Osteoarthritis is the most common form of arthritis and is also called degenerative arthritis. This is when the cartilage in the joint has deteriorated by thinning and wearing away. The smooth rubbery cartilage that glides painlessly is gradually worn away to the point that exposed bone rubs against exposed bone. This results in stimulation of nerve endings and pain. Absence of cartilage is also mechanically irritating to the joint, and the joint lining makes extra joint fluid causing swelling of the joint.
Over time the joint will make extra bone at the edges of the osteoarthritic joint called osteophytes or ‘spurs’. This causes the joint to enlarge and to stiffen as the osteophytes can change the joint shape and block how far the joint can move.
Conservative treatment measures include modifying one’s activities and unloading the joint with cane, crutches or walker. Also supplemental glucosamine, Tylenol, anti-inflammatories, pain medications may help. Physical therapy to regain motion and strength and coordination is often helpful. Weight loss in the overweight patient is important.
Injections of corticosteroid can be helpful, but can be used only 3-4 times per year. ‘Viscosupplementation’ injections with hyaluronate (Synvisc) may also help. If successful, these may work for 6 months or longer.
A compartment –unloading brace for the knee can relieve pain and delay progression of knee arthritis.
When all these measures are not working, then surgery may be recommended.
If the joint damage is in a very small, localized area, possible options include:
- A localized transplant of bone and cartilage
- A micro-fracture technique to encourage ‘scar-cartilage’ to grow
In most cases the joint damage involves larger areas and some form of realignment or resurfacing is recommended:
- Realignment osteotomy of the knee
- Partial replacement of the joint such as a Uni-compartmental replacement of the knee
- Total Joint Replacement of hip or knee