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Knee Arthritis Part Two, Pain by John Post, MD

Bob Scott

 

” ‘Bill I believe this is killing me!’ as the smile ran away from his face.”    Billy Joel

 

 This is the second in a series of three pieces on arthritis.  We hear so much about arthritis,  “degenerative change” but it’s causes are not always well understood. Those who have it know one thing – it hurts!

 Although there are approximately 100 different varieties of arthritis, many accompanying other disease processes you’ve heard of like Lupus or Lyme Disease, Osteoarthritis is by far the most common. We think of  it as an old persons problem (old being a relative term in triathlon – just ask Bob Scott (above), Kona course record holder with a 12:59 when he was 70!)

 Certainly arthritis is more common in the over 65 crowd but it’s prevalence begins to increase by age 50 in men and, unfortunately, age 40 in women.  It’s frequently a progressive problem which ends up with joint pain, swelling and stiffness, and can limit one’s quality of life.  Three fourths of adults over 70 will demonstrate some degree of arthritis on plain x-ray.  Over time, the joint lining cartilage is eroded down to bone leading to pain, disability and narrowing of the joint to the point where it could become “bone on bone.”

The drawing below shows the basic anatomy of a right knee, particularly the femur, the upper bone.  The cartilage lines the end of the bone and is normal, smooth and intact on the left side.  But, just to the right in the area labeled arthritis, you see that there are stellate cracks, with wear down to expose the underlying bone This might be the location of an injury in the past. Or, perhaps the athlete had a meniscus injury/removal earlier in life.  It’s a lot more common than you might think.

 

 

 

The function of the joint worsens over time as the disease process progresses.  Knee pain and swelling, initially present only with activity, become an issue at rest.  Many will lose range of motion and find their lives restricted by the joints lack of mobility.  I’ve had patients over the years report being “held hostage by the pain” or “a prisoner of my knee.”

 If left unchecked, the joint ultimately wears out completely as shown on the x-ray below.  The black space between the bones on the left represents the normal cartilage space, but on the right, the bones are touching. This represents end stage disease.  One of the options for this patient, if symptomatic enough and a failure to conservative care, would be replacement.  As you’d imagine, triathlon probably isn’t on the list of recommended activities following an operation of that magnitude.

  Next week, part three, options.

 www.johnpostmd.com
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