What is Knee Osteoarthritis?
Knee arthritis, often called degenerative joint disease, is characterized by the wearing of the protective cartilage of the joint. Age, injury, and general wear and tear are typical causes of knee OA. As the protective cartilage lining becomes damaged, the underlying bone is exposed causing inflammation, pain, limited mobility, and limited function. People over the age of 50 are more likely to develop knee OA, as are those who are overweight.
The diagnosis of arthritis is made via X-Rays. The doctor is specifically looking at the amount of space between the femur and the tibia. Thinning of the cartilage between the bones and irregularity of the joint surfaces indicate the severity of the arthritis. When the term “bone on bone” is used, it refers to the lack of cartilage to cushion the joint.
Every condition has a typical pattern of pain and limitation. Osteoarthritis symptoms generally progress and worsen over time. Symptoms can, however, fluctuate based on activity level or even the weather, making symptoms somewhat inconsistent.
Most commonly, knee arthritis symptoms include pain with activity (walking and stair negotiation), stiffness or limited range of motion, swelling, and tenderness (more commonly over the inside or medial aspect of the knee). Moving from sitting to standing can be painful. Occasionally, episodes of the knee ‘giving way’ can occur.
Even if you have X-Rays that indicate significant arthritic disease, surgery is not always necessary. Many people have significant arthritis but experience no knee pain. How can this be? Knee arthritis can be significantly improved with conservative osteoarthritis treatment options.
Treatment goals for many knee conditions include reducing inflammation, restoring range of motion, and improving strength and function. Osteoarthritis treatment should follow this plan.
As arthritis is an inflammatory condition, anti-inflammatory medications can be helpful in reducing this inflammation (consult your doctor regarding medications). Utilizing ice therapy can also be helpful to reduce both pain and swelling.
In significant cases, cortisone injections to help reduce inflammation are warranted. Generally no more then three cortisone injections are recommended within a one year period of time. Overuse of cortisone injections can have a negative effect on joints, increasing the speed of joint degeneration.
Another type of injection can be helpful by adding lubrication to the knee joint. Hyaluronan injections (such as Synvisc and Orthovisc) help to stimulate the natural lubricant of the knee, called synovial fluid. A series of generally three injections are given one week apart and have been shown to be effective for some in helping to delay or avoid knee replacement surgery.
As with other forms of arthritis, weight reduction can be of great benefit in minimizing joint stress.
Proper shoe wear is also very important. I frequently recommend good running shoes to help minimize joint stress. Shoes should emphasize stability as opposed to cushioning as the goal is to minimize excessive movement that creates added joint stress.
When symptoms are significant, reducing joint stress can also be achieved through the use of an assistive device such as a cane. When using a cane, remember to use the cane on the opposite side of the painful joint (if the left knee is painful, use the cane in the right hand).
Of course, when significant pain and limited function persist, knee replacement surgery is recommended. Surgery should be the treatment choice of last resort and should only be considered when conservative treatment including medication, injections, ice, and physical therapy has failed.
Physical Therapy Exercise
The treatment goals for physical therapy exercises are to restore knee range of motion and improve muscle strength. If these goals are achieved, your pain will be reduced and you’ll be back to the activity you enjoy.
Arthritic knees can lose mobility in both the ability to flex/bend and the ability to extend/straighten the knee. The use of a stationary bike has been demonstrated to be effective in improving knee mobility. The easy repetitive motion of the knee that occurs with stationary biking stimulates production of synovial fluid, the natural lubricant of the knee. Riding a stationary bike 10 to 15 minutes on a regular basis can keep the joint lubricated and improve the ability of the knee to bend.
Because muscles act like shock absorbers, muscle strengthening can help in reducing the stress directed to the knee. The quadriceps muscle group (muscles located on the front of the thigh) is the most important to knee function. However, muscle balance is also important, thus hamstrings as well as hip muscles must also be strengthened.
The following is a link to a physical therapy exercise program for assisting in the restoration of knee ROM and strength for knee osteoarthritis: knee osteoarthritis exercises.
• Knee osteoarthritis is an inflammatory condition secondary to damage of the articular cartilage.
• Symptoms include knee joint pain, limited range of motion, and limited tolerance for walking and stair negotiation.
• X-Ray evidence of knee arthritis does not mean surgery will be necessary.
• Use Anti-inflammatory medication, ice, and injections help to reduce joint inflammation.
• Riding a bike and performing knee osteoarthritis exercises can help restore knee ROM, strength, and function.
• Only when conservative treatment has failed and persistent pain and limited function continues should knee replacement surgery be considered.
You don’t have to suffer with knee osteoarthritis. Whether surgery is necessary may be up to you. Follow the knee osteoarthritis treatment plan and take control of your arthritis pain.