What is it?
Osteoarthritis is a degenerative disease which can affect any joint in the body. It is the most common of the arthritis's
Every joint surface is protected by articular cartilage which is a shiny smooth substance. In osteoarthritis the cartilage is worn away exposing the underlying bone
Osteoarthritis can be primary or secondary in nature. Primary osteoarthritis has no particular identifiable cause whilst the cause of secondary arthritis can often be traced back to a previous injury that damaged the joint surface for instance a fracture.
The knee joint is said to have three compartments to it: the patella femoral; the medial tibial femoral and the lateral tibio femoral. The patella femoral joint is between the patella (knee cap) and femur (thigh bone) the tibio femoral joint is the "hinge" of the knee the joint between the tibia (shin bone) and femur (thigh bone) In reality the three compartments are not separate and together they make up the knee joint. Osteoarthritis of the knee may affect any one or all of the compartments of the knee.
What are the symptoms of osteoarthritis of the knee?
- Symptoms come on gradually with no particular mechanism of injury. Symptoms build up over time
- There may be crepitus (creaking and cracking) on movement
- The joint can be stiff after rest, either after sitting for a while or 1st thing in the morning
- The joint tends to be painful on activity particularly if this involves weight bearing
- There may be a Bakers Cyst which is a swelling behind the knee
How is osteoarthritis of the knee diagnosed?
- The most significant aid to diagnosis is the clinical history and the signs and symptoms of the problem
- X- rays show arthritic changes
- Blood tests may be used to rule out other types of arthritis
What's the best treatment?
In February 2008 the National Institute for clinical Excellence (the body in the UK who reviews research and evidence and makes guidelines for the most effective treatment) published guidelines for the treatment of osteoarthritis in adults. They classified treatment into core treatments which are essential for people who are suffering with osteoarthritis and adjunctive treatments which have some evidence to prove their effectiveness and can be useful:
Core treatment
Exercise:
Including both general aerobic exercise and specific strengthening work. Specific strengthening work is thought to decrease the amount of translational movement in the knee limiting further degeneration. It can also alter the site of contact between the patella and the femur thus changing the load to a different part of the patella. Equally increasing the range of movement of the knee that is used when doing day to day activities increases the surface area of the femur that is coming into contact with the tibia again decreasing the load on specific points of the bone. You can get your personalised programme of exercises for OA knee from a physiobench assessment
Weight loss:
It makes sense that the heavier you are the more weight and stress is going through your knees on every step. Eat a healthy balanced diet and try to increase your amount of exercise. Try our guide to getting started with some easy exercise
Medication:
In the first instance paracetamol and anti inflammatory cream are recommended. Progressing to anti inflammatory tablets if needed.
Adjunctive treatment
Tens
A tens machine is a small portable device that provides a pins and needles sensation over the painful area. Put simply the nerves are busy conducting the pins and needles sensation and thus cannot transmit pain. Additionally tens stimulates the production of endorphins the body's natural painkillers so there is some lasting pain relief after the tens machine is taken off.
Shock absorbing inner soles/ shoes
Reduce the transmition of shock forces to the joints. In certain cases specially made insoles that alter the foot position can be helpful, these would be provided by a podiatrist.
Hot/ cold
More information about the use of ice on our physiobench advice article
Injection
Usually an injection of a local anaesthetic and a cortico steroid directly into the joint. It gives pain relief. The amount of pain relief and the length of time this lasts for varies from person to person. This is not a cure but should be considered a window of opportunity to increase exercise levels, decrease weight if appropriate, and strengthen specific muscles to increase the support to the joint.
Joint arthroplasty
A knee replacement. If only one compartment of the knee is affected it may be possible to put in a one sided replacement only leaving the natural joint on the other side. This is known as a hemi - arthroplasty.
Other Treatments
There are other treatments available for osteoarthritis of the knee, but in the review of the research NICE found no evidence to justify their use. These treatments include:acupuncture;magnetism.
Products
TENS machines, wheat bags, ice packs and shock absorbing insoles can all be purchased from
PhysioRoom
PhysioSupplies
Disclaimer: The information on this page is written to help you understand your injury. There are many possible causes for knee pain and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.
