Osteoarthritis of the Knee

Osteoarthritis - Knee

Osteoarthritis or wear and tear on the knee joint is a common cause of knee pain. We explain the injury and treatment options.

Symptoms of arthritis in the knee

Osteoarthritis knee pain is a deep aching pain in the inner knee that is worse after exercise. Stiffness in the joint is common, particularly in the morning however this may reduce with movement. There will be swelling in the knee and sometimes a clicking or cracking noises when moving the knee.

What is osteoarthritis?

Within a joint there is a very smooth fibrous connective tissue, known as articular cartilage. This covers the areas where each bone comes into contact with one another (articular surfaces). In a normal joint this articular cartilage allows for smooth movement within the joint as well as acting as a shock absorber. In addition to this cartilage is another tissue, known as the synovial membrane, which produces synovial fluid that lubricates the joint.

Osteoarthritis (also called degenerative joint disease) is the degradation and degeneration of this articular cartilage. As the disease progresses, the cartilage itself becomes thinner and in some cases may wear away altogether.

In addition, the bones themselves become thicker and may form bony “spurs”. Associated with these changes is the inflammation of the synovial membrane or thin lining which surrounds the knee joint to keep the synovial fluid or lubrication in place.

All of these factors can cause pain and impaired movement in the joint. Osteoarthritis can form in any joint but is more common in weight bearing joints such as the knee and hip.

Osteoarthritis of the knee

Osteoarthritis of the knee is common in people over 50 years of age, in particular in women. It can affect either one (unilateral) or both (bilateral) sides of the knee joint however it occurs more commonly on the inner (medial) aspect of the knee.

Knee osteoarthritis is common in individuals who play intense physical sports, such as football. Previous injury to the knee is a strong indicator for development of osteoarthritis in the future. Symptoms are known to develop slowly over a number of years.

To diagnose osteoarthritis the clinician might assess the nature and severity of pain. The will measure the amount of movement in the joint and take an X-ray of the knee. Narrowing of the joint space is a good indicator of osteoarthritis. Bony spurs can also be seen on an X-ray. In some cases an MRI scan may be necessary. This allows the clinician to see whether soft tissue changes have taken place within the joint. In certain cases a blood sample may be necessary to rule out the presence of other types of types of arthritis.

Causes of osteoarthritis include history of acute injury to the medial knee for example, meniscal or ligament trauma, prolonged and excessive use of the knee joint. Previous fractures at the site of the knee joint, obesity and genetic factors can all play a role in the development of osteoarthritis.

Treatment of arthritis in the Knee  

As yet there is no cure for arthritis. However a number of treatments can be put in place to slow the progression of the disease.

Specialist knee supports or braces known as valgus unloader braces have been proven to provide pain relief in some cases of medial compartment osteoarthritis, by reducing the load on that compartment. Buy knee supports & braces online. NSAID's- Non-Steroidal Anti-Inflammatory Drugs such as ibuprofen can provide some temporary pain relief.

Weight loss can help as obesity is associated with the onset of osteoarthritis and can have a significant effect on slowing the disease progression.

Exercise programs can help to maintain healthy cartilage and range of motion of the joint. In addition, keeping the attaching muscles and tendons conditioned and strong will aid in the joint's stability. If exercising is difficult, hydrotherapy may be useful to reduce the stress on the joints.

Muscle relaxants are usually administered in low doses and can relieve pain that arises from muscles strained in an attempt to support osteoarthritic joints. Hot and cold treatments applied to the knee can help with relief from pain and inflammation after exercise.

A viscosupplement can be administered as an injection by a clinician. This substance helps to lubricate the knee joint and can decrease the amount of inflammation.

Knee Replacement operations can be undertaken in extreme cases, both half and total knee replacements are available.

Surgery

 

Mr Villar is one of the top Orthopedic Surgeons in the World. As former Surgeon to the British Army Special Air Service Regiment he has practiced medicine in some of the most remote and challenging environments. He talks exclusively to Sportsinjuryclinic.net about knee replacement surgery.

The development of knee replacement surgery has been a major revelation in managing arthritis in knee. In the mid to late 60's it was uncommon to perform a knee replacement and the design of the replacement itself was not good. Over time the design has improved considerably and now 12 years after surgery, up to 95% of knee replacements are still functioning well.

Improvements in the procedure have taken into account the importance of alignment of the replaced joint - computerised navigation devices have been introduced to help this. Also improved surgical devices, smaller incisions and shorter hospital stays have all contributed to massive improvements over the last 5 years. Knee replacement recovery times have therefore reduced significantly.

Generally with a knee replacement, a metal cap is fitted on to the bottom of the thigh bone (Femur) and a plate is fitted on top of the shin bone (Tibia). The joint between the two is a plastic hinge joint. The plastic used to be rigidly fixed to the plate on the Tibia. In newer designs it can slide and twist - giving better, more natural movement.

It is most common for arthritis problems to affect the medial (inside) aspect of the knee. For this reason, unicondylar or partial knee replacements can be performed where only the inner part is replaced. This procedure is not necessarily a quicker procedure to perform but is associated with a better range of motion at the end.

Strengthening the muscles of the thigh and lower leg is often recommended for people with osteoarthritis of the knee. Having strong muscles surrounding the joint helps to reduce the stress on the knee joint itself and also helps maintain a good alignment of the knee. Maintaining flexibility is also beneficial to reduce stiffness.

Strengthening Exercises

 

Knee extension

Straightening the knee against resistance will strengthen the quadriceps muscles at the front of the thigh. This can be achieved in a number of ways, including using ankle weights and resistance machines. One of the easiest ways involves using a resistance band:

  • The patient sits on a chair with one end of the band tied around their ankle and the other end around one of the chair legs.
  • The band should be taut when the knee is bent at 90 degrees. The patient straightens the knee before slowly bending it and returning the foot back to the floor.
  • Perform 10-15 repetitions and repeat this 2-3 times.

Knee flexion

Still using the resistance band:

  • The patient lies on the floor with the band tied around one ankle and the other end attached to something sturdy, close to the floor. The band should be taught when the knee is straight
  • The patient bends the knee to bring the heel towards the buttock as far as possible, and then slowly straightens the knee back again.
  • Perform 10-15 repetitions and repeat this 2-3 times.

Calf raise

Calf raises are good for strengthening the Gastrocnemius muscle which is one of the two main calf muscles, but the only one which crosses the knee joint.

  • The patient stands with the feet should width apart and close to a wall or chair which can be held for balance if required.
  • The patient rises up on to the toes, keeping the knees straight, before slowly lowering the heels back to the floor.
  • Perform 10-15 repetitions and repeat this 2-3 times.
  • This exercise can be progressed by performing on one leg only.

Squats

Squats are really good exercises for strengthening all the main muscle groups of the legs and buttocks. They can start off as very shallow movements and progress until the knees reach a 90 degree angle at which point weights can be added.

  • The patient stands with the feet shoulder width apart and back straight.
  • The knees are then bent as if trying to sit on a chair.
  • The back should remain straight and the knees should not move forwards past the toes.
  • Perform 10-15 repetitions and repeat this 2-3 times.

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