-to-face evaluation with your own health care provider. It is meant to provide helpful information while you are awaiting further evaluation, or to supplement what you may have already learned after evaluation with your doctors.
Would you like to start with some general information about OA? Or would you prefer to get information more specific to your own situation?
| Last updated: | June 05, 2006 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
This information is not intended to replace the advice of a doctor. By using AOL Body, you indicate that you have read, understood, and agreed to our Terms of Service, Use of Content Agreement and AOL Body Advertising Policy. Read more about our content partners.
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