Osteoarthritis of the Knee



Osteoarthritis of the Knee

by Pat Amend, MA

Also known as degenerative joint disease (DJD), osteoarthritis (OA) is the type of arthritis involving the cartilage of a joint, and symptoms usually manifest themselves between the ages of 45 and 90.

Symptoms, as identified by the American College of Rheumatology are joint pain, morning stiffness, and buckling or instability in the joint, as well as loss of function. Durable and somewhat elastic, cartilage does not have a blood supply and gets its oxygen from the joint fluid surrounding it. When you use a joint, fluid and waste products are removed from the cartilage by the pressure involved, and when that pressure is relieved, oxygen and other nutrients return to the cartilage. Over time, however, cartilage may wear, and become less elastic. The surface of the joint may begin to grate against the bone.

While OA can occur in any joint, it is usually seen in the joints of the fingers, spine, hips, and knees. "OA is really the result of the cartilage wearing out in the joint," says Alan Schoengold, M. D., an internist and sports medicine physician in San Diego, who has also been a runner for 45 years and a lifetime member of the Run America Club. "Cartilage is living tissue, in constant turnover, very much like the cells that make new bone. With consistent use, cells remain capable of keeping up with the wearing out process. In younger, active people, there are constant rebuilding and reabsorbing phases. However, often, as people get older and more sedentary, the cartilage does not get enough stress to rebuild. The cartilage can be worn away if it is not replaced."

"In addition, athletic injuries that alter the amount of cartilage of the menisci, or shock absorber of the knee, can exacerbate the problem," says Thomas Zizic, M.D, a rheumatologist and associate professor at the Johns Hopkins University School of Medicine. "If the lateral or medial menisci become damaged, or if you tear the ACL or other ligaments, you won't have a normal distribution of the weight load and as a result, you may have additional wear."

A New Alternative Therapy
Fortunately, osteoarthritis of the knee may now be more treatable. Bionicare, a new, nondrug, noninvasive, nonsurgical treatment for osteoarthritis, may provide the electrical stimulus needed to rejuvenate and replace cartilage in the knee.

In 2003, the Food and Drug Administration approved the Bionicare BIO-1000 System, a home osteoarthritis treatment device, "for use as adjunctive therapy in reducing the level of pain and symptoms associated with osteoarthritis of the knee and for overall improvement of the knee as assessed by the physician's global evaluation. "The device consists of a four-ounce generator box and two large, surface electrodes, one of which attaches around the patient's knee, and another, with the help of Velcro wrap, attaches to the thigh above the affected knee. During therapy, the patient applies low amplitude electrical stimulation to the affected knee. For best results, the system should be used for a minimum of six to eight hours, generally at night while sleeping. Both knees can be treated at the same time, if needed.

"We believe that this device reproduces the electrical signals that the body normally produces with movement and compression of cartilage-similar to the way that weight-bearing exercise helps produce bone mass," says Zizic, who is also president of Bionicare Medical Technology, Inc., maker of the BIO-1000.

In one study, which was presented at the American Academy of Orthopedic Surgery annual meetings in March, 2004, laboratory studies indicated that this pulsed electrical therapy with Bionicare can help repair cartilage in rabbits. In addition, studies showed that treatment with Bionicare was effective in delaying the need for prosthetic reconstruction in patients with severe OA of the knee.

Fewer Drawbacks
Fortunately, Bionicare therapy does not have the drawbacks of other nonsurgical treatments for OA. "Physicians sometimes inject lubricants, called hyaluronans, into the joint," Schoengold says. "They cost between $600 and $800, and they don't last longer than a few months." Also, many of the medications that are commonly prescribed for OA-including aspirin, Tylenol and non-steroidal anti-inflammatory medications (NSAIDS)-may have gastrointestinal or renal side effects, while electrical therapy does not.

Your doctor will need to write a prescription for Bionicare before you can purchase or lease the BIO-1000 System. Bionicare has a trial program that would enable you to try the system for a minimum number of months with all payments applied to the purchase of the system. In addition, several financing programs are available to reduce monthly payments to manageable levels, and some insurance companies have begun to reimburse patients for the cost.

That's good news for runners, and for the more than 40 million other Americans who have some form of osteoarthritis.

If you think you may have OA, see your doctor immediately, as diagnosis and treatment of OA is essential to help prevent further joint damage.

To find out more, visit bionicare.com, or call 866-BIO-KNEE (866-246-5633).

About the Author: Boston-based Patricia Amend, M.A., is the co-author of The 30-Minute Fitness Solution: A Four-Step Plan for Women of All Ages, (Harvard University Press). She can be reached at Pamend@aol.com.

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