How do you manage osteoarthritis of the knee in a 50-year old woman?

This is a very serious problem these days and is associated with severe disability in some people.

Did you know that an increase in BMI from 21 to 25 is associated with an eightfold increase in the rate of osteoarthritis of the knee in women?

The choices for treatment are both non-surgical and surgical.

The non-surgical options include, of course, weight loss, strengthening, physiotherapy and exercise physiology and alteration in lifestyle.

However, the problem of weight is very difficult to deal with and it is often the case that people are unable to lose substantial quantities of weight.

The attraction of this operation is that it keeps your native knee. There are no artificial components and thus, once healed, the patient is able to return to what is effectively an unrestricted normal life.

The results from this surgery are gratifying and with the correct selection process, somewhere between eight and twelve years of good function is expected, sometimes more. We’d usually perform an arthroscopy at the same time and deal with any issues such as impinging osteophytes, meniscal tears, or the like.

The second option is replacement surgery, this being either half of the knee or the entire knee. As you may have read, the outcome from joint replacement surgery is very effective but it remains that a 50-year old woman has somewhere between 35 and 50 years of life expectancy in front of her, and with almost certain revision surgery being required, either for a half knee replacement or a total replacement, this is not the best option. However, if more than half of the knee is involved in the arthritis, osteotomy or half knee replacement is sometimes not an option. Sometimes, with severe disability, we decide to proceed to total joint replacement as it is the only viable option.

The longevity of these knees is somewhere between 20 and 25 years in an older population but there has been evidence to suggest a slightly diminished life expectancy for young people.

The advice that I would give your customers, that is your patients, is that weight loss is critical. I would also be careful against advising them to consider stem cell injections or PRP injections other than as a short term ameliorating procedure. There is little evidence in the literature to suggest that these have any lasting benefit. Stem cell injections are, in particular, very expensive and do not last.

Of course, investigation is also important in these patients and I would stress that a plain x-ray standing in zero and 40 degrees of knee flexion is the most appropriate investigation. We sometimes use long leg alignment films from pelvis to floor to help us determine the weight bearing axis if we are considering osteotomy.

MRI scan has a limited role in these people. It should not be the first line of investigation.

Don’t forget, if you wish to discuss any of these cases we are always available on the phone or in the office.