Osteoarthritis In The Knee

One Of The Most Important Areas For Our Quality Of Life

By Definition – 

Osteoarthritis in the knee is the result of a disease that causes significant degenerative changes to cartilage, eventually causing it to wear away completely, resulting in bone grinding directly on bone. Osteoarthritis cannot be cured, but the good news is catch it early and it’s progression can be stopped.

Our Member Survey Says……..

  • The Knees Were Voted The Second Most Worrying Place To Develop Osteoarthritis With 34%. The Most Concerning Area Was The Hands With 49% And The Hips In 3rd With Just 9%.

(Results from our member survey completed 10th July 2019, to be redone July 2020)

Osteoarthritis In The Knee Can Destroy Lives. Osteoarthritis On It’s Own Is Agony – But When It’s In Your Knees, Rest Is Harder And Treatment Is Tricky. We Look At All Your Treatment And Surgical Options…

Osteoarthritis occurs when the cartilage that is designed to protect your joints, breaks down – eventually resulting in bone rubbing on bone. The result is often bone ‘spurs’ (growths on the ends of your bones), that make movement both difficult and extremely painful.

Osteoarthritis in the knee is one of the most common complaints of osteoarthritis sufferers – mainly due to the central weight-bearing function of your knees that have far less supportive tissue than your spine or hips for example.

Although osteoarthritis is no longer considered to be a condition purely created by ‘wear-and-tear’ (that’s old-fashioned thinking), it is still understood to be fundamentally driven by worn down cartilage.

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Symptoms of Osetoarthritis In The Knee

There is no guarantee that your knees won’t be the first place you spot the early signs of osteoarthritis, so it is very important to know how the early symptoms may show themselves. 

Equally however, if you have already been diagnosed with arthritis in other areas, then you need to be constantly watching for the spread of the disease as early treatment is essential (but different) for every body part.

Typical symptoms of osteoarthritis specific to your knees include –

  • Pain and Inflammation
  • Water on the knee (also known as ‘joint effusion’)
  • Breaking down of the smooth cartilage (or ‘chondrosis’ for it’s technical term)
  • Joint stiffness (especially after long periods of rest)
  • Bone Spurs (also known as ‘exostosis’)
  • Locking knees (where bones spurs cause the joint to lock in certain positions)
  • A Change in The Way You Walk (this does not necessarily mean a limp, it can be walking slightly bowl-legged or knock-kneed – in other words with your knees pointed slightly inwards or slightly outwards).
  • Swelling around the affected knee
  • Extreme tenderness if you push down on your knee
  • Warmth from the skin over your knee. This is particularly strong at the end of the day.

Diagnosis Of Osteoarthritis In The Knee

When you first present to your doctor with suspected osteoarthritis in the knee (or even just a painful joint), it is likely they will follow a process very similar to below –

1) A quick discussion with your doctor around what hurts and when it hurts.

2) A Look at your current health, including how your sore knee affects your current life and what drugs you may be taking either for the pain or for other conditions.

3) An initial medical that is likely to involve some manipulation of the knee during which the doctor is looking for –

4) When the knee is moved, can they feel a grating sensation?

5) Tenderness and Swelling

6) Possibly A feeling of Cold in the joints

7) A popping or cracking feeling when the joint is manipulated

8) Joint Aspiration or Blood tests to rule out other types of arthritis such as rheumatoid arthritis or gout.

9) Scans. Starting with an x-ray but then, if you have caught it in the early stages of the disease, then an MRI will probably be needed to confirm diagnosis.

If you osteoarthritis is well developed, or you have osteoarthritis in other joints already, then an MRI will not be needed to provide the diagnosis.

Causes Of Knee Osteoarthritis

1) Age. This is true of all from of osteoarthritis, although it is now accepted as quite possible that someone young could also develop it (but it is statistically a lot less likely).

2) Obesity. This is really relevant to osteoarthritis in the knee, where perhaps it isn’t when considering osteoarthritis in the hands. Because your knees are stress-bearing joints, the more weight you carry, the higher the stress.

The higher the stress on your knees, the faster the progression of osteoarthritis and the higher the pain levels. A scoping review in 2014 concluded that even a 10% loss in body weight could lead to a significant fall in pain levels and slow the progression of the osteoarthritis.

3) Strenuous Activities. A life full of knee-wrenching activity such as playing competitive sports (football, ice hockey etc), while it may be good for your heart, very often leads to the development of osteoarthritis in the knee.

4) Knee Injuries. There are two key reason for this. On the one hand, a knee injury (even when you are younger) could lead to osteoarthritis, because of the damage already done to the cartilage/ joint.

The other reason is that a range of injuries might not directly damage your knee, but can affect how you use your knee. In actual fact, it’s not just injuries to the knee – even injuries to surrounding areas of the leg, ankle or hip could all affect the weight distribution on your knee.

A slight imbalance in the way you walk and put weight on your knee which may undetectable to the human eye, could lead to osteoarthritis in later life.

