Dr. Ebraheim’s educational animated video explains the condition of knee pain and arthritis - total knee replacement.
This video describes knee pain, knee examination, knee diagnosis and treatment .knee pain relief may need surgery .this video describes knee arthritis animation, knee arthritis symptoms, diagnosis, x rays and treatment
Knee arthritis treatment will include physiotherapy, knee injection and total knee replacement.
DR Nabil Ebraheim UTMC Toledo.
The cartilage of the knee is complex and it is made of elastic comprehensive structure.
The normal articular cartilage is called hyaline cartilage; it provides a smooth, gliding surface to help the motion of the joint.
There is about 2cc of the synovial fluid inside the knee that helps in the motion and lubrication of the joint.
Between the hyaline cartilage which is called the articular cartilage you can see the meniscus, the lateral and the medial, the meniscus is a shock absorbing cartilage or cushion between the articular cartilages.
The hyaline cartilage has 4 layers:
1- The superficial layer.
2- The middle layer.
3- The deep layer.
4- The calcified layer
After the calcified layer you find the bone.
These cartilage cells are supposed to live forever.
Good cartilage cells are sterile; they can’t make more cartilage if these cartilage cells are destroyed.
If the cartilage is subjected to excessive wear, trauma, injury, overuse, excessive weight or improper alignment, then the cartilage will wear away leaving the bone to rub against bone.
The cartilage doesn’t have the ability to heal itself by hyaline cartilage, but sometimes it can heal itself by inferior type of cartilage called fibrocartilage, especially if the area that needs to be repaired is small.
What is the treatment of the arthritis of the knee?
1- Medication: people respond differently to medications, the doctor select the type, dosage and duration of the treatment, the medication has to be safe and effective.
Ask the doctor about the side effect of the medication.
There are several medications for example: NSAIDS.
2- Losing Weight: it’s advisable to lose about 5% of the body weight, especially if the BMI was above 25.
3- Low Impact Physical Therapy: such activities like swimming or cycling, adds less stress on the knees, life style modification to protect the knee will slow the progress of the arthritis, there is a strong evidence that physical therapy will help the patient.
The physiotherapy will decrease the pain, will improve the function, increase the strength, the range of motion; physiotherapy should be individualized with program that meets the patient’s needs, the life style, and expectations.
4- The physician will also use intra-articular injection of steroids; viscosupplementation, or hyaluronic acid, injection will relieve the patient’s pain and disability.
5- Other injection methods:
- Gene therapy
- PRP
- Growth factor
- Stem cells
6- Other treatment options:
- Acupuncture
- Massage
- Glucosamine
- Chondroitin sulfate
- Valgus directing brace
- Wedges in the foot
- Arthroscopic debridement and lavage
7- Assistance devices:
- Cane
- Shock absorbing shoe
- Shoe inserts
- Knee sleeves
- Support brace
8- Arthroscopy shouldn’t be done in arthritis unless there is loose body or meniscal tear causing mechanical symptoms of recurring lacking, catching, swelling and pain.
There are some guide lines from the American Academy of Orthopaedic Surgeon AAOS: these guidelines are suggestive, and the treatment of the arthritis patient should be individualized and based on:
- The doctor’s clinical judgment.
- The patient’s clinical situation.
- The evidence tested and published.
It is a combination of all of these factors.
If it works for you, it may not work for your neighbor.
So basically arthritis can be minimal, and anything can help the arthritis ion this situation.
But if the arthritis is moderate then the physician has many options for treatment and none of those options are predictable in the result.
When the arthritis is severe, total knee is the most predictable option for treatment of arthritis.
You have to reduce the pain and improve the function of the knee.
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