Knee Arthritis Treatment Advances

---

The good news is that because osteoarthritis is affecting more and more people, there is more money to be made so more is spent on research.

Knee Cartilage or Meniscus?

---

Is knee cartilage the same as the meniscus?

Hyaluronic Acid - Can it help after Arthroscopy?

---

Hyaluronic Acid has been shown to have limited success when used in isolation to treat osteoarthritis. It helps some but not all people, and its benefits may be short lived.

A new study has looked at the use of Hyaluronic Acid after knee arthroscopy. The results of a Weill Medical College investigation showed that patients receiving a series of three injections after their knee surgery had less pain and increased mobility on follow up at 3 and 6 months.

Points to consider:

Knee arthroscopy for osteoarthritis has been shown to be of little benefit unless mechanical symptoms of meniscal tears exist.

The study was limited by a small sample size. A much larger study is required before any benefit can be confirmed.

Having three injections after surgery is likely to slightly increase the risk of infection. Any benefit would need to be large enough to offset this increased risk.


It will be interesting to see what future research reveals.

Trouble Sleeping Due To Knee Arthritis?

---

A common feature of osteoarthritis is pain at night that restricts sleep.

This is usually made worse if you have been particularly active during the day. The reason sleeping becomes an issue is that the lack of movement we do in bed causes stiffness in the joint. Once a joint is stiff, any small movements we do in adjusting our sleeping position become very painful. This wakes us up - often for only a few seconds as a quick bit of movement eases the pain - then back to sleep we go and the cycle repeats. In the early stages, many people don't wake enough to remember the episode and wonder why they are so tired the next day. As the pain and stiffness get worse the amount of movement required to ease the pain increases and movement as a remedy becomes less effective.

Medication becomes an important tool in these situations, as lack of sleep has an extremely negative effect on our mental well being. There is a reason sleep deprivation is used as torture.

What advice do I have to maximize sleep?

1) Firstly don't fall into the trap of doing less activity during the day in the hope of getting more sleep at night. This will lead to increased stiffness and a bigger problem.

2) Spend the time with your Doctor to find which drug or combination of drugs works for you. Due to our differing physical characteristics, certain drugs work better on some people than others.

3) Try using heat. Ice is used for acute sporting injuries but heat helps stiffness in chronic conditions. Many find that a nice hot bath or shower just before bed will increase the amount of sleep they get in before waking for the first time.

4) Some people find that the affected knee is very sensitive to light touch - especially from the occasional bump from the other knee. Try a pillow between the knees or a specifically designed pad if you tend to move about in your sleep.

Simple Knee Arthritis Treatments

---

New technology and possible treatment advancements often receive a lot of press coverage but later prove to be ineffective. Everyone is looking for a safe and effective treatment that works for everyone but this is proving elusive.

Osteoarthritis - A Battle of Attrition

---

Osteoarthritis is not an acute condition.

Knee Replacement Surgery - Should You Have Both Done At Once?

---

If you are unfortunate enough to require a knee replacement on both legs, occasionally surgeons will offer to do them simultaneously. This is a big decision to make as it is obviously harder to rehabilitate when you don't have a "good" leg to rely upon.

Why would anyone do this?

Well, there are some advantages. The total recovery time is usually much quicker having them done together than the total of two separate occasions. This makes it an attractive proposition for people with a hectic schedule.
You will only have to have one anesthetic, although it will be of significantly longer duration. It is also likely to cost much less than two separate surgical interventions.

The main problem is a more difficult initial phase of the recovery. For this reason surgeons pick their candidates carefully.
Simultaneous total knee replacements will only be offered to low risk patients. They need to be free of upper limb problems due to the increased initial load on the arms when ambulating. Social factors are important also. Living with an able bodied partner in level accommodation is easier than living alone on the 5th floor with no lift. Medical complications and risk factors such as cardiovascular disease, diabetes and obesity will often see a surgeon recommend one knee at a time.

If the possibility of 2 knee replacements is offered to you, discuss it with your family,and consider how much support you will receive in the short term.

There are benefits to be had, but they are best suited for highly motivated, low risk individuals with a good support network.

Knee Arthritis Pain Medication

---

When you are relying on medication to get you through the day it is important to have a good understanding of what is safe. There is no substitute for trained medical advice that is specific to your medical history. None of us are the same and some drugs work better for some people than they do for others.

Again, having a basic understanding can help you ask the right questions.

Paracetamol is a common arthritis drug. Many people do not give it credit as it is readily available over the counter but studies have shown it to be effective in treating arthritic pain. It has relatively few drug interactions and side effects but it is important to stick to the recommended amount as the overdose level is not particularly well distanced from the therapeutic dose.

