What is Osteoarthritis of the Knee

What is osteoarthritis of the knee? Dr. Jeffrey Rosen: Osteoarthritis is a disease process that involves the breakdown of cartilage inside joints of the body, through progressive wear and tear and breakdown of the cartilage, you lose the cushioning effect of the cartilage inside the joints. Dr. Stanley Dysart: It's a disease where the joint actually changes. The cartilage degenerates, the lining of the knee joint often thickens and the bone changes, the contour of the bone change, you develop cysts, you develop spurs, in other words you have a joint which is no longer the joints you had before you got the condition. Dr. Jeffrey Rosen: 46 million people in the United States of America were diagnosed with arthritis or chronic joint related pain. In 2030 that number is predicted to be 67 million people in the United States. Dr. Stanley Dysart: It's the most common form of arthritis worldwide. Dr. Jeffrey Rosen: The projected cost of arthritis to society and the numbers that are increasing over the next 20 years are largely attributed to the growing and aging baby boomer population. Dr. Stanley Dysart: It's more dynamic than that. Yes, aging is a risk factor for arthritis, but there are other risk factors that are very common, such as obesity, such as trauma and there is a large genetic component to the disease, and I say disease because the thought was previously there was a wear and tear process, but that's not very accurate. It's actually a disease process, that effects all aspects of the joint and there are multiple causes. Dr. Jeffrey Rosen: The knee joint is one the most commonly affected joints that people come into an orthopedist office complaining about arthritis related pain. And the primary reason is, we don't give our knees a rest, we are on our knees, all day, everyday. Dr. Stanley Dysart: It is subject to multiple stresses during the day. It also gets major stresses in the form of injury and other disease processes. Dr. Jeffrey Rosen: We think about carrying our body weight around, but when you add physics equations to the problem getting in and out of a chair, running up and down the stairs or jumping up and down on your knees, actually you're carrying multiples of your body weight around. 5 times, 10 times your body weight depending upon the activity that you're doing. So that a weight gain of 10 pounds on an a knee joint could be equivalent to 100 pounds of extra weight carried on the knees depending upon the level of activity that you are performing. Dr. Stanley Dysart: Diet and exercise play a critical role in the treatment of osteoarthritis. As you are aware, 60% of adults in this country are overweight and 30% are obese and those numbers continue to rise and we know that obesity is a risk factor for osteoarthritis and we know the heavy patients often have more pain. So, you take a patient who is overweight you get them to lose weight, you get them on an exercise protocol and many have less pain, and many do much better when you combine that with other treatment modalities. We also know that quadriceps weakness or weakness of the leg and knee muscles are associated with osteoarthritis. It seems that weakness may precede osteoarthritis. So exercise, the proper diet and weight reduction if you're overweight are all critical aspects in the treatment of osteoarthritis. Dr. Jeffrey Rosen: You should think of the muscles around the joint, they are shock absorbers in a car, and the stronger and healthier they are, the more they help protect the inside of the joint from the everyday forces of walking around and getting up and down stairs and hills. It's also important that flexibility training be performed in order to prevent the stiffness that comes in association with the osteoarthritis disease process. Dr. Stanley Dysart: There are patients I see that are overweight and they have arthritis. In that subset you definitely want to have an exercise, but the right exercise is very important. You don't have them run, you don't have them jog, and you don't have then do things that heavily impact the joints and that seems to make sense. But I get many patients that want to run. So I do exercises that are low stress to the joints but enable them to exercise, like walking, like stairmaster, like elliptical, these type of exercises don't heavily stress the joints but you get what you need to increase the burning of your calories. Dr. Jeffrey Rosen: Many times we have to deal with patients who seem to be stuck between a rock and a hard place, because in order to exercise, they need to use joints that are painful when they use them. It's very important to consult a doctor who may refer them to a physical therapy specialist to help get them going and get them moving. If a patient is at the point where they cannot engage in a regular physical therapy or exercise program, because their joints are so painful, then they may need to seek further intervention. Dr. Stanley Dysart: I don't think arthritis is preventable. Previously it was thought about being a process of wear and tear. But we now know that it's not quite accurate. Arthritis is actually a disease that has a certain process that involves aligning of the joint, the cartilage and the bone. And the bone actually changes. You get spurs, you get cysts and you get a change in the contour. Dr. Jeffrey Rosen: Although we can't stop of the progression of the disease, we can slow that progression down through proper nutrition and diet, regular exercise, trying to maintain an ideal body weight and minimizing the trauma and impact on our knees, and by keeping what we call healthy joints or healthy knees through good and proper muscular training. Dr. Stanley Dysart: Well, you can modify the processes that create those changes, perhaps it is. And that seems to be the holy grail of the problem. Dr. Jeffrey Rosen: The one thing I would tell patients who are recently diagnosed with osteoarthritis is to understand that there are treatments available and that they need to consult their physician who takes care of their primary medical care, who may refer them to a muscular skeletal specialist, to discuss all of the available treatment options. Dr. Stanley Dysart: I'd also want them to note that they have to participate in their own treatment. If overweight, lose weight, if they aren't exercising, exercise, if their dies is inappropriate, change their diet. If they'll contribute to their own treatment, the results of their treatment will be much, much better than if they don't.