Transcription:
Knee Osteoarthritis: Causes, Symptoms and Treatments

Joey Wahler (Host): It's a very common degenerative joint disease among adults, especially affecting the knees. But there are treatment options. So we're discussing knee osteoarthritis. Welcome to the Live Greater podcast series. Information for a Healthier You. From the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler, our guest, Dr. Kevin McCoy. He's an orthopedic surgeon, a member of the Orthopedic Center, a partner of UM Shore Regional Health, and a member of the UM joint network. Dr. McCoy, thanks for joining us.

Dr Kevin McCoy: Thanks for having me Joe.

Joey Wahler (Host): Great to have you. And so, first, in a nutshell, what exactly is osteoarthritis? If you have it, what's going on there?

Dr Kevin McCoy: Yeah, so osteoarthritis in its simplest form is just a wearing out of that regular articular cartilage, which caps the ends of the bones in the knee joint. And ends up happening is as that cartilage wears out, you get ups and downs of inflammation and people can see increasing in their Pain, swelling and stiffness depending on what that inflammation is doing.

Joey Wahler (Host): And so in terms of osteoarthritis, how common an area is the knee to be afflicted with that?

Dr Kevin McCoy: Yeah, the knee is, probably the most common. About 50% of people in their lifetime will experience some symptoms of knee osteoarthritis. It generally prefers the weight bearing joints, such as the hip and the knee, but also involves other, joints as well, such as ankles. Your low back and your neck is very common areas as well.

Joey Wahler (Host): So you mentioned a few of the symptoms a moment ago. How about if you hear a snap, crackle or pop, if you will, in the knee? Is that a sign that that's what might be going on?

Dr Kevin McCoy: Yeah, it certainly can be. hHat a lot of people develop, some cracking underneath their kneecap. As you bend that knee, that kneecap goes up and down a groove on the end of the thigh bone, and when we're 20, it's a nice, smooth cushion, like an ice luge. And as we age, some of that cartilage starts to wear down. So when you bend the knee, that kneecap can kind of sound like it's going up and down a cobblestone street.

Joey Wahler (Host): So from Ice Luge to Cobblestone Street.

Dr Kevin McCoy: Yeah. I try to describe things in simple terms. It's easy to understand.

Joey Wahler (Host): Absolutely. Very nice. So at what point then, in terms of what they may be feeling, should someone see a joint expert?

Dr Kevin McCoy: Again, the increase in pain typically associated with arthritis is usually an inflammation issue, so, Personally, when I start to develop some pains in my knees or elsewhere, I usually like to get on an anti-inflammatory for a week or so and see if we can settle it down without any significant intervention. So I usually recommend people start with that. of course if you have continued pain after that, I think it would be reasonable to seek out a joint replacement surgeon or a other physician just to maybe get some x-rays, see exactly what's going on there, and see if you need to get a little more aggressive with your treatment.

Joey Wahler (Host): I'm gonna ask you more about that option in a moment. But first, how about the difference between osteoarthritis and rheumatoid arthritis and how each affects the knee?

Dr Kevin McCoy: Both of them at the end of the day lead to degradation of the cartilage, like I talked about. osteoarthritis is just good old fashioned. Arthritis, has a genetic component, but there's certainly a wear and tear component as well. Rheumatoid arthritis is a little bit different in that it's actually an autoimmune disorder. So what you get is your immune system actually attacks the synovium or the lining of your joint, and this leads to wearing out of that articular cartilage.

Joey Wahler (Host): So it's really not so much necessarily what you're doing or not doing on those knees during the course of your life. It seems like as much as these joints are just typically not meant to hold up a hundred percent over a full lifespan?

Dr Kevin McCoy: There's certainly a genetic component to this, so in some sense there's not much you can do. But there's also other disorders, such as injuries you might have had when growing up. wear and tear, if you like to do impact activities such as running, sometimes this can lead to arthritis down the line.

Joey Wahler (Host): So in terms of treatment options, getting back to that, you mentioned anti-inflammatory meds. Will that lessen pain. Will that remove it? What can people expect?

