Ask the Doctor: Taylor Dunphy, M.D.

Q. I think I may have arthritis in my knee. What are some of the latest advancements in treatments I should consider?

A. More than 30 million adults in the United States have osteoarthritis, and the lifetime risk of developing symptomatic knee arthritis is 45 percent. Knee pain, swelling, loss of motion, clicking and catching are all symptoms that can be related to knee arthritis, which can affect patients of all ages. Fortunately, treatment of knee pain and arthritis has changed with recent technological advancements provide clinicians with tools to individualize treatments to address pain and dysfunction associated with all forms of knee arthritis.

Treatment of early knee arthritis begins with conservative measures. Oral anti-inflammatory medications and Tylenol have been shown to be effective in early arthritis, while physical therapy, weight loss and activity modification can significantly improve knee function and pain. Customizable knee braces can be utilized to help shift weight off areas of damaged cartilage to areas of normal cartilage. If pain becomes severe, corticosteroid injections can be administered to help reduce local inflammation associated with arthritis (with better results shown in younger patients with early arthritis).

Research has led to a new class of knee injections for arthritis treatment. Hyaluronic acid injections have been designed to help recreate the joint fluid, which protects and nourishes cartilage. These synthetic molecules are administered as a single injection or as a series, and act as a lubricant for the knee. Another treatment option for early knee arthritis is the injection of Platelet Rich Plasma (PRP). PRP injections are created by spinning the patient’s own blood in a centrifuge to concentrate platelets, which contain growth factors that have been shown to reduce inflammation and pain in knee arthritis. Clinical results are promising, with better performance shown in younger patients with early arthritis. Similar to PRP, stem cell injections are emerging as a potential treatment option, but large clinical studies are still forthcoming.

If surgery becomes necessary, several new techniques can treat localized arthritis. Isolated cartilage defects can now be addressed with MACI (Matrix-induced Autologous Chondrocyte Implantation), a new minimally invasive technique completed in two stages. During MACI, cartilage is first obtained from a patient’s knee arthroscopically and then sent to a laboratory, where the cartilage cells are multiplied and manipulated for re-implantation. The patient’s own cartilage is then re-implanted at a later surgery to fill the cartilage defect. Patients with more diffuse arthritis localized to only one side of the knee joint can be treated with a partial (unicompartmental) knee replacement, which replaces only the arthritic portion of the knee through a smaller incision This preserves ligaments, providing a more “normal” feel, and often does not require an overnight hospitalization.

When patients progress to end-stage or “bone on bone” arthritis, total knee replacement remains the gold standard treatment. Today’s modern knee replacements last 15-20 years, and patients are walking the day of surgery, hospitalized for only 1-2 nights, and able to return back to normal activities such as biking, golf and swimming.

Taylor Dunphy, M.D., specializes in orthopedic surgery at Hoag Orthopedic Institute.