5) Gender. Unfortunately it is a fact that sex and hormones play a part in developing osteoarthritis. The fact that being female makes you statistically more likely to develop osteoarthritis is one of the main reasons the definition of osteoarthritis as a disease caused purely by ‘wear-and-tear’ has changed. This very insight was noted in the ‘journal osteoarthritis and cartilage’

6) Genes. Another reason why osteoarthritis isn’t just a disease caused by natural wear and tear – your genes have been found to have link to the likelihood of you getting osteoarthritis.

7) Abnormalities. If you are born with abnormalities such as misshapen limbs or a reduced level of cartilage or synovium, then you are much more prone to getting osteoarthritis in the knee.

8) Weak Thigh Muscles. Not exercising and leading a sedentary lifestyle, will leave your knees vulnerable due to a lack of support from your thigh muscles.

9) Diabetes or Poor Blood Sugar Control. High blood sugar levels affects both the function and structure of cartilage. If you suffer with diabetes, this is even worse as it increases the chances of inflammation as well.

According to The Arthritis Foundation, more than 47% of people in the US with diabetes also suffer with one form or another of arthritis.

9) Poor ‘Gait’ Structure. This means you are walking with an incorrect or biased allocation of your weight. A Gaitscan machine can show the differences between how you should be walking and how you are actually walking.

Stages Of Osteoarthritis In the Knee

There are four basic stages of osteoarthritis in the knee. It is important to recognise the symptoms early (especially if you haven’t already been diagnosed with osteoarthritis). The faster you start treating osteoarthritis, the easier it is to slow down the diseases’ progression.

Stage One – Mild

At stage one, it is unlikely you will feel much, if any, pain – and your joint is likely to appear normal on x-ray , with no noticeable cartilage erosion (although some minor damage will be taking place).

The only real giveaway is the possible existence of small lumps of bone (known as osteophytes) that may start growing on your knee.

Stage Two – Minor

This is the first stage that you are likely to notice obvious symptoms. You are likely to start feeling stiffness in your knee, and some discomfort after sitting for a while.

Anatomically, the space between your bones will appear on x-rays as normal, although your cartilage will start to thin and more osteophytes will grow. As tissue around your bones starts to harden, so an additional thin layer of bone will appear underneath the cartilage.

Stage Three – Moderate

By now you will feel considerable discomfort while walking and there may even be physical signs of inflammation around your joint.

Under your skin, the cartilage damage is continuing – enough that x-rays will now show the loss clearly. As a result the gaps between the bones in your knee are narrowing and the bones themselves are starting to thicken, forming further outwardly visible bumps.

This is the first point at which you may also start to suffer with ‘water on the knee’ (also known as synovitis) – when your knee produces extra synovial fluid to cushion the joint that leads to further inflammation.

Stage Four – Severe

At this point you are likely to be in severe pain (as the stage name suggests). Your joint (s) will be stiff with feelable grinding/ friction as your bones crunch against each other.

Further bumps are very likely to emerge and your bones may even become deformed due to the loss of symmetrical cartilage.

Any scans will show bone against bone, with no visible gap in between (the cartilage has broken down and worn away).

If you are at this stage, then it is fair to assume that painkilling injections followed by surgery are probably your only two realistic options.

Tricompartmental Osteoarthritis

Ultimately, your knee is the meeting point of four key bones – the femur comes from above and connects to the patella (or knee cap), while the tibia and fibula come from below into the knee.

The point that these bones converge upon creates a series of 3 small compartments –

1) The Lateral femorotibial compartment (also considered as the outside of your knee)

2) The Media Femorotibial Compartment (the inside of your knee)

3) The Patellofemoral Compartment (the point that your kneecap meets the Femur)

Tricompartmental Osteoarthritis is said to occur when all three compartments of your knee suffer cartilage degeneration.

This is generally accepted to be the most severe form of osteoarthritis in the knee, because your entire joint is affected and so damage to both your knee’s cartilage and the synovium (the lining of the joint) is very likely to be widespread and substantial.

Treatments for Osteoarthritis In the Knee.

1) Assistive Devices.

Tools to help take the strain off your knee such as walking sticks or canes can help considerably. However, there are also a range of others devices such as supportive knee braces or even shock-absorbing in-soles (for your shoes) that can help to lessen impact on your joint.

2) Hot/ Cold Therapy.

Similar to that used by athletes, this involves either getting your joint very hot or very cold. This can be done by taking different temperature baths or, for more frequent/ convenient treatment, using pre-purchased hot/ cold compresses.

The theory here is that having both not only relaxes your muscles (heat), but also stimulates bloodflow (cold).

3) Chemical Pain Relief.

You can get a range of NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen over-the-counter in pharmacies that can help.

If this is not effective, then your doctor may look at a range of stronger painkillers leading up to opioids, depending on your personal situation.

4) Lifestyle Changes.

Changing your exercise to low-impact activities such as swimming can have a very positive impact – as can taking up swimming if you don’t currently exercise at all. If you can build up the muscle around your knee, then it stands a reasonably good chance of healing itself.

Similarly, losing weight was discussed in limited detail before, will greatly help by reducing the stress you are exerting on your knee joint every time you try to walk.

