Dear Dr. Garner,
I have been diagnosed with arthritis of the knee. My right knee hurts so much that I limit the amount of walking I am doing. Is there anything that might help me other than Motrin or Advil?
Bum Knee in Bensonhurst
 
Dear Bum Knee,
Your problem is a common one, and one that most people get relief from anti-inflammatory medications, such as Motrin or Aleve.

Arthritis, or more formally, osteoarthritis, is a disease the causes the breakdown of the cartilage (shock absorbers), that protect the ends of bone.

It can appear in any joint, but the knee is particularly vulnerable, because it is a weight-bearing joint that undergoes daily wear and tear.

The key words in the above sentence are “weight bearing.” 

One of the most overlooked treatment options is to lose weight, even only five pounds. This weight loss, regardless of the weight you started with, gives pain relief similar to taking strong medications such as narcotics.

The cartilage that I mentioned above helps to keep the bones lubricated and prevents them from rubbing against one another. As the arthritis progresses, the bones of the knee get closer and closer until they rub against one another. This causes a lot of pain, and when it gets to the point of damage, from rubbing against one another, no amount of medication will help eliminate the pain. At this point, surgery is recommended to replace the damaged joint.

New techniques for joint replacement are remarkable, and patients are up and walking in no time. It is really satisfying surgery for the patient, as well as providing the opportunity for a patient to become active and exercise once again.

Before getting ahead of ourselves with surgery, there are treatment options short of surgery that will benefit most people.

Regular exercise is important, because the muscles surrounding the knee are prone to become very small, when not used. For those who can’t walk, swimming and cycling are good options.

Using weight machines, which are available in all gyms, can strengthen the muscles surrounding the knee. Often, strengthening the quadriceps muscle (the one on the front of the thigh) cures much of the knee pain.

Wearing the right shoes is important. Well-cushioned shoes can reduce the impact on your knees as you walk.

You can also take weight off the knee by using a cane or other walking device.
A physiotherapist is a key partner in combating knee pain. He or she can show the correct way to exercise, as well as to apply tape and support to relieve pain. I strongly suggest you ask your doctor about a referral. There are many excellent gym/therapy facilities, and they are usually covered by insurance. They definitely help to speed up the recovery process.

Genetics can often factor into developing arthritis of the knee, and it may be common in certain families. Unfortunately, there is not much that can be done about preventing this type of arthritis, but it can be treated.

You mentioned that Motrin-type drugs have not been helpful. Actually, Tylenol is the pain relief pill of choice because it is effective and easy on the stomach.

I strongly suggest against narcotics, which are habit forming and have been implicated in falls, as people are very sleepy after taking them.

Steroids may be helpful as an injection into the joint, but require repeated use to relieve the inflammation and there are many harmful effects with prolonged usage, either orally, or by repeated injections.

Glucosamine is a supplement that may help relieve arthritis pain. While it has not been proven to help in major studies that have been performed, some people, including doctors, swear by it. I suggest you speak with your physician to learn more about it.

A new treatment is available which has produced wonderful results for some patients. It is known as viscosupplementation. A common brand name is Synvisc, which you may have heard of.

In this treatment, your doctor injects a lubricant material into the joint. The exact way it works is not clear, but it seems to improve the functioning of the natural lubricants that the knee has. The injections are usually given in a series, and there is marked improvement of cushioning of the knee joint and lubricating effects of the natural fluid in the knee that has been damaged by arthritis.

It is injected directly into the knee joint over the course of three doctor visits, one week apart.

For maximum relief, one must receive all three injections.

Some patients may feel better after the first injection, but most experience the greatest relief eight-to-12 weeks after beginning treatment.

Possible Surgery

In patients with severe pain who do not respond to conservative measures, surgery may be considered. As noted above, there has been considerable success with joint replacement, and a new technique recently introduced involves partial joint replacement. This technique is tailored to the specific needs of the patient and may yield superior results to traditional knee replacement.

In summary, the following are treatment options for arthritis of the knee:

• Weight loss – most important, yet least commonly performed treatment.

• Activity Modification – limit certain activity, and learn new exercise methods, such as swimming.

• Get a referral to a physical therapist – this is essential to maximize benefits of exercise and weight training.

• Walking aids – using a cane in the hand opposite the affected knee will help decrease the demand placed on the joint.

• Medications – remember Tylenol is the first choice.

• Controversial medications – Glucosamine helps to keep cartilage healthy and may help repair damage. No definitive studies back this up, but many doctors (myself included) find it both personally helpful, as well as useful in  patients.

•  Synvisc – may delay the need for surgery and give rapid improvement of symptoms.

• Surgery – knee replacement, both total and partial. Another possibility is arthroscopy during which a doctor inserts a tiny camera into the knee and cleans up scars and torn cartilage.

 I think the key to dealing with knee pain is to have access to the right doctors including a rheumatologist, physiatrist (rehab physician), and physical therapist. It is also important to have access to a gym or rehab center.

I hope this answers your question and that you are shortly back on your feet, exercising and enjoying life.

Remember, that our next Ask the Doctor TV Show on The Prayer Channel will be seen at 8 p.m. on Tuesday, April 1. That’s Ch. 97 on Time Warner and Ch. 30 on Cablevision.

Have a great week and be well.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He is the host of The Prayer Channel’s call-in show “Ask the Doctor.”