Knee arthritis is inflammation of the knee joint that often causes disability, pain and swelling. Because of the strain placed on the knee due to everyday use, arthritis is particularly common in this joint. Arthritis in his various forms causes the knee joint to degrade – either due to cartilage loss and resulting bone spurs, or degradation of the synovial membrane that covers the knee joint.
The progression of arthritis is different in every patient but may start as relatively mild. As it progresses, normal, everyday activities can become difficult, and when it becomes severe, can be debilitating. There are over 100 different forms of arthritis, which in some cases might affect children, but most cases are in adults.
Types of Arthritis
While there are many forms, the three most common forms of arthritis are osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.
Osteoarthritis represents pain and disability as a result of wear and tear on the knee joint. The cartilage in the knee, known as the meniscus, can start to wear away. This can be due to mechanical wear and tear, but also inflammation caused by chemical imbalances, usually as a result of obesity. Osteoarthritis usually comes on slowly and typically affects people over the age of 50. However, as obesity has increased in prevalence, ever-younger patients are presenting with moderate to severe osteoarthritis. As the cartilage wears away, bone begins rubbing on bone and bone spurs begin to form. These bone spurs can be very painful and cause significant disability.
Rheumatoid arthritis is a chronic and progressive form that not only affects the knee, but many joints throughout the body. The synovial membrane, a protective covering of the knee joint, begins to swell and causes pain and disability. Rheumatoid arthritis is an autoimmune disease, which means that the body’s natural defenses turn on themselves and attack healthy tissue. This can result in cartilage loss, ligament damage and softening of bone.
Post-traumatic arthritis occurs after a single injury, or multiple injuries to the knee. Post-traumatic arthritis is most common after a break or fracture and can manifest years or even decades after the injury. Even injury to the cartilage or ligaments of the knee can bring about post-traumatic arthritis sooner or later. Some patients experience mild to moderate arthritis after a traumatic injury, which is often managed with occasional pain medication and a knee brace. Fewer experience serious arthritis, which may require further intervention including surgery or a total knee replacement.
Getting a Diagnosis of Arthritis
Most forms of arthritis come on relatively slowly and patients tend to modify their lifestyles to accommodate the pain. However, there will be a point where the pain and disability is significant enough that the patient is forced to see their doctor. At this point, a medical history and physical examination is often sufficient to determinate a preliminary diagnosis of arthritis. However, imaging is very helpful in understanding the extent of the inflammation and the resultant damage to the knee joint. X-rays are often sufficient to see loss of joint space and understand the extent of bone spur formation. If we suspect soft tissue injury, we may need to order an MRI or CT scan as x-rays do not show these structures. Blood tests may also be ordered especially if rheumatoid arthritis is suspected.
Treatment Options for Arthritis
If caught early enough, arthritis is often treated non-surgically in the form of lifestyle modification. Strenuous and high-impact activities such as running, tennis, basketball and soccer should be avoided, and swimming, bike riding and walking should be used as the primary form of exercise. Patient will also be encouraged to lose weight to reduce the strain on the knee. Finally, any activities that aggravate the pain or disabilities such as climbing stairs should be avoided when possible.
Physical therapy may be employed to reduce swelling, strengthen the musculature around the knee joint and improve range of motion. The length and scope of the physical therapy program will depend on the patient’s particular circumstance.
Patients may also experience relief using cold or heat applied to the knee. Pain medication may be necessary on occasion to minimize discomfort. Some ointments or creams may offer relief as well. Patients with rheumatoid arthritis will require specific antirheumatic drugs to slow the immune system’s attack on the joints.
Supplementation may also be helpful for some patients and should be discussed with your orthopedic surgeon. Glucosamine/chondroitin compounds mimic the joints’ natural composition. Other supplements may also be helpful as some have anti-inflammatory properties. However, remember that most of these supplements are unregulated and many are unproven.
Alternative therapies such as acupuncture and magnetic pulse therapy may offer patients some relief but have not been proven effective in the clinical setting.
Assistive devices such as canes, special shoes and knee braces may be employed if the patient experiences relief.
Patients who do not experience sufficient relief from lifestyle change and medication, may opt for corticosteroid injections into the joint. These injections can be performed occasionally and should be used sparingly because they can worsen the progression of the joint disease over the long-term. Eventually, the steroid injections will fail to offer sufficient relief.
Surgery for Arthritis
When lifestyle change and injections no longer offer sufficient relief, surgery can be considered. Patients who suffer from significant disability and are unable to perform normal daily activity will likely be referred for one of several different surgical options. During consultation, we will offer a practical surgical solution to the specific arthritis issue.
Cartilage graft may be considered for younger patients with arthritis, to fill a gap in the cartilage. This tissue can be sourced from another part of the knee or from a tissue bank.
A synovectomy involves the removal of part of the synovial lining to reduce pain and swelling in the knee. This is reserved for patients with rheumatoid arthritis.
An osteotomy is where the tibia or femur is reshaped to shift pressure to another part of the knee. This is reserved to earlier stages of arthritis and only if the arthritis has damaged one part of the joint with the other side being healthy. Bear in mind, that shifting the weight also puts more pressure on the healthy side of the knee, therefore steps must be taken to minimize damage to the healthy side.
A knee replacement may be considered in cases where the knee has lost most of its function and the patient cannot continue with daily activities. A partial knee replacement only replaces a portion of the knee that is damaged, while a total knee replacement is a complete replacement of the joint with prosthetic implants.
The Bottom Line
Arthritis is a chronic and degenerative disease that cannot be cured. However, we do have many interventions, from simple lifestyle change, to medication and injections, and finally joint replacement surgery. These can all offer patients temporary or permanent relief. In every case, it is important to speak to your orthopedic surgeon early on in the progression of arthritis to make sure you have the most treatment options available.
If you are experiencing chronic knee pain or have been diagnosed with arthritis of the knee from your primary care physician, please call us to schedule a consultation and learn more about your arthritis treatment options.