5) Physio.

Again, some light resistance exercises that build up the muscles around your knee, without crunching your full bodyweight down on it, can really help.

6) Acupuncture

There is some debate as to how effective acupuncture is in general, let alone on osteoarthritis, but some claim that it works, so we decided to include it as a possible option.

7) Balneotherapy

Soaking your knee in a special mix of warm mineral water has claims to relieve some of the pain. Certainly the concept of using heat to treat your knee is well understood. Adding the minerals, is a concept that is open to further scrutiny.

8) Using A TENS Machine.

A TENS machine (Transcutaneous Electrical Nerve Stimulation) uses weak electrical pulses to help with pain and healing. We deal with TENS Machines in more detail HERE

9) Injections.

If your pain is not controlled by any of the options above, the next step may well be a pain killing injection. This could either be a steroid injection for pain/ inflammation relief or an injection of hyalagan, to improve your general symptoms.

Be warned however – while corticosteroid injections help with pain relief in the short-term, the long-term likelihood is that will worsen your condition so use should be limited and certainly never contain more than 3 or 4 a year.

10) Surgery.

This is normally a last resort, but does have a high chance of success. Typically, you will either have a knee revision or a complete replacement.

Both are very painful immediately after surgery, but with lots of careful rehabilitation, the outlook in today’s world is very good.

Even with a complete replacement, the chances of walking pretty much pain-free are very high and typical prosthesis (the replacement joint) tend to last around 15 to 20 years before wearing out.

Including the revisions, there are four basic options for knee surgery, normally offered in the following order –

1) Arthroscopy. A surgeon attempts to remove or flush out any damaged bone fragments that may be causing further pain. While they are looking, they can often spot any torn ligaments or damage to the meniscus and can repair it at the same time.

2) Cartilage Grafting. Much less used, but involves taking cartilage from another area of your body and trying to graft it around your knee joint.

3) Partial Knee Replacement. As It says on the tin – removes a damaged part of your knee and seeks to replace it with similar.

4) Total Knee Replacement. The entire joint is removed and a whole new, ceramic knee is bolted in to your leg bones.

Stages Of Treatment.

Typically, at stage one (mild), it is likely that you wont have a formal diagnosis and may rely on an ibuprofen or similar painkiller in the event that you feel some discomfort in your knee.

At Stage two, you should be at your doctors door, banging it door (not literally) to ensure you get  a diagnosis, so if it is osteoarthritis you can start taking measures to try and control/ slow its progression.

This will typically involve more specialised exercise (aqua therapy/ swimming/ cycling) to build strength around your joints.

It may also involve use of assistive devices such as a knee brace or walking cane to help keep some of the pressure of your knees.

You are likely to be trying TENS therapy and possibly even acupuncture.

You may also consider looking at custom orthotics (special in-soles for your shoes to help readjust the way you walk).

By stage 3, it is likely you will still have all the above plus stronger painkillers and maybe the first of your corticosteroid injections (if you decide to go opt for them).

At stage 4, after several more potential injections, surgery is likely to be the only option. Either a partial revision or a complete replacement will be decided on with your doctor, depending on how far your osteoarthritis has progressed.

Stem Cell Therapy For Cartilage Replacement?

Theoretically, stem cell therapy can regenerate cartilage in humans. If so, it is possible that it might be able to help regenerate the cartilage in patients with osteoarthritis.

In 2018 a meta-analysis analysed all the different ways of using stem cell therapy to treat osteoarthritis, only to conclude that the long-term results were at best inconsistent.

Not only that, but the costs were extreme and even greater problems were found with anyone that had a body mass index of more than 35.

Furthermore, the side effect profile associated with stem cell therapy on your knee were substantial including cells that actually reproduced in the wrong place and a substantial risk of tumors!

While stem cell therapy may well become an option in the future, at the moment it still teeters dangerously on the edge of practical medicine.

The Final Word –

The knees are one of the most overloaded joints in the body, so it is perhaps no surprise that they are also one of the most likely to suffer with osteoarthritis.

Unlike in some other parts of your body though, options for treating osteoarthritis in the knee does have the advantage that surgery can supply a complete working replacement.

This should always be a final resort as there are considerable risks with any surgery and the outcome is only likely to last 15-20 years anyway.

Instead, as with most forms of osteoarthritis, you need to identify it fast, put a treatment plan together with your doctor and start trying the various treatment options above.

Time is key because the faster you diagnose osteoarthritis in the knee and start specifically treating it, the easier it is to slow it’s development and continue living an active life.

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References –

1. H Bliddal, A R Leeds and R Christensen. (April 2014). Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review. Obesity Reviews.
2. V. Silverwood, M. Blagojevic-Bucknall, C. Jinks, J.L. Jordan, J. Protheroe, K.P. Jordan. (April 2015). Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis and Cartilage.
3. Jevotovsky DS, Alfonso AR, Einhorn TA, Chiu ES. (Mar 2018). Osteoarthritis and stem cell therapy in humans: a systematic review. Osteoarthritis and Cartilage.

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