Dr Kevin McCoy: Anti-inflammatory medications for short periods of time, I think is a reasonable option. and the idea is as you decrease that inflammation, it should decrease your discomfort. There's also other modalities such as icing or using a soft knee brace or maybe modifying your activities for a short period of time that may help things settle down. Injections are also another option. We use steroid quite frequently. It's been around a long time. It works quite well and it's a reasonable thing to do two or three times a year as needed.

There's also visco supplementation, injections. A lot of people group them into gel injections as they're called. They're expensive. The studies really haven't shown them to be any better than steroid, but certainly in some patients they can lead to some significant benefit.

Joey Wahler (Host): And so you mentioned earlier that surgery can also be an option. If so, if that's called for, what exactly can you do there?

Dr Kevin McCoy: For the most part in terms of arthritis, you really need some type of arthoplasty or replacement. There are some patients that are good candidates for a partial replacement if you have arthritis isolated to one of the three compartments in the knee. More often than not, what is necessary is a total knee replacement where we end up resurfacing all the articulations within the knee with metal and plastic. It's certainly a significant undertaking. It takes about an hour and a half to do the surgery, and it is an extended recovery. It takes about three months to recover. and Involves a lot of physical therapy.

Joey Wahler (Host): So hoping not to get to that point if possible. How about ways of preventing OA in the knees during the course of our day? If we're not there yet, what can we do to ward this off?

Dr Kevin McCoy: Unfortunately, there's not a whole lot you can do to ward off OA. certainly keeping your weight as low as possible can help. for every pound that you have. Your knee actually sees four or five pounds during regular everyday activities. So keeping your weight as low as possible can help. Otherwise avoiding the impact activities, that may aggravate the knee, can certainly help.

Joey Wahler (Host): What might some of those be?

Dr Kevin McCoy: I think great activities for people that may be predisposed or have some arthritis would include biking, swimming, riding, the elliptical. . These are all low impact activities that help strengthen the muscles around the knee to give the knee some support.

Joey Wahler (Host): And so you mention elliptical, so I presume you mean elliptical over treadmill if your knees are sensitive, right?

Dr Kevin McCoy: Yeah, I think the elliptical is a little bit lower impact, but the treadmill is still a reasonable option if that's something that does not aggravate your knees.

Joey Wahler (Host): And bike riding, should that be kept to a reasonable distance? I presume you're not recommending a hundred mile journey for someone that may have a knee condition. Right?

Dr Kevin McCoy: I think a hundred miles would be a little bit excessive. But certainly trying to ride the bike three or four times a week, maybe for shorter half hour to one hour sessions are a great way to keep that quadriceps muscle in your thigh strong, which helps support the knee.

Joey Wahler (Host): How about when someone has osteoarthritis in one knee? How often will they then, if not at the same time, eventually have it in the other knee, do the left and right usually go together or not necessarily?

Dr Kevin McCoy: Not necessarily is the answer. I see plenty of people that have it in both knees. I see plenty of people that just have it in one knee, and the other knee really looks great again, I think in a lot of times. This happens because somebody may have had an injury in their youth that led to the arthritis, but it's something I see a lot of and it's hard to predict.

Joey Wahler (Host): Gotcha. And so in closing here, what would you say your overall message is to those that are suffering from osteoarthritis In terms of what outlook they could expect?

Dr Kevin McCoy: Yeah, I think the overall message is that the inflammation is what creates this pain in arthritis, and we should start with the basics in terms of controlling that, such as anti-inflammatories, modifying your activities and using some low impact exercises to help keep the knees strong. If you need to get more aggressive, something like injections or physical therapy can help. And the knee replacement is really a last resort for somebody that's failed all the conservative treatment modalities.

Joey Wahler (Host): Well folks, we trust you are now more familiar with osteoarthritis in the knee. Dr. Kevin McCoy, Thanks again so much.

Dr Kevin McCoy: Thank you.

Joey Wahler (Host): And you can hear more shows just like this one at umms.org/podcast. Again, umms.org/podcast. Now, if you found this podcast helpful, please do share it on your social media. And thanks for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, hoping your health is good health. I'm Joey Wahler.