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Knee Osteoarthritis

Knee Osteoarthritis  - The Joint Injection Clinic

Knee osteoarthritis (OA) is a common condition that affects the cartilage, a smooth, flexible tissue that cushions the ends of bones in the knee joint. Over time, the cartilage in the knee joint can wear down and become rough, leading to pain, stiffness, inflammation and loss of function in the knee.

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Who is affected by knee osteoarthritis?

 

Knee osteoarthritis is most common in adults over the age of 50, and the risk of developing it increases with age. