From the ArcaMax Publishing, Lifelong Health Newsletter:
http://www.arcamax.com/news/lifelonghealth/s-419481-951103
Almost half of all U.S. adults and nearly two-thirds of obese adults
will develop painful osteoarthritis of the knee by age 85.
Osteoarthritis of the knee is more frequent after the age of 50, but
can occur at any age. On occasion, it is precipitated by an injury,
but more commonly it occurs as a result of a lifetime of wear and
tear. It can lead to a great deal of disability, interfering with
mobility, increasing the risk of falls, contributing to deconditioning
of the muscles, and markedly impairing quality of life.
For most adults, the presenting symptom is pain, which is made worse
by movement. As the disease progresses, the knee can swell and become
deformed. This condition can be very painful and difficult to manage,
prompting many patients to look to arthroscopic surgery as a solution.
However, new research indicates that the minimally invasive procedure
may not be as beneficial as once thought.
Thanks to magnetic resonance imaging (MRI), a detailed evaluation of
the abnormal knee is possible. In many cases the knee exhibits loose
fragments, the cartilage is irregular and a torn meniscus is
frequently found.
In patients who continue to have pain despite treatment with
analgesics, arthroscopic surgery may be recommended. The procedure
involves inserting a flexible fiber-optic scope and other small
instruments through a tiny incision in order to remove loose material
in the knee, to smooth out irregular and damaged cartilage and to
remove bone spurs. Often a torn meniscus is repaired.
Although arthroscopy's efficacy is controversial, there is a general
feeling that arthroscopy greatly relieves symptoms and reduces the
need for a total knee replacement.
In the past few years, this conventional wisdom has come into
question. Two research studies recently published in the New England
Journal of Medicine indicate that the value of arthroscopic surgery is
questionable.
In the first paper, a group of Canadian orthopedic surgeons,
rheumatologists and physical therapists treated 178 patients with an
average age of 60 who had moderate to severe osteoarthritis. All
received appropriate pain management and physical therapy. Eighty-six
of the patients also received arthroscopic surgery. After two years,
the two groups experienced equal improvements in pain, mobility and
stiffness. Based on these results, the researchers maintain that
arthroscopic knee surgery adds no value to the treatment of patients
with moderate to severe osteoarthritis.
The second study raised questions about the effectiveness of
arthroscopic surgery in repairing a torn or damaged meniscus.
Researchers performed an MRI of the right knee of 1,000 subjects
between the ages of 50 and 90. Thirty-five percent of participants had
significant meniscal tears that increased to more than 50 percent
between the ages of 60 and 70. The tears were more common in men.
Remarkably, 61 percent of those with significant tears reported no
pain at all even when clear evidence of osteoarthritis was present.
Simply put, the tear in the meniscus may not be related to any
arthritic pain and therefore, arthroscopic surgery will likely be of
little value in treatment.
Based on this information, it seems clear that for patients with
osteoarthritis of the knee, pain management should involve
medications, physical therapy and exercise. Initial treatment involves
the use of analgesics, particularly acetaminophen (Tylenol) and
nonsteroidal anti-inflammatory drugs (NSAIDs -- Motrin, Aleve, Mobic,
Celebrex). Ideally, analgesics should be taken on schedule, as it is
much easier to prevent pain than to relieve it. Medications must be
combined with physical therapy and later with exercise (walking and
strength training). For older adults with knee osteoarthritis,
engaging in moderate physical activity at least three times per week
can reduce the risk of arthritis-related disability by 47 percent.
Osteoarthritis is more common in overweight adults. Weight loss of as
little as 11 pounds reduces the risk of developing knee osteoarthritis
among women by 50 percent.
While there is little need for arthroscopic surgery, partial or total
knee replacement remains a mainstay of therapy for those patients in
whom pain is continually present and unrelieved by pain management,
movement is very difficult and quality of life is poor. There is no
question that this operation, done under the right circumstances, can
be very successful. Remember, though, that appropriate medical care
combined with exercise and weight loss may prevent the need for a
major surgical procedure.
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Dr. David Lipschitz is the author of the book "Breaking the Rules
of Aging." To find out more about Dr. David Lipschitz and read
features by other Creators Syndicate writers and cartoonists, visit
the Creators Syndicate Web page at www.creators.com. More information
is available at www.drdavidhealth.com.