Arthritis is one of the five leading causes of disability among elderly men and women. The risk for disability from arthritis is as great as that from cardiovascular disease.

A smooth, slippery, fibrous connective tissue called articular cartilage acts as a protective cushion between bones of a joint. Arthritis develops as the cartilage begins to deteriorate or is lost. As the articular cartilage is lost, the joint space between the bones narrows. This manifests as pain an early symptom.

As the disease progresses, the cartilage thins, becoming grooved and fragmented. The surrounding bones react by becoming thicker. They start to grow outward and form spurs. The synovium (a membrane that produces a thick fluid that helps nourish the cartilage and keep it slippery) becomes inflamed and thickened. It may produce extra fluid, often known as "water on the knee," that causes additional swelling.

Over a period of years, the joint slowly changes. In severe cases, when the articular cartilage is gone, the thickened bone ends rub against each other and wear away. This results in a deformity of the joint. Normal activity becomes painful and difficult.

	Normal and Arthritic Knee Joint

Three basic types of arthritis may affect mainly knee and hip joint:

1. Osteoarthritis (OA) is the most common form of arthritis. OA is usually a slowly progressive degenerative disease. It most often affects middle-aged and older people.

2. Rheumatoid arthritis (RA) is an inflammatory type of arthritis that can destroy the joint cartilage. RA can occur at any age. RA generally affects all the joints of the body.

3. Post-traumatic arthritis can develop after an injury. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, ligament injury or meniscus tear in the knee.

The pain associated with arthritis develops gradually, although sudden onset is also possible. Affected joint may become stiff and swollen, with difficulty in bending or straightening. Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing or kneeling. The pain may often cause a feeling of weakness in the joint specially in the knee, resulting in a "locking" or "buckling."

Clinical examination of patient and symptoms of the patient – pain, swelling, inability to perform activities, deformity and altered gait. I will get x-rays and blood tests depending on type of arthritis.

In its early stages, arthritis is treated with conservative, nonsurgical measures. Initial treatment is generally directed at pain management. OA pain may have different causes, depending on the individual and the stage of the disease. Thus, treatment is tailored to the individual.

• Lifestyle modifications can include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities such as climbing stairs that aggravate the condition.

• Exercises can help in increasing range of motion and flexibility as well as helps to strengthen the muscles around the joint.

• Using supportive devices such as a cane.

• Other measures may include applications of heat or ice, water exercises, liniments or elastic bandages.

Several types of drugs can be used in treating arthritis. Because every patient is different, and because not all people respond the same to medications:

• Anti-inflammatory medications can include aspirin, acetaminophen or ibuprofen to help reduce swelling in the joint.

• Glucosamine and chondroitin (kon-dro'-i-tin) sulfate are oral supplements may relieve the pain of osteoarthritis.

• Hyaluronate (hi-a-lou'-ron-ate) therapy consists of a series of injections designed to change the character of the joint fluid.

• Special medical treatments for RA include disease-modifying drugs.

Medications	Injection

If arthritis does not respond to these nonoperative treatments, you may need to have surgery:

• Arthroscopic surgery uses fiber optic technology which enable the surgeon to see inside the joint and clean it of debris or repair torn cartilage.

• An osteotomy cuts the shinbone (tibia) or the thighbone (femur) to improve the alignment of the knee or hip joint.

• A total or partial knee arthroplasty replaces the severely damaged knee joint cartilage with metal and plastic.

Arthroscopy	Hip Replacement	Knee Replacement