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.

Around the world, scientists are all looking for the 'Holy Grail' of osteoarthritis treatment - the ability to re-grow articular cartilage.

The bad news is that despite much effort, we are still some way off a simple solution.

Autologous Chondrocyte Implanting is currently being used to treat areas lacking articular cartilage. This involves multiple operations. Firstly some cartilage cells are harvested via key hole surgery. These are grown in a laboratory before being implanted to cover the defect in the second procedure. Results vary depending on the size and location of the original lesion. It is also costly, and has a lengthy rehabilitation.

Scientists are looking for a simple way to re-grow cartilage. One that can be administered via injection or a single operation.

A new study out of the U.S. has had some promising results using a nanofiber gel in combination with a microfracture technique. The success has so far only been achieved on animal models but it offers hope for the future. This type of treatment is minimally invasive and just what we are looking for. Lets hope the follow up studies are positive as well.

See the full article here.

Knee Cartilage or Meniscus?

Is knee cartilage the same as the meniscus?

This is a common area of confusion when discussion knee problems with a doctor. The confusion is due to doctors using different terms to everyday people.

From a doctors point of view, you have both in your knee. Hopefully anyway.

What is a meniscus?

You have two menisci in each knee. One on the inside of the knee (medial meniscus) and one on the outside (lateral meniscus). Each is a roughly 'C' shaped piece of cartilage that acts as a shock absorber. It has a wedge shape when profiled that helps to contribute to joint stability. The meniscus can be torn by twisting activities and is a common sports injury. This is commonly called a 'torn cartilage'.

What does a doctor mean by cartilage?

To avoid confusion (among themselves only it appears) doctors always refer to 'meniscus' when appropriate, saving the word 'cartilage' for use when discussing Articular Cartilage.

Articular cartilage is the smooth lining of our joints that allows us to move freely without pain, over many years and while weight bearing. As you can imagine, to do this task it is very hard and does not tear like a meniscus. It does however wear away over time or as a result of injury. This wearing the articular cartilage is what we call osteoarthritis.

Are they linked?

Since the meniscus protects the joint by absorbing shock, any injury to it that results in its full or partial removal during surgery increases the risk of osteoarthritis.

These two structurally different types of cartilage work as a team to allow movement and protect the bones of the leg. Losing one or both can have serious consequences.

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.

New research has looked at basic treatments and found some of the simple things are surprisingly effective.

Looking at adults between the ages of 35 and 64 with knee osteoarthritis, the study compared a strengthening program, a self management program, and a combination of both. Participants were followed over a two year period and were tested with variety of outcome measures.

Many people would think that these types of treatment would not significantly help their arthritis but the results showed that all groups improved in every test. The tests included leg press strength, range of motion, balance, stairs, work capacity and reported pain.

We should all start our management of osteoarthritis by implementing the simple treatments that have been shown to improve quality of life. After that we can look for further treatments.

The full research article can be found here

Osteoarthritis - A Battle of Attrition

Osteoarthritis is not an acute condition.

There will be good days and bad, but it is a long term, degenerative condition that needs to be addressed with an appropriate strategy.

As a general rule, the longer a condition lasts, the less likely a "quick fix"exists. A 30 year history of osteoarthritis is not going to be fixed by a pill.

The reason I bring this up is that long term diseases take long term commitment to influence. You do not have to accept the inevitability of osteoarthritis, but you have to realize that to alter the course of this disease, long term lifestyle changes are required.

There are many treatments that claim to help osteoarthritis, but you will find that the non-surgical ones that have been shown to help take time to show their benefit. Weight loss and quadriceps strengthening increase mobility and decrease pain but usually take a minimum of 6 weeks to take effect.

The "take home message" here is that you can have a positive effect on your knee arthritis but you need to get serious and treat it like a job. Sign yourself up for two months of hard work then reassess your condition. I think you will be pleasantly surprised.

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.