NSAIDs or Non Steroidal Anti-Inflammatory Drugs are also typically used to combat arthritic knee pain. Many of these drugs are also available over the counter. They do have some common side effects to be aware of such as exacerbation of asthma and gastrointestinal tract bleeding. They should always be taken after food for this reason. Aspirin is a member of this family of drugs. It is usually safe to take these drugs in combination with paracetamol.

Opioids are another category of common knee arthritis medications. Codeine (a.k.a. Tylenol 3) is often sold as a combined preparation with paracetamol. Codeine is a strong pain killer but can have serious consequences if overdosed and can cause constipation even at recommended levels. Care should be taken combining any codeine product with paracetamol as it is so common for the codeine tablet to contain paracetamol that any additional paracetamol can lead to overdose and liver damage.

If you are not happy with the relief your current analgesia is delivering, discuss your options with your physician or pharmacist. Get specialist advice as the interactions between drugs are extremely complicated and your personal medical history needs to be taken into account. Some drugs can be combined to give extra relief but this process needs to be overseen by a professional.

Waiting for a Total Knee Replacement?

---

Unfortunately, for many people it will eventually get to the stage where there only thing that is going to help is a total knee replacement ( also called a total knee arthroplasty).

It is not uncommon for there to be a waiting period between when the decision is made and when the operation occurs. This may be a matter of weeks or, in the case of public health systems, many months.
Once you have agreed to a knee replacement your next question should be: What can I do between now and the surgery?

1) Remain as active as possible: Don't cease all painful activity while you wait. Continue as best you can despite the pain. Decreased activity can lead to loss of muscle strength and increased knee stiffness.

2) Work those quads: The stronger your quadriceps muscle, the easier it will be for you to recover from the surgery. Even if your wait is only a few weeks, improvements can be made.

3) Educate yourself about Deep Venous Thrombosis, a potential complication of surgery. Learn what you need to do to decrease your risk. This link goes to my article on DVT

4) Prepare your house: Remove trip hazards such as rugs. Remove clutter. Do any jobs that will be difficult after your operation.

5) Practice Crutches: If you have never used crutches before, consider learning how to uses them BEFORE your operation. Try stairs with crutches with and without a rail.

These are all simple, easy things to do and they can make your recovery much more pleasant. Don't waste the time before your operation - use it to your advantage.

Unicompartmental Knee Replacement

---

What is the point of replacing only half of the knee?

Why do Knee Replacements hurt more than Hip Replacements?

---

Although not always the case, most people who have had both a knee and hip replacement report that the knee is the more painful.

There are a few reasons for this, the main one being the location of the incision.

There are multiple ways of approaching a hip replacement but all of them result in the incision being 'out of the way'. A knee replacement has the incision straight down the front of the knee. This has an effect on the rehabilitation.

To prevent the knee from stiffening, the knee must be quickly exercised. This means bending the knee and stretching the skin around the incision. This is responsible for a lot of the post-operative pain. After a hip replacement, you are not required to do movements that stretch the scar, in fact you are told to avoid them.

This is why I tell people you can be a little lazy and do OK after a hip replacement, but to get a good result from a knee replacement, you are going to have to work. The pain is something that gets in the way but should be seen as a temporary obstacle to years of pain free walking.

You should be going into a knee replacement operation focused and motivated. It will be a few weeks of toil for the greater good. I have always found that those who have put up with the pain of an arthritic knee for years manage with ease. At least this pain is because of an operation that is going to help. That is much easier to deal with than the pain of arthritis that gains you nothing.

Alternative Supplements - What else is there besides Glucosamine and Chondroitin?

---

As the evidence mounts that Glucosamine and Chondroitin are not going to help everyone, are there other supplements out there that may help relieve the pain of knee arthritis?

Knee Braces for Arthritis - Can you fit them yourself?

---

That depends....
When you buy a brace from a regular store the extra price covers things such as fitting and face to face instructions. You need to weight up the savings versus the loss of the extra service when buying online.

If a shop doesn't offer fitting then you will be much better off buying on the internet. The Brace Shop is a good place to get an idea of what is available.

Basic Exercises for Severe Osteoarthritis

---

The big problem with exercising for severe arthritis is that everything hurts and seems to make things worse.  You quickly become discouraged and give up. Sound familiar?

Squats causing pain - What are you doing wrong?

---

Building up the quadriceps muscles protects the knee joint, slows the progression of osteoarthritis, and can decrease pain.