General Advice

Certain measures can be undertaken to slow down this wearing away process and delay or even prevent the onset of arthritis and the need for surgery.

Exercise

You should allow your knee to be a "barometer". When it aches or swells - you have done too much.

Avoidance of those activities which cause your knee to swell and/or ache. Prolonged running and demanding sports such as football, squash or badminton are out if the damage is between the main tibia and femur. Jumping, bending, stair and hill climbing are to be avoided if the damage is under the kneecap.

Anti-inflammatory Medication

You will need to take anti-inflammatory tablets occasionally if you have a "flare-up" or a particularly busy time. Your family doctor can prescribe medication or alternately Ibuprofen can be purchased at a chemist. If you do not suffer from gastric irritation, you should take anti-inflammatory tablets for two or three weeks to settle down the inflammation and swelling in the knee. The anti-inflammatory tablets should be taken after eating. If nausea, vomiting or abdominal pain develops you should reduce the dosage. If despite reducing the dosage gastric irritation continues then the tablets should be stopped and you should contact your general practitioner. Anti-inflammatory tablets include Indomethacin, Voltarol, Brufen and Naprosyn. If gastric irritation occurs then you general practitioner can prescribe enteric-coated tablets or new varieties of anti-inflammatories such a Vioxx.

Weight Loss

If you are overweight you must lose some. The excess load will wear the joint out more quickly. It is often difficult to lose weight when activity is restricted. If you cannot diet well, I would recommend a dietician.

Physiotherapy

Muscle strengthening exercises can have a significant effect on the discomfort, stability and strength of the knee. Static quadriceps exercises consist of tensing the muscle on the front of the thigh whilst the knee is straight. Hold the contraction for 5 to 10 seconds, rest for 5 or 10 seconds and begin again. This should be repeated 10-50 times. Whilst lying on your back the straight leg should be lifted into the air and held for 5 to 10 seconds, then lowered rested for 5 to 10 seconds and repeated 10 to 50 times. Knee bending should be achieved by sitting on a high chair or table and bending the knee over the edge. The good leg may be crossed over the bad one in order to assist.

Glucosamine

Many patients find taking proprietary glucosamine dietary supplement to be helpful. Alternately cod-liver oils is a traditional remedy. However there is little objective evidence to support taking these dietary supplements. Many patients find that their symptoms fluctuate especially with cold and wet weather. This is a normal cycle of events. Many patients also find that drinking red wine or port makes the joint ache more noticeably.

Supports

Braces and supports commonly help relieve the discomfort of degenerative joints. These include insoles or foot orthotics. These are particularly appropriate for patients with flat or pronated feet. Us of soft heeled shoes rather than leather soles shoes helps to cushion the heel strike in the walking cycle and is helpful.

Knee supports are also very helpful and popular. Where the knee swells or feels uncomfortable a simple knee sleeve, neoprene sleeve or tubigrip bandage may be helpful. This provides support, a feeling of security and comfort to the knee and may reduce the amount of swelling. Specific special supports are needed for patients with uni-compartmental, patellar or patello-femoral arthritis.

Steroid Injection

Injection of steroid and local anaesthetic into the inflamed tendon or into the knee joint can help the inflammatory process to settle down. The steroid is only active in the local area of the injection and has no effect on the surrounding bones or the general metabolism. The injection may be painful for several minutes, but an improvement in the pain is then noticed. The improvement may last for several weeks or months or indeed be permanent. If the symptoms return, one or two further injections may be helpful, more than this rarely has any advantage and may damage the joint. If two or three injections have been undertaken without any lasting effect then alternative treatment and possibly surgery should be considered. Whilst steroid injections into the knee joint may be helpful in this way there is some evidence to suggest that it may accelerate the wearing process. Therefore whilst intra-articular injection into the knee joint may be appropriate if the joint is very arthritic and a joint replacement is imminent. In other circumstances it is often best to avoid a steroid injection and consider an arthroscopy to treat the internal damage.

Hyaluronic Acid Injection

Joint injections either with hyaluronic acid (Synvisc) or a similar substance may be considered, and may be helpful. For early degeneration or in patients in whom there has been a rapid deterioration or injury keyhole arthroscopic treatment may prove to be very helpful. Alternately joint replacement may be appropriate because of advanced disease or where the other treatments prove to be ineffective. However where there is no internal damage to the menisci or cartilage and where there are continuing symptoms such injections may be helpful. They have been shown to be as effective as steroid injections for early arthritis of the knee but are not damaging to the joint itself.

Also see the following articles: Viscosupplementation and Chondroitin and Glucosamine

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