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If you are one of the millions of Americans suffering from an arthritic condition of the knee, the amount of information and options may be overwhelming.  From creams, to braces, to medications, herbal remedies and surgery – it can be difficult to know which treatments are snake oil and which are viable options. 

Below, Board Certified Orthopedic Surgeon and Chairman of the Valley Hospital Total Joint Center, Dr. Nicholas Alexander highlights which treatments have been shown to be the most effective for knee arthritis.

1. Viscosupplementation

Also known as hyaluronic acid, this injection is used as a supplement to the body’s own production of lubricating fluid.  This naturally occurring substance, often harvested from rooster combs, serves as a lubricating fluid so that knee can function properly and help avoid the bones of the knee from rubbing together.  Those patients with osteoarthritis have been shown to have a decrease in the quality or viscocity of the fluid, as well as a decrease in the quantity of the fluid, resulting in stiffness and difficulty in bending the knee.

This office based procedure uses a small needle to inject this lubricating fluid directly into the knee joint, thus increasing the volume and quality of this liquid cushion. This typically involves 3-5 injections administered once a week, and may last 6 months or more. Depending upon each patient’s specific condition, this procedure can be repeated every 6 months.

2. Steroid Injections

The purpose of these injections is to use corticosteroid medications to reduce the inflammation that is causing the pain associated with knee arthritis.  Corticosteroids work by reducing inflammation locally at the site of the injection.  These local injections provide quick relief pain and swelling without many of the systemic side effects associated with oral steroids.

The relief from these injections can last several weeks or months, depending upon each patient’s specific condition. Usually no more than three injections, per knee joint, per year are administered

3.  Knee Replacement

Knee Replacement should be considered when treatments such as medications, physical therapy and the options listed above have failed to provide adequate relief of your pain and the reduced mobility has affected your quality of life and the ability to carry out your activities of daily living. 

There are four basic steps to performing a knee replacement procedure:

-Preparation of the bone: The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.

Positioning of the metal implants: The removed cartilage and bone is replaced with metal components that cap the ends of the cut bone, thus recreating the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.

-Resurfacing of the patella: The under-surface of the patella (kneecap) is cut and resurfaced with a plastic button.

-Insert a spacer: A medical-grade ultra high molecular weight polyethylene plastic spacer is inserted between the metal components to create a smooth gliding surface.

The surgery usually lasts approximately one to one and half hours and is usually performed using nerve blocks and intravenous sedation and/or light general anesthesia .  Weight bearing and physical therapy begins the same day of surgery. Typically, this involves a 2 day stay in the hospital, although in some cases this can be done with only an overnight stay.  Rehabilitation after knee replacement usually involves 2-3 months of physical therapy and a home based exercise program to regain mobility and strength.

Seeking Treatment for Knee Arthritis

Dr. Nicholas Alexander is the Founder of Mahwah Valley Orthopedic Associates and a Board Certified Orthopedic Surgeon specializing in both the surgical and non-surgical treatment of hip and knee conditions. Dr. Alexander completed his Fellowship in Adult Reconstruction and Reconstructive Surgery of the Hip and Knee at the Johns Hopkins School of Medicine and has over two decades of experience. He also serves as the Chairman of the Valley Hospital Total Joint Center. Dr. Alexander has offices in Mahwah and Clifton, NJ. If you, or someone you love, is considering treatment for chronic knee pain, contact us today for a consultation.

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