What is an arthroscopy?

Arthro is a prefix meaning joint. It is from the Greek word for joint, 'arthron'.

The suffix '-oscopy' mean to look inside.

Put together you have 'looking inside a joint'. Occasionally, an arthroscopy is used purely for diagnostic purposes and this literal definition stands true. Usually however, the surgeon does more than just look inside, they take action and address any pathology found. Today, the term arthroscopy refers to any procedure performed using small incisions and an arthroscope.

During an arthroscopy, a camera is placed into the joint via one incision and the tools to perform the surgery via another. Arthroscopy is also known as "key hole surgery" due to the small incision size.

The small incision means less trauma to the joint and quicker recovery times. It is also considerably less painful compared to an open surgical procedure. Most arthroscopies are day cases, with the patient able to return home that night.

The knee is the most common joint to be operated on via arthroscopy. Meniscal tears are the main indication for arthroscopic surgery. They can be trimmed back to a stable base, retaining the healthy meniscus. This has a much better result than the historical treatment of an open total menisectomy.

Because of the small incisions and instruments used, there is a limit to how much can be done via arthroscopy. Despite this, even when a larger incision is required, surgeons now do as much as possible with the arthroscope before resorting to traditional methods.

The many benefits of arthroscopy means that if it is possible to do all that needs to be done, it will be done that way. Less pain and swelling, shorter stay, and decreased risk of infection are the positives, the only limits are what you can achieve through such a tiny incision - often so small it doesn't require stitches, tape may be enough.

Unfortunately you can't do total knee replacement via arthroscopy - you can't fit the prosthesis through a 1/4 inch incision. Who knows what the future holds, but for now arthoscopy is a highly efficient way to do minor orthopaedic surgery.

How to Lose Weight with Knee Arthritis

There is a large amount of evidence that proves losing weight decreases knee pain in those suffering from osteoarthritis.

Unfortunately, it is the pain itself that is usually responsible for weight gain.

It is natural to want to avoid pain, so arthritis leads to decreasing activity levels. This often happens slowly at first but before you know it the pounds are on and they don't want to go anywhere. These extra pounds put more strain through the knee and lead to more pain, completing the vicious cycle.

So how do you break out of the downward spiral of pain and weight gain?

Firstly lets start with a good amount of common sense. Weight loss is difficult with two fully functional legs that are pain-free. In order to achieve weight loss with arthritis you need to formulate a plan and stick to it.

Weight gain occurs when the fuel going into us is not matched by the work that we do. To lose weight we need to use up more energy than we provide ourselves. This needs to be achieve by limiting what goes in, and increasing the work we do, removing stored fuel from our bodies.

A quick word on dieting: What is required is a lifestyle change towards healthier food. You can forget fad diets or anything targeting rapid weight loss. Health Magazine published a list of the Top 10 Healthiest Weight loss plans. A panel of doctors, scientists and nutritionists rated over 60 programs to find the overall best. The winner was the Structure House weight loss program that educates to achieve lasting results. As you can pick up the book for around $10 (see link in side panel under 'I recommend') this should be the limit of your outlay on the dieting side. Anything costing hundreds of dollars should be avoided as it is usually all marketing and no science.

OK, so you are on the way to eating better. Now the hard part. How do you exercise with knees that cause so much pain?

Here are my tips:

• Avoid any exercise that increases your pain. We want to increase overall activity. If you have a major flare-up and don't walk for 2 days you will do less not more. You will not be able to 'push through' the pain. It doesn't work that way.
• Start gently. Measure how much you walk each day over a few days (a pedometer is great for this) then gradually increase. You don't have to start off with any specific knee exercises. Just try and walk more.
• Don't be rigid in your activity. You want the average activity to go up each week. If you are having a bad day with strong pain, take it easy and make it up when things are better. Forcing yourself to walk a mile on a bad day causes flare-ups and usually results in you quitting the exercise program.
• Consider water. Exercise in water reduces stress on weight bearing joints. This means you can do more work without increasing pain. Even if you can't swim, waist deep water has some benefit, chest high water more.
• Work the arms. Although increasing thigh muscle strength is of benefit to knees also, for the purpose of losing weight, your body doesn't care where the work is done. Burn off more energy than you put in and your pounds disappear.
• Use whatever helps. If your pain is less in the middle of the day do your exercise then. If painkillers are effective for you, do your exercise an hour after taking your pills. If you are stiff and in pain first thing in the morning avoid exercise at this time and ease yourself into the day. Consider a knee brace or support if it helps you do more.

