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Saving Knees From Arthritis - Advice From Doctors

New York (Sep 1, 2011)

Drs. Jeffrey Geller and Jeffrey Radecki
Jeffrey A. Geller, left, is an orthopaedic surgeon.
Jeffrey Radecki, right, is a physiatrist.

Whether we play golf or just watch it on TV, practice ballet, hip hop, or tai chi, or just stroll around the block, almost half of all Americans are likely to develop some degree of arthritis in the knees. Both lifestyle and genetic factors can lead to arthritis, a degeneration of the cartilage cushion in the knee joint, said Jeffrey A. Geller, M.D., an orthopaedic surgeon at NewYork-Presbyterian/Columbia University Medical Center. "We're not 100 percent certain what leads to knee arthritis, but it's likely a combination of excessive wear and tear combined with the aging process and some kind of genetic predisposition."

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Risk factors for knee arthritis also include obesity, prior knee injuries or surgery, and a misalignment of the bones, said Jeffrey Radecki, M.D., a physical medicine and rehabilitation specialist at NewYork-Presbyterian/Weill Cornell Medical Center. "Some people are either bow-legged or knock-kneed (called excessive valgus or varus), which increases the load on their knee joint. And when people have certain hip or ankle problems, the forces across the knee may increase, as well."

Well before people reach their 60s, when arthritis symptoms usually start, they can take steps to prevent arthritis or lessen its impact, both Drs. Geller and Radecki said. "I tell people in their 20s to 50s that the best way to preserve their knees for later in life is to lose weight and decrease the load that their knees see throughout the years," said Dr. Radecki. "Losing a pound of body weight decreases the weight on the knee four-fold. This is the best modifiable risk factor we have right now."

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Another important step is strengthening the muscles around the knee and avoiding activities that are hard on the joint, said Dr. Geller. "As people get older they should switch from sports like basketball to lower impact activities like bicycling, spinning, or the elliptical trainer, which strengthen the leg muscles. Stronger muscles there provide support and help compensate for mild to moderate arthritis."

When arthritis develops and begins to be painful, Dr. Geller advises patients that minor knee pain is normal – "that happens with wear and tear," he said. "But if people have uncomfortable pain that lasts for two to three weeks, trouble doing everyday activities, swelling that doesn't go away with rest and ice, or locking of the joint, they should see a doctor." People who are extremely active but can't keep up their activities because of pain should also see a doctor, he said.

A course of physical therapy can be helpful in the early stages of arthritis, said Dr. Radecki. "Sometimes the beginning of treatment involves working with a physical therapist to strengthen the muscles surrounding the knee, improve flexibility, and increase balance." Doctors often combine physical therapy with medication such as non-steroidal anti-inflammatory drugs (NSAIDS) to control the painful episodes, he added.

Aside from knees or arthritis, a television
spot for the hospital with Dr. Geller.

If pain and swelling persist, doctors may turn to treatments that are a little more aggressive. "In patients who develop arthritic flares we can inject either a corticosteroid into the knee," Dr. Radecki said, "which can help with acute flares. Or we can use viscosupplementation, a family of chemicals formulated to replicate the normal synovial fluid of the knee. These can work fairly well for certain patients and relieve the pain and disability caused by their knee osteoarthritis."

For patients whose arthritis continues to progress and who eventually need a knee replacement, there are more options than in the past, said Dr. Geller. "If only part of the knee is affected we can perform a partial knee replacement, inserting a device that addresses just the damaged part of the knee." He added, "Why remove healthy and functional parts of the knee when you can replace just a small part of the knee and get 90-95% pain relief?"

Some people eventually develop arthritic damage that is extensive and affects all parts of the knee. These patients need a total knee replacement, Dr. Geller said. Knee replacements are briefly traumatic, but are continually improving. "Once a patient has recovered from the knee replacement, their quality of life will be significantly better. We've improved the surgical technique as well as the pain control to more quickly get patients back to work, and back to life. A lot of companies are developing replacements that are more anatomic and will be able to preserve more of the natural ligaments," said Dr. Geller. "Those are about three to five years away from being available to patients."

Contributing faculty for this article:

Jeffrey Radecki, M.D., is an Assistant Attending Physiatrist at NewYork-Presbyterian/Weill Cornell Medical Center and an Assistant Professor of Clinical Rehabilitation Medicine at Weill Cornell Medical College.

Jeffrey A. Geller, M.D., is the Director of Minimally Invasive Joint Replacement and the Chief of the Hip Fracture Service at NewYork-Presbyterian/Columbia University Medical Center. He is also an Assistant Professor of Clinical Orthopaedic Surgery at Columbia University College of Physicians and Surgeons.

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