Standing up to knee arthritis

A common source of knee pain is arthritis, where the joint is inflamed due to a chronic infection or as a result of the cartilage wearing away. In this article, a consultant orthopaedic and trauma surgeon delves into the intricacies of knee arthritis and what can be done to address it.

The knee is one of the body’s largest joints, located at the junction of the femur (the thigh bone) and the tibia (shin bone), and topped by the patella (kneecap). Surrounding it are an assortment of muscles, ligaments, and cartilage. Arthritis is when the cartilage that protects and provides padding between the knees no longer functions as it should, is damaged, or erodes.

What is knee arthritis?

Aside from pain, arthritis in the knees is characterised by a swelling and stiffness around the knee, and eventually resulting in restriction of movement as the condition continues to deteriorate over time. There are three kinds of arthritis that can affect the knees:

• Osteoarthritis, which is a gradual wear and tear of the knee’s cartilage that is typical in older people, especially if a lot of time has been spent putting strain on the knee, such as occupations or hobbies that are high-impact (for example, plumbers and runners).
• Rheumatoid arthritis, which is part of an autoimmune disease where the synovial membrane in the knees, which provides lubrication to keep movement fluid, becomes inflamed.
• Post-traumatic arthritis, which is the result of injury such as a fracture or dislocation, and forms quickly unlike other kinds of arthritis. It can happen in anyone and is most common in younger people due to higher levels of physical activity (such as sports injuries).

How is knee arthritis diagnosed?

Knee arthritis is typically diagnosed after a comprehensive physical examination, where a doctor will take note of the patient’s mobility, stiffness, pain and discomfort, and any signs of damage. It is likely that the patient will undergo an X-ray to assess the extent of the condition. If further scans are needed, then an MRI or CT scan can be undertaken. The patient may also have a blood test to determine the type of knee arthritis.

How is knee arthritis treated?

Most treatments for arthritis prioritise making the patient comfortable and improving mobility. Both rheumatoid and osteoarthritis cannot be cured permanently; post-traumatic arthritis may heal on its own with adequate rest, though it will take several months.

There are surgical and non-surgical options for treating knee arthritis, and doctors will recommend that non-surgical options are explored before performing surgery – however, those with severe pain and immobility are prime candidates for a knee replacement or arthroscopy.

Non-surgical treatments include physiotherapy, such as exercises and stretches to strengthen the muscles and help support and stabilise the knee, medication to bring down inflammation and help with pain management, and mobility tools, like canes and walking sticks, a knee brace, and shock absorption shoes. For those who with obese, “lightening the load” on the knees by losing weight can have a significant impact. Patients are encouraged to not strain the knees with activities like trampolining or running and instead consider low-impact activities such as swimming or cycling.

If non-surgical treatments have not been fruitful or if the arthritis is extremely debilitating, then surgery can be considered. There are several procedures that can address knee arthritis to restore mobility and eliminate pain.

An arthroscopy is one of the most common procedures for the knee. Using a few small incisions around the knee, a surgeon is able to access the internal structures with instruments and the camera/lighting tool that is the arthroscope. From there, doctors are able to assess and address the damage to the joint and repair tissue.

For very severe damage to the knee, there is the option of a knee replacement, where bone components of the joint are replaced with artificial implants that can be made of plastic, silicone, and metal. The worn or faulty tops of the tibia and femur are sawn off and fitted with the implant, and the kneecap is replaced on top. If the damage is only on one of the bones, then a partial knee replacement can be performed instead. Knee replacements can last around 15 years, which is why surgery is a final option so that the need for replacement revision surgery is avoided.

An osteotomy is a procedure to cut and reshape bone in order to redistribute pressure, correct deformities or malalignment, and repair a damaged joint. It involves removing sections of bones and then using screws and metal plates to stabilise and realign the bone for healing. For the knees, it is usually performed in earlier stages of osteoarthritis when damage is only on one side of the joint.

If you are struggling with knee arthritis and would like to explore treatment, consult with a specialist via Top Doctors today.