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Surgeon reviews science behind conservative treatments for unicompartmental knee arthritis

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KOHALA COAST, Hawaii — There are several nonsurgical treatments available to patients with osteoarthritis (OA) of the knee, but which ones work best, and in which combination, is still a matter of debate, said Jack M. Bert, MD, at Orthopedics Today Hawaii 2009.

Some of the conservative treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, steroid injections, viscosupplementation, bracing and acupuncture.

NSAIDs continue to be the most widely prescribed medications for arthritis, and many patients with arthritis have used them for years. “However, approximately 103,000 people are hospitalized each year and approximately 16,500 patients die annually as a result of using NSAIDs,” at a cost of $1 billion, Bert said. Two of the most common adverse effects of NSAID use are bleeding and toxicity.

They inhibit cyclooxygenase (COX), resulting in a decrease in prostaglandin synthesis, he said.

COX-2 is the inducible form of the enzyme, blocking arachidonic acid from reaching the catalytic site and thus blocking the creation of prostaglandins. “Many patients look to COX-2 inhibitors as a safer alternative to NSAIDs,” he said.

Some patients take steroid injections three or four times a year to relieve the pain from OA and restore some function. According to some reports, repetitive intra-articular injections of steroids in the knee “may be effective for up to 2 years,” Bert wrote in his abstract.

Viscosupplementation, which involves injections of hyaluronan, has received more attention in the media in recent years as a more natural choice to treating osteoarthritis, he said. “In effect, it improves viscosity and enhances elasticity by replacing the joint fluid that is missing in the knees of patients with OA.”

Several researchers have reported early success with it, although patients with the least amount of OA tended to show the best results, he said.

Meanwhile, a growing number of patients are exploring other treatment options, including a regimen of vitamins and/or dietary supplements, as well as glucosamine and chondroitin sulfate. While some early reports claim that patients achieved some collagen growth (glucosamine), more studies are needed, Bert said.

Reference:

• Bert JM. The conservative care of unicompartmental arthritis of the knee. Presented at Orthopedics Today Hawaii 2009. Jan. 11-14, 2009. Kohala Coast, Hawaii.