Treatment Options for Degenerative Knee Arthritis: A Patient's Guide

Treatment of Degenerative Knee Osteoarthritis

My father has pain in his left knee.
He has seen the director of Zhudong Hospital twice and has taken Sulinton tablets and the muscle relaxant AN-AN, but he still does not require surgery.
However, after about a month of medication, he continues to experience pain.
On one occasion, when he was in pain, he consulted another physician, Dr.
Chen (as the director was not available that day), who suggested that my father needs surgery.
I would like to ask:
1.
My father has significant pain in one knee while the other knee is fine.
Could this be due to an old injury rather than degenerative knee osteoarthritis caused by cartilage degeneration? Some people say that degenerative knee osteoarthritis typically presents symptoms in both knees, not just one.
2.
Is my father a suitable candidate for arthroscopic surgery to remove the medial meniscus of the knee? Are there orthopedic surgeons in Zhudong, Hsinchu, or Taipei who perform arthroscopic surgeries similar to those done by Dr.
Lu Shao-Rui from Tzu Chi Dalin Hospital? I noticed in the common Q&A that Director Shi also seems to perform this procedure.

Shu, 40~49 year old female. Ask Date: 2011/11/06

Dr. Shi Guozheng reply Orthopedics

Degenerative arthritis can occur in a single knee joint, but it may also affect both knees, especially if there are old injuries or degeneration present.
The use of arthroscopy for debridement in cases of degenerative arthritis has significantly decreased in recent years due to inconsistent outcomes.
Whether further surgical intervention is necessary requires reevaluation.
There is an outpatient clinic available at Zhudong Hospital on Wednesday mornings that can be utilized for this purpose.

Reply Date: 2011/11/06

More Info

Understanding treatment options for degenerative knee arthritis can be quite complex, especially when considering the individual circumstances of a patient. In your father's case, it appears that he is experiencing significant pain in one knee, which raises important questions about the underlying causes and the most appropriate treatment options.

1. Is the pain in one knee indicative of an old injury rather than degenerative arthritis?
While it is common for degenerative knee arthritis (osteoarthritis) to affect both knees, it is not a strict rule that both knees must show symptoms. Osteoarthritis can indeed manifest in one knee more severely than the other, especially if there is a history of injury or trauma to that knee. Previous injuries, such as ligament tears or meniscal damage, can lead to changes in the joint that predispose it to arthritis. Therefore, it is plausible that your father's knee pain could be related to an old injury rather than generalized degenerative changes. A thorough evaluation, including imaging studies like X-rays or MRIs, can help determine if there are specific structural issues contributing to the pain.

2. Is your father a candidate for arthroscopic surgery to clean up the knee?
Arthroscopic surgery, or knee arthroscopy, is a minimally invasive procedure that can be used to diagnose and treat various knee problems, including the removal of loose bodies, repair of meniscal tears, and cleaning up damaged cartilage. Whether your father is a suitable candidate for this procedure depends on several factors, including the specific diagnosis, the extent of damage in the knee, and his overall health status.

If your father has significant mechanical symptoms (like locking or catching in the knee), or if imaging studies reveal a meniscal tear or loose fragments, arthroscopy may be beneficial. However, if the primary issue is degenerative arthritis without significant mechanical problems, the benefits of arthroscopy may be limited. In such cases, conservative management, including physical therapy, medication, and possibly injections (like corticosteroids or hyaluronic acid), may be more appropriate.

Recommendations for Treatment Options
1. Consultation with an Orthopedic Specialist: Given the conflicting opinions from different doctors, it may be beneficial for your father to seek a second opinion from a reputable orthopedic surgeon who specializes in knee conditions. This can provide clarity on whether surgery is necessary and what type of procedure would be most beneficial.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and reduce pain. A physical therapist can tailor a program to your father's specific needs, focusing on low-impact exercises that are gentle on the joints.

3. Medications: If the current medications are not providing adequate relief, discussing alternative pain management options with his physician may be worthwhile. This could include different classes of pain relievers or adjunct therapies like topical analgesics.

4. Injections: If conservative measures fail, your father might consider corticosteroid injections for inflammation or hyaluronic acid injections to improve lubrication in the joint.

5. Lifestyle Modifications: Encouraging weight management, low-impact activities (like swimming or cycling), and avoiding activities that exacerbate knee pain can also be beneficial.

6. Surgical Options: If all conservative measures fail and your father's quality of life is significantly impacted, discussing surgical options, including arthroscopy or even knee replacement, may be warranted.

Conclusion
Navigating the treatment options for degenerative knee arthritis requires careful consideration of the individual patient's condition, history, and preferences. It is essential to have open discussions with healthcare providers to explore all available options and make informed decisions. Your father's situation is unique, and a tailored approach that considers his specific symptoms and overall health will yield the best outcomes.

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