Only if really necessary
RPA Janssen MD PhD Assoc Prof is faculty at the...
RPA Janssen MD PhD is moderator at the VOCA congress Sports Injuries: lower extremity. Venue:...
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The knee is an important joint in the lower extremity. It is the articulation between the femur, tibia and patella (kneecap). These bones are covered by a protective layer: the cartilage. Cartilage is important for adequate knee motion.
Cartilage lesions and osteoarthritis
Cartilage may be damaged by heavy loads on the knee. Causes are running activities, fractures, accidents, previous meniscectomy and overweight. Cartilage lesions lead to pain and limitation of weightbearing activities. Cartilage has a low healing potential. Osteoarthritis is defined as the absence of cartilage, exposing bare bone.
Long walks become more difficult. Patients experience knee stifness and often swelling of the knee. Cycling is easier than walking. It becomes difficult to extend the knee and walking occurs with a limp. Pain is depending on the extend of the disease.
Leg extension exercises and restoration of a functional dynamic gait pattern is important in arthritic patients. Patients should refrain from placing a cushion below the knee at night. There seems to be no role for heavy fitness exercise machines.
Hyaluronic acid injections
Hyaluronic acid is a constituent of normal cartilage. It may be injected in the knee in an outpatient setting. The effect varies between patients, but does not harm the knee. So it may be worth the try. If it works, the serial injections may be repaeted. These injections are of little value in end-stage knee osteoarthritis.
Indications for arthroscopy of the knee are limited to removal of loose bodies or microfracture treatment of cartilage. One should be cautious in arthroscopy of an arthritic knee: patients sometimes experience more pain after surgery. New European legislation in 2012 will prohibit many experimental cartilage treatments available at this time. Follow my Twitter and blog for updates on knee topics (Dutch only).
Knee arthroplasty (prosthesis)
A knee prosthesis is the last option in end-stage osteoarthritis. Succes rate is high. One should be well aware of the advantages, versus the limitations and possible complications of this procedure.