Knee Osteoarthritis

What is it?

Osteoarthritis is a degenerative condition which affects many different joints of the body. The word ‘osteo’ means bone and ‘arth’ pertains to the joint whilst ‘itis’ means inflammation. Knee osteoarthritis occurs within the knee joint and can affect the joint between the thigh and shin bone (tibiofemoral joint) and/or behind the knee cap (patellofemoral joint).

Osteoarthritis involves the gradual wearing away of the cartilage at the bone ends over years until a cascade of events occurs which leads to typical osteoarthritic symptoms becoming apparent. Over time the joint space narrows and the pressure between the bone ends becomes greater. As the cartilage thins further, the bone margins grow and produce osteophytes in a bid to increase the surface area of the joint and reduce the pressure. The once tight supportive ligaments which span the joint become slack and eventually tighten to adjust to the narrowed joint space. The tissues which surround the joint can become inflamed leading to an overproduction of synovial fluid within the joint. The muscles which cross the joint weaken through disuse and inhibition resulting in a gradual loss of joint stability over time.

The combination of these changes inevitably leads to joint stiffness, swelling, pain, intermittent inflammation and a reduction in the individuals’ function.  Some individuals with marked degeneration may need to be seen by an Orthopaedic surgeon who will assess their joints and advise on any surgical management which may be required. Commonly, the operation of choice for those suffering with advanced and debilitating osteoarthritis is the Total Knee Replacement (TKR).

Causes
 

There are many factors which can increase the risk of developing Osteoarthritis. It generally affects women more than men and is common in middle age (50+). There are genetic factors which can increase the risk and it can run in families. Having a history of previous joint damage such as a fracture which goes through the joint surface or damage to the cartilage especially in the knee can predispose to earlier degenerative changes. If you are unfit, generally stiff and overweight excessive strain can be put through the joint which can worsen osteoarthritic symptoms.

Treatment

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following:

• Advice regarding activity modification and symptom easing solutions

• Electrotherapy i.e. ultrasound, and interferential to reduce pain and inflammation

• Acupuncture for pain relief and control of inflammation

• Correction of anatomical abnormalities to offload painful areas of the knee, i.e. orthotics

• Provision of knee supports or walking aids if appropriate

• Adjustment of relevant biomechanical factors i.e. tight and overactive muscles

• Soft tissue and joint manipulation to address stiffness or restriction of normal movement

• Progression of a tailored rehabilitation programme including appropriate strengthening and stretching exercises with a functional emphasis