Physiotherapist Paul O’Connell talks through the signs, symptons and treatment options for knee osteroarthritis
Knee Anatomy
Over the ends of any bone that forms a joint (articulates) with another bone, we find shiny white cartilage that we call articular cartilage. As part of the ageing process, being active and/or maybe having injuries at certain times in our lives we can potentially damage the articular cartilage. Unfortunately, the cartilage has next to no blood supply so it cannot heal itself like our skin. With time this damage can go from being very mild and develop into something more significant and depending on where the damage is can start to become symptomatic.
We grade the progression of knee osteoarthritis using a 4-grade scale. Although grade 4 can look very bad, sometimes a patient with these changes actually has very little pain. Conversely, patients with grade 2 or 3 changes can really struggle so it is important that we assess you fully as well as getting any investigations.
Examination
If we are just looking for osteoarthritis, then usually an X-ray is sufficient but if we suspect early changes (grade 2) with maybe a meniscal tear then an MRI would be used as well. This should give us clear information on what is going on within your knee but as I said before, this must be backed up with a full clinical examination.
Symptoms
The symptoms you get from knee osteoarthritis can vary but on the whole, you will experience the following:
- Pain – especially when loading the knee itself so walking long distances and going up and down the stairs can become a real issue. You may also experience pain at night which affects your sleep.
- Stiffness – the joint may feel stiff, especially first thing in the morning or after sitting for a long period
- Swelling – you may be aware of the knee swelling at different times depending on what you have been doing
- Reduced activity – due to the pain you may not be going out, using the stairs and are generally less active
- Graunching – you may be aware of the joint graunching, clicking and cracking at times
Treatment options
The good news is there is a long list of potential treatment options for knee osteoarthritis. You should always look to start conservatively through a physiotherapist who can provide a full assessment and if required look to get some further investigation (Xray) via your GP or a specialist. Physio will involve providing information and guidance on things like weight loss, orthotics, activity management and most importantly, putting together a structured exercise plan to help get the knee and you, fitter and stronger.
Sometimes we do add more invasive techniques and even surgery to the treatment plan, which can include:
- Corticosteroid injection – this is basically a very strong anti-inflammatory that is injected directly into the joint with the aim of reducing any inflammation and therefore pain.
- Hyaluronic acid (HA) injections – HA naturally occurs within our joints and helps with lubrication. Unfortunately, with knee OA we produce less HA so the idea is to increase the HA levels via injection.
- Uni-compartmental knee replacement (UKR) – if only one compartment of the knee is affected, usually the medial side, then you can have a UKR. This is a great option as the surgery is less invasive and leaves more of your normal anatomy in place.
- Total Knee Replacement (TKR) – if there is widespread change within the knee and you have not responded to the conservative methods then a TKR will be the next option. This involves cutting away the end of the thigh bone (femur) and the top of the shin bone (tibia) and replacing them with new metal components. They put a small plastic spacer between the new components to act as a new “cartilage”. If required, you can also have the back of the kneecap (patella) replaced.
If you would like any more information on knee osteoarthritis or have had knee surgery and would like some help with your rehab, please get in touch 01202 473800