Medial Knee OsteoArthritis (OA)- What Else Can You Do? - Unload it and more
Waiting for a knee replacement and the quality of life is poor? Most often the inner knee cartilage wears out first. Measures to take the load off the inner knee are helpful.
Waits for knee replacement can take years and some elderly just don’t feel up to it. There are two techniques to take the weight off the inner knee:
1) Lateral knee wedges:
Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis
A Preliminary Investigation Russel Rubin et al
Journal of the American Podiatric Medical Association Volume 95(4): 347-352, 2005 abstract
- radiographically confirmed medial compartment knee osteoarthritis
- “custom-molded foot orthoses with a 5° lateral heel wedge+ - in most shoes this would be 3- 4 mm high in a wedge laterally.
- 50% + better within 3- 6 weeks:
One site for heel wedges is Alimed:
http://www.alimed.com/Alimed/product/HAPAD-Posting-Heel-Wedges,17615,259.htm
Best to use an insole (like have in some runners) and self adhesive it underneath so the big part of the wedge faces the outside ot the heel. I have used weather stripping (cut) as an option but they need to be replaced after 1-2 weeks.
2) Unloading knee braces - can be bulky and may need custom fitting (and hence more expensive)
The Effectiveness of Self-Adjustable Custom and Off-the-Shelf Bracing in the Treatment of Varus Gonarthrosis Louis Draganich
The Journal of Bone and Joint Surgery (American). 2006;88:2645-2652. abstract
For Canadian customers I cam across this example:
http://www.ossur.com/?PageID=3007
For US customers this:
http://www.ossur.com/unloaderadj
Interestingly, the article found [patients]”may benefit significantly with respect to pain relief and reduced stiffness from use of either brace. (custom or over the shelf).
What are some other measures?
1) for severe OA using radioactive Yttrium I have wrote elsewhere: here
2) Botox helps wrote here
3) Although it has been assumed there is steroid injection failure, repeated injections have not been shown to be harmful and may be helpful wrote here
4) Joint lubricants: - Hyaluronan
Originally derived from cock’s combs, this agent as been injected in knees with some benefit. I prefer Durolane as it is one injection rather than the 3 of synvisc. They discuss efficacy here: Here is a three month followup study:
5) I usually find at least half the knee pain is actually the structures around the kneecap and in the muscles - don’t believe me? - talk to any one who has had a knee replacement and still in pain. I saw someone this week with pain mostly over the course of her saphenous nerve:
I plan on nerve blocking it with semi-neurolytic 5% lidocaine with some kenalog steroid added with hope it will knock it out for a while (patient needs to take antibiotics per injection and for the day to prevent possible infections)
5) A recent article was published on severe OA knee and pain in elderly:
When Knee Pain Becomes Severe: A Nested Case-Control Analysis in Community-Dwelling Older Adults George Peat and Elaine Thomas
The Journal of Pain, Vol 10, No 8 (August), 2009: pp 798-808
The found the following measures used:
- Dieting to lose weight
- Knee exercises
- Painkillers and opioids
- Oral arthritis pills - DANGEROUS in elderly re stomach bleeds and results may not be that great this article found little benefit from oral meds: writeup here
- Topical meds - a topical arithitis med “Penssaid has been found as helpful as oral medication - I found it more potent if gabapentin added: discussed here
- other med: - I have mentioned the use of ant-inflammatory antibiotics here and herbal SAMe here ; glucosamine and chondrointin have been already mentioned though the benefits seem the same as NSAIDS writeup here
- Ice is a good standby
- A certain amount of exercise as beneficial
- Prolotherapy has been used in the knee but I have not had much experience there yet.
- One recent article in
International Musculoskeletal Medicine 30(2) July, 2008 61 - 66
A Retrospective Audit of Patients with Osteoarthrtis Knees treated with Prolotherapy in a General Practice
A. Jacks, A Edgeworth
10 mls of 10% Dextrose and 0.5% lidocaine mix injected every 4-8 weeks by lateral midpatellar approach. Some had more than two shots.
Results after 3-6 months:
Any other suggestions?
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