Knee Osteoarthritis
Osteoarthritis is the most common form of arthritis in the knee, and often occurs in those aged 50 years and above due to degeneration, wear and tear. The cartilage in the knee joint gradually wears away, becoming frayed and rough, resulting in bone rubbing on bone. This causes pain which will only worsen over time and can significantly affect quality of life.
Signs and Symptoms
Pain typically develops gradually, although sudden onset may occur, following an acute exacerbation.
Other symptoms include:
- Stiff and swollen joints, making it hard to bend or straighten the knee, especially after a long period of inactivity
- Pain and swelling
- Pain that flares up after vigorous activity
- Increased pain with changes in the weather
- Cracking, clicking or snapping of the knee caused by loose fragments of cartilage or bone rubbing against the joint surfaces
- Feeling weak or buckling in the knee
- Limping
Causes and Risk Factors
Knee osteoarthritis is usually degenerative, following wear and tear, and associated with older age. Although uncommon, knee osteoarthritis can also occur in young people with previous knee injuries (e.g., fractures, meniscus tears), repetitive stress injuries (following excessive high impact activities over a long period of time), or increased body weight, all of which can result in raised contact pressures within the knee joint.
Although less common, knee osteoarthritis can occur in young people too, especially those who are very athletic as long-distance running, for example, puts them at a higher risk of developing the condition.
Diagnosis
Your orthopaedic specialist will start off by taking a medical history to check for the severity of the symptoms and whether there was previous knee injury.
This will be followed by a physical examination of your knee to look for:
- Swelling, warmth or redness
- Tenderness (pain on pressing parts of the knee)
- Limitation in range of knee movement
- Instability
- Deformity (‘leg looks crooked’)
- Abnormal walking patterns
- Involvement of other joints
Your orthopaedic specialist will also use imaging tests to help determine if you have knee osteoarthritis:
- X-rays – provide detailed pictures of the bone to help distinguish among the different forms of arthritis, to assess the severity of the osteoarthritis, and look at the overall alignment of the lower limb
- MRI/CT scans – may be needed to determine the severity of the osteoarthritis or cartilage damage, the parts of the knee affected, and check for associated meniscus or ligament injuries or tears
Treatment
The treatment for knee osteoarthritis is dependent on your age, the severity of your condition and the symptoms you experience. Ultimately, the main goal of treatment is to help you relieve pain, allow you to resume your usual activities and prevent permanent injury to your knee.
Your orthopaedic specialist may recommend non-surgical treatments such as activity modification, losing weight, or using a walking aid. Physical therapy can help to strengthen surrounding muscles, such as the quadriceps, and maintain knee movement. A knee brace can help to take the weight away from the affected side of the knee or to improve knee stability.
Pain relievers and anti-inflammatory medication can be prescribed to reduce joint pain and inflammation.
Injections can be performed to help reduce the inflammation and improve lubrication within the knee joint. This can be in the form hyaluronic acid (a constituent of cartilage) in a gel like form or steroids.
If conservative treatments prove to be ineffective, your orthopaedic specialist may recommend surgery. There are a few types of surgical procedures to treat knee osteoarthritis:
-
Arthroscopy (keyhole) surgery
– small incisions are made and a camera and specialised instruments are inserted into the knee to repair damaged cartilage, remove unstable or loose cartilage fragments, repair a torn meniscus, or remove unstable meniscus tear flaps. Arthroscopy is best performed in the early stages of arthritis, and being a keyhole procedure, allows shorter recovery times. -
Knee Osteotomy
– either the tibia (shinbone) or femur (thighbone) is cut and shifted to improve the overall alignment of the lower limb, thereby offloading the affected part of the knee. This procedure is commonly performed in younger patients, as it preserves the native knee joint, potentially allowing return to a higher level of activity. -
Knee Arthroplasty or Replacement
– involves removing the damaged cartilage and bone, replacing it with an artificial joint (prosthesis) to restore the function of the knee. This can be in the form of a partial or total knee replacement, depending on the extent of arthritic involvement. Newer technologies such as robotic assisted knee arthroplasty and patient specific instrumentation have allowed more accurate positioning of the knee components, resulting in better knee alignment. Knee replacements have been proven to greatly reduce the pain associated with arthritis and have restored many patients to an active lifestyle.
Every case is different; hence it is best to consult an orthopaedic surgeon for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Dr Poh is experienced in the full range of knee arthritis treatments, and is adept at using the latest technology to improve your outcomes. Reach out to us today if you suspect that you are suffering from knee osteoarthritis and let us help you enjoy a better quality of life.
Frequently Asked Question (FAQ)
1) How can I prevent knee osteoarthritis?
In younger people, knee osteoarthritis can often develop due to other knee injuries. To avoid injuring your knee it is important to always warm up before exercise, wear proper footwear, and use proper technique when jumping and landing.
Exercises which strengthen the muscles around the knee joint can also be helpful in preventing knee osteoarthritis. Ensure proper form when doing exercises that involve the knee such as squats or lunges.
Other ways of preventing knee osteoarthritis include maintaining a healthy weight, avoiding activities that involve repetitive stress on the knees, using knee protection, and taking breaks to stretch your knee if you are standing or sitting for long periods of time.
2) How can I manage knee osteoarthritis at home?
The pain, swelling, and stiffness in the knee from osteoarthritis can make it difficult to carry out basic tasks at home. To alleviate the symptoms you can try applying hot or cold to the affected knee. Gently massaging the muscles around the knee joint may also improve blood flow and reduce pain.
Other ways of managing knee osteoarthritis include keeping your weight at a normal level, low-impact exercises such as swimming, walking, or cycling, using assistive devices to support your knee joint, and avoiding activities that put stress on your knees.
3) When do I need to see a doctor for joint pain?
Infrequent mild knee pain may not require a visit to a doctor to check. However, there are a few tell-tale signs and symptoms of knee osteoarthritis that you should look out for. These are frequent moderate to severe pain in a joint, swelling, stiffening, redness or warmth in a joint, tenderness, and difficulty moving.
If your daily activities are affected by joint issues, or if your symptoms last 3 days or more then you should make an appointment with your doctor for a checkup. This also applies if you encounter multiple episodes of joint pain in a month.
