Weight Loss - maybe a better alternative to combat osteoarthritis

First, surgery is only considered when a full trial of conservative measures has been tried. Strengthening of the leg is the most successful method of decreasing knee pain from osteoarthritis. There are many people with bone on bone arthritis who have only minor pain because they keep their weight down and their muscles strong. Strong muscles stabilize the bone and help transfer the weight from the damaged articular surface. Even a 10- pound weight loss can help some individuals, and, when combined with a quad- and hamstring-strengthening program, weight loss is one of the most effective ways of decreasing pain. Proper shoe wear and sometimes shoe inserts decrease the stress to the knee. Increased aerobic exercise, such as swimming, biking, and water exercises, increase endorphin levels and decrease a rthritic pain independent of the muscle improvement. Finally, elastic sleeves help retain heat and help some individuals deal with arthritic pain.

Medication is also a mainstay of conservative treatment. An independent study has shown glucosamine and chondrotin sulfate help 70 percent of people, but the medications are slow in onset requiring six weeks in many individuals to show benefit. They are safer than nonsteroidal antiinflammatory drugs (NSAIDs), but occasionally the medications may elevate a person’s cholesterol level. NSAIDs are faster and are more helpful with acute pain but have more long-term side effects and can interact with other medications. Sodium hyaluronate injections are effective in moderate arthritis. Cortisone is effective for short-term relief especially when trying to deal with an acute painful flare-up or getting a few more months out of a damaged knee; however, regular use does damage the cartilage and has well known proven systemic side effects.

If conservative measures have failed to alleviate the pain, and patients are significantly altering their activity level and lifestyle, they risk becoming weaker and less healthy. In significantly obese individuals, physicians face the dilemma of whether to proceed or wait until medical or surgical intervention brings the patient’s weight into better control. Obese individuals who undergo a successful knee replacement do not lose weight after surgery just by increasing their activity level. Many individuals do not understand this, and feel that they cannot lose weight until they have their knee arthritis pain resolved. Appropriate counseling is needed to educate patients about the greater risk of infection, wound-healing problems, venous thrombosis, manipulation, patellar-tracking problems, and pulmonary embolism with surgery in the obese versus the relief of pain it provides. It is always better to lose weight first with its medical benefits as well as decreased surgical complications.

X-rays documenting arthritic involvement responsive to surgery are the next prerequisite for considering surgery. Traditionally, medical compartment arthritis in the young was treated with bony realignment 20 by tibial osteotomy. There is now a trend to treat these individuals with partial knee replacement because it affords better short- and long-term results. But the question is how young is this true? The cause of medical arthritis may be the determining factor in young individuals, and there is still a place for tibial osteotomy, especially when malalaignment is present.

There is also the evolving question of bilateral versus unilateral knee replacement. Traditionally bilateral was felt to be much riskier but more cost effective. With modern joint camps and better anesthesia management, recent studies have found that in people younger than 80 there may be no greater risk with the exception of greater blood transfusion rates. The risk is 7 percent in a unilateral replacement versus 35 percent in bilateral knee replacement for blood replacement.

Meeting the challenge of helping younger individuals with osteoarthritis of the knee will become a major problem for physicians in the coming years. Hopefully with ac tivity modification, strengthening, weight reduction, and medication we can delay these patients’ need for surgery.