By the time we’re 50, our knees have carried us more than 75,000
miles. Most of us don’t give our knees a second thought—until
degenerative arthritis takes its painful toll and limits our day-to-day
Degenerative knee arthritis (osteoarthritis) occurs when the knee joint’s
cartilage — a smooth, slippery substance that lines the ends of
bones — wears away.
“Healthy, normal cartilage allows the ends of bones to roll and slide
easily against each other during motion. But too much wear on the cartilage’s
surface leads to its deterioration, similar to how tread on the tires
of a car wears down over time,” orthopedic surgeon
Michael Repine, MD, of Boulder Medical Center explained during a free health lecture held
on June 20 at the Boulder Jewish Community Center.
“Osteoarthritis of the knee is this mechanical wearing down of the
cartilage surface. When the cartilage is thinned or absent, problems such
as pain, swelling, instability and limited motion occur,” Dr. Repine said.
Dr. Repine said the symptoms of knee osteoarthritis can include:
• During weight-bearing activities
• While sleeping at night
• Located across entire knee or focally to an area
• Usually slow in onset, with a gradual increase
• Warmth in the joint
• Swelling or stiffness, which can be more pronounced after a period
LIMITED MOTION, GRINDING AND POPPING
• Loss of flexibility or restricted range of motion in the joint
• Overall weakness, causing the knee to give way or buckle
• Creaking, crackly or popping sounds during movement
Non-Surgical Treatment Options for Knee Arthritis
According to Dr. Repine, physical therapy is almost always the first step
in treatment, with the goal of reducing pain and improving range of motion
and strength. He also described other non-surgical treatments and the
pros and cons of each:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Pros: Decreases inflammation and pain.
• Cons: When used long term, there is a risk of gastrointestinal bleeding.
• Pros: Many sufferers find nutritional supplements helpful such
as glucosamine and chondroitin.
• Cons: Too many of these products don’t measure up to their
claims and data on proven effectiveness is somewhat inconsistent. None
have passed FDA testing to prove effectiveness.
“Since there are thousands of supplements on the market, conduct
your own personal trial study. Take a supplement for awhile to see if
it works or not," said Dr. Repine.
• Pros: Relatively well-tolerated procedure that offers very predictable
reduction in pain. It often “buys time” for patients whose
joint isn’t quite ready for total replacement.
• Cons: The injection must be placed carefully and can soften the
cartilage with repetitive use. Also, it tends to mask symptoms.
Viscosupplement injection (hyaluronic acid)
• Pros: Protects any remaining cartilage and helps improve the biochemical
environment of the joint, offering reliable reduction in pain.
• Cons: None with appropriate patient selection. However, there’s
a small potential for a reaction with repetitive administration.
Stem cell therapy
• Pros: Anecdotal reports appear promising when osteoarthritis is
• Cons: It's expensive and uses are still being heavily researched.
Surgical Treatment Options
Still, even after taking these steps, many people with knee osteoarthritis
look to surgery as a way to get relief from bone-on-bone pain and resume
the physical activities they love.
Arthritis located in a well-defined area is most often treated arthroscopically.
Sometimes cartilage transplantation or resurfacing can also be an option.
“For these surgical treatments to be effective, we must catch the
damage early on, before any secondary bone changes occur,” according
to Dr. Repine.
More advanced arthritis often requires more advanced surgical options,
including Mako robotic-arm assisted surgery for
partial knee resurfacing and total knee replacement.
However, Dr. Repine warned that you shouldn't wait too long to consider
surgery because "you can miss the boat for certain procedures.”
He then went on to explain how BCH's computer-assisted Mako technology
uses a state-of-the-art robotic arm with computer-guided mapping software.
Mako syncs a patient’s preoperative CT scan data to intraoperative
data, providing each patient with a personalized surgical plan based on
their unique anatomy. This allows for the highly accurate placement and
alignment of a knee implant.
BCH’s Foothills Hospital was the first facility in Colorado to offer
Mako total knee replacement.
“It is a real game changer,” Dr. Repine said, “Mako Total
Knee Replacement is the latest and greatest for total knee replacement.
It can offer the potential for a shorter recovery time and more natural
feeling knee for knee replacement patients.”
If you suffer from symptoms of knee osteoarthritis, schedule an appointment with
Michael Repine, MD, by calling 303-440-3036.
Click here to view PowerPoint slides from Dr. Repine’s lecture on “Relieving
Arthritis Knee Pain.”
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