These are just a few ideas to get you started. It is also a great idea to combine a weight loss program with specific exercises to build the quadriceps muscle as this also helps decrease pain. Finding the right one (that doesn't cause a flare-up) takes a bit of trial and error. A Physical Therapist is helpful here to guide you through the process. The will know 20 or 30 different ways to exercise your quads. One of them will work for you.

Now we have covered food and exercise all you need is a large dose of motivation with a bit of commitment thrown in. Always the toughest two ingredients to sustain.

High Tibial Osteotomy

There is plenty of information around on total knee replacement but relatively little on the common surgical precursor, the high tibial osteotomy.

Osteotomy is a medical term meaning 'to cut a bone'. High tibial refers to its location, just below the knee joint. So this operation's name pretty well describes what happens. But why cut the bone?

Osteotomies are done to change the alignment of a bone and hence the angle of a joint. If your knee is bow-legged, you are taking all of your weight through the inside half of your knee. This leads to much greater rates of wear and much more pain. A high tibial osteotomy aims to straighten out your leg to evenly share the load between the inside and outside of your knee.

The are two main types of osteotomy for knee osteoarthritis. Opening wedge and closing wedge.

In an opening wedge, a cut is made in the tibia and the two sides are separated. The wedge shaped space is filled with a bone graft.
In a closing wedge, two cuts are made and a wedge shaped piece of bone is removed. The two edges are then brought together creating the desired change angle.
Both types of operation then require the bone to be fixed, usually with a plate and screws.

A high tibial osteotomy does not make the joint unworn so is looking to decrease pain rather than completely relieve it. The operation is seen as a way of delaying a total knee replacement in those considered too young. It is not suitable for everyone so individual cases need to be discussed with your surgeon.

It works for me!

Over the years I've lost count of how many people have come up to me and said "Have you heard about this?......" and described something that is helping their pain.
I tell everyone to remember that pain is a personal experience. My simple answer has always been - if it helps, go for it.
It doesn't matter what it is that helps, if it works for you and you have less pain, it can't be a bad thing.
The reason governing and professional bodies publish guidelines is that they are looking at what helps large populations and what is cost effective. A positive recommendation does not guarantee the treatment will work for you, just as a negative report does not mean it won't benefit you.
These guidelines help protect consumers from unscrupulous operators who prey on the desparation caused by chronic pain. The guidelines give you a probability that any given treatment will work for you.
If you know something is unlikely to work, you may save that $200 for a treatment with better prospects.
Recent reports have included comparative descriptions. By showing that, on average, hyaluronic acid injections are as effective as NSAIDs, it helps the average arthritis sufferer get the same benefit from the option that costs a few dollars rather than the one that costs a few hundred.

Consensus?

Yet another organization has published their recommendations for treating the osteoarthritic knee.

The Agency for Healthcare Research and Quality - part of the U.S. Department of Health and Human Services - has a paper titled "Osteoarthritis of the Knee: A Guide for Adults"

We now have both the government and the surgeons themselves agreeing on the following:

• Glucosamine and Chondroitin usually do not decrease pain or increase movement


• Viscosupplementation Injections (Hyaluronic Acid) have little effect


• Arthroscopy has no lasting benefit for the arthritic knee (unless there is a co-existing condition such as a torn meniscus or loose body).

The level of evidence continues to increase and although not 100% conclusive against these treatments, it is now apparent that they will not significantly benefit arthritis sufferers as a group.

Remember, that all of the reviews I have mentioned recommend the 3 proven treatments:

• Exercise


• Weight loss


• Painkillers

They are not very exciting but they have repeatedly been shown to work.

The good news is that this disease is worth billions of dollars worldwide. This means there is a massive incentive for orthopaedic companies to research new treatments.

Fingers crossed there is a break through soon.