Dr Abhijit C.
Kawalkar, Orthopaedic & Joint Replacement Surgeon
Orange City Hospital and Research Centre, Nagpur
What is knee osteoarthritis?
Osteoarthritis (OA) is a painful condition of the joints. It involves loss of cartilage, often along with mild inflammation and bony changes, as well as weakness of muscles surrounding the joint. This results in pain, swelling and stiffness of the joint.
Osteoarthritis (OA) is a common problem for many people after middle age. OA is sometimes referred to as degenerative, or wear and tear, arthritis. OA commonly affects the knee joint. In the past, people were led to believe that nothing could be done for their problem. Now doctors have many ways to treat knee OA so patients have less pain, better movement, and enhanced quality of life.
What are the causes of osteoarthritis?
Many factors increase your risk for developing osteoarthritis.
Age: The ability of cartilage to heal itself decreases with age. Osteoarthritis typically affects people middle-aged and older.
Heredity: Certain genes have been linked to osteoarthritis. Inherited traits, such as being bowlegged, knock-kneed, or double-jointed, can also put you at greater risk for the disease.
Weight: The more you weigh, the more stress you put on your knee joints and thus more chances of OA..
Injury: Previous knee injury, such as a sports injury, can lead to osteoarthritis later in life.
Overuse: People in occupations that involve repeated kneeling or squatting, or heavy lifting and walking, are vulnerable to repetitive stress injuries in the knee. This makes them more likely to develop osteoarthritis.
Other illnesses: If you have had other problems with your knee, such as gout or knee infection increases the risk of osteoarthritis.
What happens in osteoarthritis?
The main problem in OA is degeneration of the articular cartilage. Articular cartilage is the smooth lining that covers the ends of the leg bones where they meet to form the knee joint. The cartilage makes the joint surface smooth and thus helps in decreasing friction. When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. Small outgrowths called bone spurs or osteophytes may form in the joint.
What are the symptoms of Osteoarthritis?
The symptoms are mainly pain, swelling, and stiffening of the joint. Pain is usually worse after activity, such as walking. Early in the course of the disease, you may notice that your knee does fairly well while walking, then after sitting for several minutes your knee becomes stiff and painful. As the condition progresses, pain can interfere with simple daily activities. In the late stages, the pain can be continuous and even affect sleep patterns.
How do doctors identify OA?
The diagnosis of OA can usually be made on the basis of the initial history and examination.
X-rays can help in the diagnosis and may be the only special test required in the majority of cases. X-rays can also help doctors rule out other problems, since knee pain from OA may be confused with other common causes of knee pain, such as a torn meniscus or kneecap problems. In some cases of early OA, X-rays may not show the expected changes.
Magnetic resonance imaging (MRI) may be ordered to look at the knee more closely. An MRI scan is a special radiological test that uses magnetic waves to create pictures that look like slices of the knee. The MRI scan shows the bones, ligaments, articular cartilage, and menisci. The MRI scan is painless and requires no needles or dye.
What is the treatment of osteoarthritis?
Your doctor will develop a personal treatment plan to relieve your joint pain and stiffness.
Lifestyle changes: If pain does not interfere with your daily routine, your doctor may first recommend lifestyle changes to protect your joint and slow the disease’s progress.
Regular Exercise: If you regularly do high-impact exercises (running or competitive sports), switching to low-impact activities will put less stress on your knee. Walking, cycling, and swimming are good low-impact options.
Weight loss: If you are overweight, losing just a few pounds can make a big difference in the amount of stress you place on your knee joint.
Physiotherapy: Specific exercises can improve the range-of-motion in your knee and strengthen the muscles in your leg that support the joint. Assistive devices, like braces, splints, or shoe inserts, can also help reduce stress on your joint.
Medications: If your pain affects your daily routine, or is not relieved by initial methods, your doctor may suggest medications. Acetaminophen (Paracetamol) is used for mild to moderate pain or Non steroidal anti-inflammatory medicines (aspirin, ibuprofen etc) for moderate to severe pain and swelling.
Dietary supplements: Some people report that over-the-counter supplements like glucosamine and chondroitin sulfate provide pain relief. Talk to your doctor before using supplements.
Steroid injections: Cortisone is a powerful anti- inflammatory medicine that is injected directly into your knee joint, but it has few side effects so it is not commonly used.
Visco-supplementation: This injection therapy may be an option for patients who have mild to moderate arthritis and their symptoms do not respond to other non surgical treatments.
Surgery: Your doctor may consider surgery if your pain worsens and causes disability.
Arthroscopy: This procedure can be used to remove torn and loose cartilage pieces, or smooth out areas of worn cartilage. The more advanced your arthritis is, the less effective arthroscopy will be.
Osteotomy: The bones around the knee are cut and realigned to take pressure off of the affected side of the knee joint.
Joint replacement: An artificial knee replacement is the ultimate solution for advanced knee OA.
Surgery may be used to replace a damaged joint with an artificial joint. The most common reason for having joint replacement surgery is pain that is preventing you from doing your usual activities and having an active lifestyle and is not controlled by a combination of non pharmacologic and drug treatments.
Joint replacement surgery dramatically relieves pain in most people with severe symptoms of hip or knee OA.