The Arthritic Knee in the Middle-aged Athlete

E i C Mi k MDEric C. Mirsky, MD

Individuals are more activeInjuries can lead to arthritisTKR successful in older individualsOptions for younger, active people

Wearing away of the joint cartilageLining erodesSpurs form (osteophytes)

PAINJoints stiff and swollenLose range of motionMay disrupt sleep

Wear and tear on jointsGenetics, aging, injuriesObesityDeformity of a joint

Early xray changes but no symptomsDiagnosis based on symptoms, exam and radiographs

Cartilage wears awayJoint loses its normal shape and functionOsteophytes formBone and cartilage may break off

Exercise and Physical therapyBracing and OrthosesNSAIDsSteroid injectionsJoint fluid therapy (viscosupplementation)

Reduce pain and improve functionMuscle strengthening and aerobic exercisesWeight loss to decrease stressCompliance is a concern

Goal is to improve function by reducing symptomsModerate OAH l i i i lif lHelps maintain active lifestyleDelay surgery

Mild analgesicsAnti-inflammatory GI side effectsCOX-2 inhibitors

IceIceTylenolNarcoticsNarcotics

Corticosteroids for pain flaresCorticosteroids for pain flaresHyaluronic acid therapySynvisc, etcy ,

ArthroscopyHigh Tibial Osteotomy (HTO)Unicondylar knee replacement (UKR)Total knee replacement (TKR)

Role is controversialInitial benefitPlacebo effect?Effective for unstable meniscal tear or mechanicalEffective for unstable meniscal tear or mechanical complaintsCareful patient selection and counseling

Preserves the native knee jointPostpones TKRRedirects weight-bearing axisResults deteriorate over timeLess popular today

Younger patients with isolated disease Preserves the natural feel of the kneeRecent resurgence of interest and popularityMost patients will eventually convert to TKR

Final optionExcellent long-term resultsImplants unlikely to loosen with use

65% able, but at lower level and with decreased frequencyNo evidence correlating with looseningI i d dImpact exercise not recommended

Treatment of OA in young, active patients remains a challengeNonoperative management does not alter the natural history of the disease processnatural history of the disease processTreatment based on symptoms and expectationsexpectations