Once you are seen and evaluated, treatment of your condition will be undertaken. Treatment for arthritis initially begins with either aspirin or a nonsteroidal anti-inflammatory medication. Aspirin is an effective anti-pain and anti-inflammatory agent alone; however, the aspirin has to be taken at a certain dosage and frequently to slow proper blood levels to build up. If it is not taken routinely and at the proper dosage, the appropriate blood levels will not build up and it will not work as well as it should. Do not vary the recommended dosage. In recent years, newer medications have been made available for the treatment of pain and inflammation of osteoarthritis. All of them have similar chemical make-up and most, like aspirin, can cause irritation of the stomach.
Your symptoms and the state of your arthritic process will influence the type of anti-inflammatory medication which we will recommend for you. Some people are unable to tolerate some of the antiinflammatories because of side effects but can take others without much difficulty. A different nonsteroidal anti-inflammatory medication may work well for one of your friends but not work for you. The proper medication will be prescribed to you and tailored to your particular condition.
If the anti-inflammatory medications do not give you any significant relief or if you are suffering and having a marked amount of pain and discomfort in your knee, a cortisone injection into the knee may be recommended. When injected directly into the inflamed joint, these cortisone injections usually decrease the swelling of the soft tissues and reduce the accompanying pain. Cortisone can accelerate the generation of the arthritic joint if given on a regular basis over a prolonged period of time. Injections of cortisone should only be used for the relief of occasional problem pain. Fortunately, in many cases, relief of symptoms from a cortisone injection may last for several months following a single injection.
In addition, it is very important with arthritis to maintain the proper body weight. Certainly, being overweight places a significant stress on your joints, particularly the lower body joints which transmit body weight to the ground. Getting down to your proper weight frequently does make the symptoms much less marked and, in addition, can potentially keep you from having to undergo surgery.
Physical therapy is also an important treatment modality. We feel that by strengthening the muscles around the knee, you can improve the general “health” of your knee. In addition, other physical therapy modalities might be helpful in relieving your pain. If pain or discomfort persists despite an appropriate conservative treatment program, surgery may be helpful. There are several different operative procedures which can be performed for osteoarthritis.
The first alternative is arthroscopic joint debridement and shaving of the roughened joint surfaces as well as dealing with possible degenerative cartilage tears in the knee at the same time. This operative procedure can be performed in those individuals who do not have markedly advanced degenerative changes present.
For the ones with more advanced degenerative changes present, larger surgical procedures will be necessary. In the younger individuals who have arthritis predominantly on only one side of the knee joint, an operation known as an osteotomy can be performed. This is where the leg bone is cut and realigned to allow transmission of forces across the good side of the knee. This is an operation that is useful in younger individuals with arthritic knees.
If the arthritis involves the entirety of the knee joint, an osteotomy would not be successful. The only other alternative in an older individual would be a total knee replacement. With the development of synthetic materials, total joint replacement surgery has become a practical solution to advances osteoarthritis. Although the majority of today’s replacements are for the hip and knee, replacements for other joints, such as, fingers, toes, wrists, elbows, shoulders, and ankles are currently being developed.
Do not expect a new joint to perform as well as the one Mother Nature provided. Total knee replacement involves retreading the joint surface with metal and plastic implants. This is done as a last resort in the treatment of your knee condition when all conservative modes have failed. This operation is done primarily to relieve pain and discomfort and improve function. The results have been gratifying, although there are some significant complications which can occur in a relatively small percentage of patients.
The goal with osteoarthritis is to treat each patient individually consisting initially of conservative treatment and if that fails, proceed with surgery selectively tailored to each individual’s situation. In summary, many people with osteoarthritis lead normal and active lives. Medication and physical therapy can help reduce pain and restore movement to stiff joints, If necessary, surgery can be used to improve function of the joints and to decrease pain and discomfort and improve the quality of life. Although osteoarthritis cannot be cured, its symptoms can be managed and the patient can often enjoy a more useful and active lifestyle.
*The information contained in this patient education page is intended to help you and your families/caretakers better understand a particular diagnosis and/or the treatment options available. If you have any questions after reading this, please don’t hesitate to contact Dr. Longobardi’s office at 201.343.1717 for a further explanation.
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