Arthritis in the Knee

Q:  I am a 70-year-old woman in good health except for osteoarthritis of one knee, a result of trauma. It's a common annoyance for many people, and I fear becoming severely handicapped as my life goes on. I wear orthotics in my shoes and that helps my balance, but the knee is typically swollen and hurts with a pinching feeling as I walk. Running is out of the question.

Presently I am not on any pain pills and I have cut down on my physical activities (I am an athletic instructor at a senior center for four hours a week now instead of 9). I do brisk walks 30 minutes four days a week now instead of 7. I still have pain but I've learned to live with it.

Since the cartilage wearing down is the causative factor, have any cartilage transplantations been successful as a treatment for knee arthritis? Is there any cartilage-building pill I can take? I've heard that Knox gelatin in orange juice is a good one. I've tried many -- even shark's cartilage -- and nothing works for me.

Or do I just have to think of other treatments like knee replacement? If I do decide on knee replacement, will I really be pain free, and will I be able to improve my stride and go up and down stairs without pain? I appreciate your help.

A:  Osteoarthritis, also called degenerative joint disease, is the most common joint disease, affecting 80% of people over the age of 75. You are a classic example, because the knee joint is the most common site, and women are twice as likely as men to have arthritis of the knee.

As you stated, cartilage loss from the joint results in the pain, cracking, and stiffness. Bone surface is exposed as the cartilage softens and thins. The cartilage serves as a shock absorber, so pain is really noticed with movements causing more impact on the knee, such as going up and down stairs.

Regarding cartilage transplantation, I have good and bad news. The good news is that cartilage transplantation has been successful and is available at the Medical College of Wisconsin. The bad news is that you would not be a candidate for it because of the extent of your arthritis and your age.

William Raasch, MD, Associate Professor of Orthopedic Surgery and Director of Sports Medicine at MCW, recently returned from Sweden where he was trained in this special technique by Dr. Lars Peterson, the originator of cartilage transplantation. They have had good results over the past decade with young people (usually less than 40) who have a small tear in their knee cartilage from a sports injury or other accident. Cells of normal cartilage are removed from the patient at another joint site and are then injected into the damaged area. Up to eight years later, normal cartilage growth can be demonstrated.

Knee replacement does produce striking improvements in pain and ability to move for patients with severe osteoarthritis. Ultimately the patient has to make the decision about how much the arthritis is affecting their life. Because the joints last about 10-15 years, a person might want to postpone surgery for a few years if they are still only in their fifties or sixties, to avoid having to repeat the operation. People like you in their seventies are at an ideal age for the procedure.

According to Dr. Raasch, most patients are in the hospital for three to five days for knee replacement and able to be up and walking soon afterwards. In a knee "replacement," the whole knee is not really replaced -- new surfaces are created, but the same ligaments and tendons remain. After the operation, people should not run a marathon, but can usually be quite active, such as playing doubles tennis.

Obviously before you think about a big procedure like surgery, there are other treatments to consider (By the way, there are a few other types of surgery besides replacement that can also be done.) Anti-inflammatory medications, physical therapy for strengthening and occasionally steroid injections into the knee joint may all be helpful.

I applaud you for staying so active in spite of your pain. Dr. Raasch told me about a Harvard study that showed that running does not hasten the progress or worsen arthritis. A person may experience more pain, but is not necessarily causing more damage. I guess the message would be that it is alright to keep as physically active as possible within the limits of your pain and stiffness.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.