Glossary

There are three basic types of arthritis that may affect the knee joint:

Osteoarthritis (OA) is the most common form of knee arthritis. OA is usually a slowly-progressing degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people.

Rheumatoid Arthritis (RA) is an inflammatory type of arthritis that can destroy the joint cartilage. RA can occur at any age. RA generally affects both knees.

Post-traumatic arthritis can develop after an injury to the knee. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, ligament injury, or meniscal tear.

There are a number of surgical treatment options for knee pain and immobility, including the following:

Arthroscopic surgery uses fiber optic technology to enable the surgeon to see inside the joint and clean it of debris or repair torn cartilage.

An osteotomy cuts the shinbone (tibia) or the thighbone (femur) to improve the alignment of the knee joint.

A total or partial knee arthroplasty replaces the severely damaged knee joint cartilage with metal and plastic.

Cartilage grafting is possible for some knees with limited or contained cartilage loss from trauma or arthritis.

There are also a number of non-surgical treatments for knee pain and immobility:

Lifestyle modifications include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities that aggravate the condition, such as climbing stairs. Many, but not all, people with osteoarthritis of the knee are overweight. Simple weight loss can reduce stress on weight bearing joints, and can result in reduced pain and increased mobility.

Physical therapy and exercise can be effective in reducing pain and improving mobility. An individualized plan can be developed by your physician or a physical therapist. Supportive devices such as a cane, energy-absorbing shoes or inserts, a brace, or knee sleeve can be helpful. A brace can assist with stability and function.

Anti-inflammatory medications can include aspirin, acetaminophen or ibuprofen to help reduce swelling in the joint. Simple pain relievers such as Tylenol are available without a prescription. A more potent type of pain reliever is a nonsteroidal anti-inflammatory drug or NSAID. These drugs, which include brands such as Motrin, Advil and Aleve, are available in both over-the-counter and prescription forms. COX-2 inhibitor is a special type of NSAID that is often prescribed if knee pain is moderate to severe. Common brand names of COX-2 inhibitors include Celebrex and Vioxx. It should be noted that Vioxx was recently withdrawn from the market by its manufacturer.

Glucosamine and chondroitin (kon-dro'-i-tin) sulfate are oral supplements that may relieve the pain of osteoarthritis. These are two large molecules that are found in the cartilage of our joints. Supplements sold over-the-counter are usually made from synthetic or animal products.

Corticosteroids are powerful anti-inflammatory agents that can be injected into the joint.

Viscosupplementation is a method of adding fluid to lubricate the joint and make it easier to move. This fluid is a concentrate of hyaluronic acid, or hyaluronate (hi-a-lou'-ron-ate), a molecule that is found in the joints of the body. Therapy consists of a series of injections designed to change the character of the joint fluid. There is less fluid in a knee with osteoarthritis than in a healthy knee. Three to five weekly shots are needed to reduce the pain, but the pain relief is not permanent. Injections are given for moderate to severe pain. They can be very useful if there is significant swelling, but are not very helpful if the arthritis affects the joint mechanics.

Special medical treatments for rheumatoid arthritis include gold salt injections and other disease-modifying drugs.

Alternative therapies include the use of acupuncture and magnetic pulse therapy. Many forms of therapy are unproven, but reasonable to try, provided you find a qualified practitioner and keep your physician informed of your decisions.

Acupuncture uses fine needles to stimulate specific body areas to relieve pain or temporarily numb an area. Although it is used in many parts of the world and evidence suggests that it can help ease the pain of arthritis, there are few scientific studies of its effectiveness. Be sure your acupuncturist is certified, and do not hesitate to ask about his or her sterilization practices.

Magnetic pulse therapy is painless and works by applying a pulsed signal to the knee, which is placed in an electromagnetic field. Like many alternative therapies, magnetic pulse therapy has yet to be scientifically proven.

Other measures may include applications of heat or ice, water exercises, liniments, or elastic bandages.

Birmingham Hip Resurfacing
When is Birmingham Hip Resurfacing NOT appropriate? The BHR System should not be used in a patient who:

• Has an infection of the body or blood.
• Has bones that are not yet fully grown.
• Has any blood vessel-related disease, muscle-related disease, or nerve-and-muscle-related disease that will prevent the artificial hip joint system from remaining stable, or that may prevent following instructions during the recovery period.
• Has insufficient bone health or strength due to:
• Severe bone loss (osteoporosis) or a family history of severe bone loss.
• Bone loss, such as avascular necrosis, affecting more than half of the femoral head.
• Multiple fluid-filled cavities (cysts) greater than one centimeter in the femoral head.
• Note: a test, such as DEXA scan, may be needed to determine the level of bone loss.
• Is female and of child-bearing age. It is unknown whether metal ions released by the device could harm an unborn child.
• Has a kidney with significantly impaired function. The patient will need testing (creatinine, GFR, BUN) before and/or after surgery to test the kidneys.
• Has had reactions to wearing metal jewelry (metal sensitivity).
• Has a suppressed immune system due to diseases such as AIDS, or is receiving high doses of corticosteroids.
• Is severely overweight.

Your doctor will need complete information about your overall health to determine whether the BHR system is right for you. You should tell your doctor about any health problems, even if they are not related to the hip, because some medicines and diseases (such as diabetes) can affect kidney or bone strength [1].

More long-term research is needed to evaluate the potential risks and benefits of hip resurfacing. Some studies have raised concerns about a higher failure rate with resurfacing, which requires additional surgery. Although hip resurfacing may be attractive because it preserves more bone, this potential advantage must be weighed against the potential risks of additional surgeries. Your x-rays, MRI, and other images provided will be reviewed on a case-by-case basis. Your Travel Care Coordinator will provide you with the surgeon’s recommendations and you may always discuss the reasons for the recommendation with the surgeon or a BridgeHealth nurse.