By FREDERIC W. RHINELANDER
STEOARTHRITIS requires definition before its treatment can be dis-0 cussed. I shall define it as degenerative joint disease which is symptomatic. As is the case with all chronic disabilities, primary consideration must be given to the patient as a whole. The patient with painful degenerative knees is usually a female, and she is often obese. She is generally middle aged, and she is apt to be much worried about her condition. .4t the outset, she must be assured that she does not have "arthritis" (in the sense that she fears), that she is not on her way to becoming a deformed cripple. She must be assured that her joints are simply wearing out a bit prematurely, and that the process can be alleviated by simple measures. Her general way of life may have to be slowed down; she may have to be put on a reducing diet.
Above all, she must be led into having complete confidence in her physician. Otherwise, no treatment will be effective, for she will not cooperate.
The first symptoms of degenerative joint disease are primarily on a mechanical basis. Normal wear and tear have been aggravated to the degree that pain on use develops. Therefore, the basis of treatment is rest. Often the activity which first causes pain in the knees is use of stairs. Obviously, the patient should plan her life so as to limit any such painful activities as milch as possible.
Local support of a painful knee is also available. An ace bandage affords minimal protection. The bandage must be wide enough (at least six inches), and it must extend from just above the bulge of the calf to a point about six inches above mid-patella. The bandage must be applied sufficiently snugly that the patient feels its support and notices some restriction of knee motion. This means that the bandage should be removed whenever the patient is to sit or lie down for any period of time, because circulatory embarrassment will result from lack of muscular activity. In order to achieve greater support, and more restriction of motion, a piece of felt, cut into the shape of a horseshoe, may be applied under the ace bandage. The curve of the horseshoe should lie just above the patella. This keeps the &It in position, and compresses