By Alexander Germanis
Anyone who has ever ridden on the handlebars of their friend’s bicycle understands the benefits of padding. This is made all the more evident when that bike hits a bump. But padding and cushioning go beyond the purpose of mere comfort; they are often necessary in order to prevent excruciating pain.
Within the knee joint are cushions meant to absorb shock and ease movement. Cartilage—a slick, fibrous connective tissue made of collagen—serves to cushion the knee joint throughout its course of movement. But when that connective tissue begins to wear down, the knee is “sitting on the handlebars,” as it were. This can result in a condition known as osteoarthritis of the knee.
Knee osteoarthritis is “the most common disease of the advanced age,” says Dr. Ricardo Vallejo, a doctor with Millennium Pain Center in Bloomington. “It is considered to affect 16 percent of the population over the age of 45, 20-30 percent over the age of 65, and almost 45 percent over the age of 80.”
That is not to say that knee cartilage breakdown does not happen in the younger years. Even though the main reason for the osteoarthritis is age, there are other mitigating factors that may expedite the onset of the condition. “It can be secondary to many different conditions,” Dr. Vallejo explains, “including sport injuries, trauma, repetitive work, mechanical stress, hard labor, heavy lifting, repetitive motion, mal-alignment, and sometimes excess body mass.”
A very painful condition brought on by deterioration of the cartilage in the knee, the osteoarthritis, in turn, brings on a “significant deterioration of function because of that pain,” the doctor says. Furthermore, there is “restriction of movement and [an increase in] sleep disturbances.”
As evidenced by the above numbers, and because of the additional problems in which knee osteoarthritis results, it is one of the five leading causes of disability in elderly patients. This, naturally, means there are a number of ways to initially combat it. “Patients have been treated with physical therapy,” Dr. Vallejo begins. “If you follow previous recommendations, a patient will initially be treated with a mild analgesic, like acetaminophen or ibuprofen, and those who do not respond will be switched to stronger medications, even opioid medications.”
However, especially as the majority of those who suffer from this condition are in their advanced years, the doctor warns, “it is important to consider that as patients become older they become more sensitive to these medications. Even medications that we may think are safe, like over-the-counter anti-inflammatories, may have a significant impact—not only on kidney function or liver function, but they may also increase the risk of cardiovascular events.”
Other options surfaced as a way to deal with that complication; unfortunately, they present problems of their own. Injections of cortisone into the joint or the injection of a protein enzyme called hyaluronidase into the joint have been used since 2003. However, as Dr. Vallejo points out, “According to the American Society of Orthopedic Surgeons, the evidence for [the effectiveness of] this therapy was limited.” In fact, “there is inconclusive evidence for most of the regular treatments offered for this condition.
”That has left very few options for the millions of elderly sufferers who cannot risk taking even simple oral medications. For them, the doctor states, “Surgery is the only alternative.” As if to add insult to injury, surgery can be just as risky or even riskier than medication. For example, comorbidity—the existence of two or more chronic medical conditions or diseases within a patient—“will prevent these patients from going to surgery or make it a high risk for them to go for surgery,” the doctor says. “And, at the same time, not every patient will have alleviation of the symptoms.”
Fortunately, for the many who live within this dark tunnel of pain, discomfort, and ineffective treatments, there is a light up ahead. To learn more about the dangers of knee osteoarthritis, its treatments, and to find out what new treatments are being developed to improve patients’ quality of life, read part two of ‘Knee Osteoarthritis and its Treatments’ in next month’s issue of Healthy Cells Magazine.
Millennium Pain Center, located at 1015 S. Mercer Avenue in Bloomington, provides the most advanced and comprehensive pain management for a wide variety of conditions. Drs Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America. For more information, you may contact them at 309-662-4321, or online at www.millenniumpaincenter.com.
Photo credit: KenTannenbaum/iStock