Check-up: Having had severe osteoarthritis in my knees for many years, my left knee has become so painful and swollen that I'm finding it hard to get around. I've tried medication, exercise and rest but the problem is getting worse. What other options are left to me?
Osteoarthritis is a degenerative joint disease.
A chronic disorder of the cartilage and surrounding tissues, it is typically characterised by pain, stiffness and gradual loss of function.
Treatment options include exercising the joint gently and massage. The application of heat/cold packs to the joint helps ease pain and the use of anti-inflammatory agents and painkillers can help to control symptoms.
If an accumulation of fluid around the joint is limiting joint mobility then this can be removed followed by an injection into the joint of a special form of cortisone.
This only provides short-term relief and steroids cannot be used on a long-term basis as they can further damage the joint. Alternatively, the injection of a substance called hyaluronate, a component of normal joint fluid, can provide significant pain relief in some.
A course of physiotherapy would help increase the range of joint mobility while an occupational therapist could advise you on suitable adaptation of your home/work environment to maximise your functional ability.
If, after all these methods have been tried and your mobility is severely compromised, then joint replacement may be an option.
If I opt for joint replacement, what exactly would it involve?
Joint replacement, typically of the hips and knees is usually recommended when other forms of treatment have failed to control pain and mobility has become compromised.
Under general anaesthetic the knee cap is removed and the ends of the femur (thigh bone) and tibia (shin bone) are smoothed down so that the new component - called a prosthesis - can be attached firmly. After surgery a period of recovery and rehabilitation is recommended.
But are there any down sides to having this procedure done?
All major surgery has inherent risks. However, this type of procedure is usually very successful and almost always improves the level of function while decreasing pain. But the artificial joint will not last forever and doctors often recommend that surgery be delayed as long as possible in younger people to minimise the need for repeat procedures.
You really need to talk to your GP or rheumatologist about your reducing mobility and get their advice as to where to go from here based on your specific needs and concerns.