1. My Aching Knee! Koco Eaton, M.D.

2. Degenerative Arthritis Wearing away of the cartilage on the ends of the bone Wearing away of the cartilage on the ends of the bone Knee pain, typically worse at night Knee pain, typically worse at night Stiffness and swelling in the knee Stiffness and swelling in the knee Decrease in usual activities due to pain Decrease in usual activities due to pain Loss of joint space on x-ray Loss of joint space on x-ray

3. Degenerative Knee X-ray

4. Conservative Treatment Lifestyle modifications Lifestyle modifications Physical therapy Physical therapy Heat and ice Heat and ice Anti-inflammatories Anti-inflammatories Glucosamine and chondroitin sulfate Glucosamine and chondroitin sulfate Cortisone injections Cortisone injections Hyaluronate therapy (i.e. Supartz or Synvisc) Hyaluronate therapy (i.e. Supartz or Synvisc)

5. Hyaluronate therapy Highly purified sodium hyaluronate Highly purified sodium hyaluronate Comes from the comb of a rooster Comes from the comb of a rooster Used for treatment of knee pain caused by osteoarthritis when medications and/or physical therapy are inadequate Used for treatment of knee pain caused by osteoarthritis when medications and/or physical therapy are inadequate Given in three injections, each one week apart Given in three injections, each one week apart

6. Knee Replacement When conservative measures fail, a knee replacement may be necessary to alleviate the pain When conservative measures fail, a knee replacement may be necessary to alleviate the pain Replaces knee joint cartilage with metal and plastic Replaces knee joint cartilage with metal and plastic Last 10 – 15 years Last 10 – 15 years Require a hospital stay with rehabilitation, typically 1-3 weeks Require a hospital stay with rehabilitation, typically 1-3 weeks

7. Knee Replacement

8. Meniscus Tears Symptoms include: Symptoms include: Stiffness and swelling Stiffness and swelling Tenderness on the joint line Tenderness on the joint line Fluid on the knee Fluid on the knee May be caused by a particular maneuver such as a twist or squat May be caused by a particular maneuver such as a twist or squat Can also be a degenerative process over time Can also be a degenerative process over time

9. Meniscus Tears

10. Initial treatment: Rest, Ice, Compression, Elevation Initial treatment: Rest, Ice, Compression, Elevation Anti-inflammatory medications Anti-inflammatory medications Arthroscopy may be necessary to trim out the torn piece Arthroscopy may be necessary to trim out the torn piece However, arthroscopy can exacerbate underlying arthritis – patients with arthritis may do best with conservative treatment However, arthroscopy can exacerbate underlying arthritis – patients with arthritis may do best with conservative treatment

11. My Aching Knee! Any questions?