Patient: I have had bad pain in my right knee for over 2 years now. I am missing 70% cartilage in my knee and I have trouble sleeping at night. What is the best way to solve this problem?
Doctor: Thank you for your question. Deterioration of the articular cartilage of the knee joint is commonly caused by a disease known as osteoarthritis. Osteoarthritis is one of the most common causes of disability in middle aged and elderly persons. It occurs when the cartilage within articular joints deteriorates over time. Cartilage functions to cushion and reduce friction between bones. As a result, increased friction will result in pain and inflammation of the articular joint that is affected. Besides pain, and swelling, one may also experience joint stiffness, decreased flexibility and and a grating/grinding sensation as the joint articulates.Although this is a disease commonly associated with advanced age, hormonal changes and obesity certain occupations that put excess strain on the joints. In fact, osteoarthritis can be evident in professional athletes who perform a lot of running or high impact sports such as football, or basketball.Since you have a 70% deterioration of cartilage in you knee joint, the progression of your osteoarthritis is very severe. The pain you are experiencing that is disturbing your sleep is directly related to this deterioration. Unfortunately to do date, there is no way of replacing the deteriorated cartilage but there are many methods that can be tailored to your specific needs. Since you have expressed that pain is your primary issue, the first line approach is to use oral analgesic medication. Such medications include acetaminophen, and other non-steroidal anti-inflamatory medications. These generally work well however, they can cause some GI upset along with the potential of liver damage. Other medications for pain can be used are of the narcotic type, such as hydrocodone. These types of medications tend to work more effectively and help with sleep over a longer period of time however but there is a very high risk of becoming addicted to them, especially when you are in a lot of pain such as yours.Physical therapy has been shown to greatly preserve the range of motion of an osteoarthritic joint. This can also provide you with a great deal of education in how to protect your joint from activities that aggravate the pain thereby reducing the pain.There are some medications that can be injected directly into the joints that can provide relieve if you do not want to take medications that act systemically. Such interjoint injections include anti-inflammatory steroids and specially designed joint lubricants which are similar to the naturally occurring lubricants present within the joint.As you can glean from information we have provided there are a multitude of ways that we can treat the pain in your joint due to arthritis. The best approach is generally a combination of the aforementioned, specifically tailored to treat your personal needs, and disease progression. What we suggest is that you consult a specialist in rheumatologist who can assist you in medically treating your pain. If you are still finding that your pain is too much, it may be time to consult an orthopaedic surgeon to discuss your candidacy for knee joint endoprosthetic replacement surgery. We do not want to alarm you buy this, but we are trying to paint a broad picture of the treatment progression of your condition so you are able to have an idea of what to expect. Please be guided accordingly. We hope you feel better.Thank you for choosing AskTheDoctor.com