Knee Arthritis

Sometimes called the ‘wear and tear’ arthritis, Osteoarthritis is the commonest cause of Knee arthritis. Occasionally the arthritis is caused by inflammation (Inflammatory arthritis like Rheumatoid arthritis).

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Sometimes called the ‘wear and tear’ arthritis, Osteoarthritis is the commonest cause of Knee arthritis. Occasionally the arthritis is caused by inflammation (Inflammatory arthritis like Rheumatoid arthritis). Osteoarthritis can affect any joint, but most affected are the weight bearing joints like the Knee joint.  Since Arthritis gradually worsens over time, early start of treatment can lessen the impact on life. Although there is no cure of Osteoarthritis, there are many options of treatment available that can help manage the symptoms and stay active.

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The Knee joint is one of the largest and strongest joints in the body. It is made of the lower end of the Femur (thigh bone), upper end of the Tibia (Shin bone) and the Patella (Kneecap) Smooth and slippery cartilage called the articular cartilage covers the surfaces of these 3 bones

This protects and cushions the bones, thus enabling them to move easily and freely.

Two wedge-shaped pieces of cartilage called Meniscus act as "shock absorbers" between your thighbone and shinbone.

They are tough and rubbery to help cushion the joint and keep it stable.

The joint is lined by a thin membrane like lining called the synovium.

What happens to the Joint in Arthritis?

Osteoarthritis is a wear and tear process that mostly occurs in people at 50 or over but can occur in those under the age as well. In Osteoarthritis, over a period, the cartilage wears away. During this process, the cartilage becomes rough and irregular and space between the head and socket of the joint reduces gradually. Eventually all the cartilage wears away, resulting in bone rubbing against bone. This process most of the times is gradual and pain worsens over time. 

Causes of Arthritis

There are certain factors which predispose to the development of Osteoarthritis. 

  • Advancing age
  • Family history of osteoarthritis
  • Previous injury/ fracture to the Knee Joint (Posttraumatic Arthritis)
  • Obesity
Symptoms of Arthritis

Gradual onset of pain and stiffness, worsening over time are the most common symptoms. Additional symptoms include:

  • Pain in your Knee that often flares up with activity but with time, can be present at rest or disturb your sleep. Pain can increase in cold weather. Pain may cause a feeling of ‘buckling’ or ‘weakness’ in the Knee.
  • Stiffness in the Knee joint that makes it difficult to walk or bend.
  • "Locking" or "sticking" of the joint, and a grinding noise (crepitus) during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the Knee.
  • Stiffness in the Knee that affects the ability to walk and may cause a limp.
What happens when you see a Consultant?

First step in the assessment will be a detailed History of your symptoms. Any background history of injury, previous treatment, and any other health problems that you may have. 

This is followed by a thorough physical examination of the Knee joint and any other joints or areas that may be the cause of your pain.

With a detailed History and Physical Examination, the Specialist will have a good idea about the cause of your symptoms. To confirm the diagnosis, following investigations are considered: 

Weight bearing X-rays of the Knee and the Kneecap: A weightbearing x-ray of the Knee is a simple test which gives all the necessary information about bones and the extent of arthritis. Often this is the only imaging needed to make a diagnosis. X-rays of an Arthritic Knee show a narrowed joint space, changes in the bone and presence of bony spurs called osteophytes. 

Other imaging: Magnetic Resonance Imaging (MRI) which better defines the soft tissues like ligaments, meniscus and tendons around the Knee joint is often useful; a Computerised Tomogram (CT) may be rarely needed to plan your treatment.

Blood Tests: Most common type of Arthritis is ‘wear and tear’ type of Arthritis, but occasionally inflammatory arthritis like Rheumatoid Arthritis can affect the Knee and some blood tests are useful in the diagnosis.

How is Knee Arthritis treated?

Although there is no cure for Arthritis, there are many treatment options available: 

NON-SURGICAL:  

Early treatment of Knee Arthritis is non-surgical. Your specialist may recommend one or a combination of the following: 

Lifestyle modification: Some changes in lifestyle can help protect the Knee and reduce the symptoms. These include reducing activities that aggravate the symptoms like bending or climbing stairs, reduce the stress on the Knee by avoiding high-impact activities like jogging and take up low impact activities like swimming or cycling and reducing weight. 

Physiotherapy: Individualised exercise regime organised by your specialist and physiotherapist may help improve the core strength and improve the range of motion.

Assistive devices: Using walking aids like crutches, walking stick or a Zimmer frame can improve mobility and reduce pain by taking the weight off the Knee. Other devices like a long-handled reacher can also help.

Medication: Over the counter Painkillers or Nonsteroidal anti-inflammatory drugs (NASID) may help relieve the pain. Sometimes your doctor may prescribe stronger painkillers or NSAIDs to help alleviate the symptoms. It is important to be aware of the side-effects of these tablets.  

Knee Injections: Occasionally Knee injections may be beneficial in alleviating symptoms. These are often used in combination with other non-surgical modalities to improve the core strength and flexibility or to optimise other medical conditions before surgery. 

SURGICAL:

When the non-surgical treatment is unsuccessful in controlling the symptoms, the specialist will recommend surgical treatment.

Arthroscopy: During arthroscopy, the specialist makes small incisions and thin instruments to diagnose and treat joint problems. Arthroscopic Surgery is not often used in the treatment of Arthritis, but useful in treating degenerative tears of the menisci that are part of the arthritic process. 

Cartilage Grafting: Usually used in young patients to treat small areas of cartilage damage. Cartilage graft from the healthy non-weight bearing parts of the knee is harvested and grafted into the affected weight bearing cartilage areas. 

Osteotomy: Used in early-stage Arthritis when one side of the joint is damaged. The Thigh bone or the shin bone is cut, realigned and reshaped so that the weight distribution through the damaged portion is shifted. If chosen correctly, can effectively alleviate the symptoms of Arthritis.  

Total or Partial Knee Replacement: The specialist will remove the worn-out parts of your Knee joint and replace it with a combination of Metal and Plastic joint surfaces.