Introduction

Nicholas A. DiNubile, MD
Special Report Editor

From A Special Report: Osteoarthritis of the Knee

Keeping Aging Adults Active


Arthritis is one of the most common ailments facing today's physicians. According to a recent report published by the American Academy of Orthopaedic Surgeons,1 arthritis affects more than 32 million Americans, or almost 1 in 8. It is the second most frequently reported chronic condition. Fifty percent of persons older than 65 years of age are affected, and this will worsen in the upcoming years with the aging population, particularly baby boomers.2 It is estimated that by the year 2020, 60 million Americans, or 18% of the population, will have to deal with the day-to-day impact of arthritis on their life.

A problem affecting that many people will also be an economic challenge for our healthcare system. Arthritis is the leading cause of disability in our nation, more so than heart disease, cancer, or diabetes. In the workplace, it ranks behind heart disease as the leading cause of work disability. Arthritis results in more than 500,000 hospitalizations per year, with an estimated cost of $82 billion. It has been estimated that arthritis and other rheumatic conditions have an annual economic impact equivalent to a modern recession, with a total cost of 1.1% of the gross national product.1

Physicians are faced with many arthritic patients who are presenting at younger and younger ages. The sheer volume of patients, combined with other changes, affect the physician's approach:

  • There are numerous evaluation and treatment options for arthritis. However, there is no one perfect treatment for everyone, at any age, so treatment must be individualized based on the severity of symptoms, the degree of arthritis, and the patient's activity level and expectations.
  • In the new information-charged millennium, physicians must be willing and able to discuss the wide range of traditional, alternative, and emerging—sometimes experimental—options with sophisticated, informed patients. We must always give the best scientifically supported advice with one eye on cost effectiveness and the other on our Hippocratic Oath to "first, do no harm." More treatment, more surgery and more intervention does not always mean a better outcome or a happier patient.
  • Despite the increasing number of options for treatment, patients are often looking for simple advice, education, and reassurance. Most of my arthritis patients do very well with simple conservative measures such as exercise, activity modification, and an occasional medication or injection.3,4 For others, major reconstructive surgery is the appropriate "simple" plan.

Physicians must be aware of the entire treatment spectrum available to them, and this Special Report provides that information. The focus is on osteoarthritis of the knee, but many of the principles apply to other joints. The knee was chosen because it—along with the hip, spine, and fingers—is the most common location for osteoarthritis. In the ongoing Framingham Study,1 osteoarthritis of the knee, because of its high prevalence, accounted for more functional limitations than any other disease assessed. Also, in 1995, 3 outpatient knee procedures (arthroscopy, meniscectomy, and ligament repair) accounted for 5% of all outpatient surgical procedures.1 Peter C. Vitanzo, Jr, MD, and John M. McShane, MD, review the pathophysiology of arthritis and give practical tips for clinical diagnosis and evaluation. K. Wayne Marshall, MD, PhD, and David D. Waddell, MD, outline the nonoperative management of osteoarthritis of the knee, including exercise and other nonpharmacologic therapies, medications, supplements, and the innovative area of viscosupplementation. Brian J. Cole, MD, and Sudeep Taksali give a comprehensive review of operative treatment for the arthritic knee, including the role of arthroscopy, the indications for joint replacement, and the exciting new area of articular cartilage restoration and resurfacing. Dr Waddell has provided case reports of his experience with active patients with arthritis who underwent viscosupplementation.

It is clear from this Special Report that there have never been so many excellent options in the treatment of osteoarthritis. Although there is currently no cure for arthritis, the future has never been brighter. I believe that the important role of prevention will continue to grow.5 In the past we focused primarily on control and treatment of arthritis-related symptoms, but times have changed. As our basic scientific understanding of articular cartilage biology and repair expands, we are entering an era of true disease modification. With the emergence of gene therapy, including the use of growth factors and tissue engineering, we are approaching the day when we actually might use the word "cure" when we speak of arthritis. It is indeed an exciting time for the patients and physicians who deal with osteoarthritis on a daily basis.


Nicholas A. DiNubile, MD is clinical assistant professor, department of orthopedic surgery, Hospital of the University of Pennsylvania, Philadelphia, and orthopedic consultant to the Philadelphia 76ers basketball team and the Pennsylvania Ballet. He has been a consultant for Wyeth-Ayerst Laboratories.

Address for correspondence: Nicholas A. DiNubile, MD, Llanerch Medical Center, 510 W Darby Rd, Havertown, PA 19083.

References

  1. Praemer A, Furner S, Rice D. Musculoskeletal conditions in the United States. 2nd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons, 1999
  2. Kalb C. The jock v. the clock: weekend athletes and the perils of middle age. Newsweek. May 24, 1999:76,81
  3. DiNubile NA. Osteoarthritis: how to make exercise part of your treatment plan. Phys Sportsmed 1997;25(7):47-58
  4. DiNubile NA. The role of exercise in the treatment of osteoarthritis. Am J Med Sports. 1999;1(4):188-200
  5. DiNubile, NA. Expanding medical horizons. Phys Sportsmed 1997;25(7):45-6

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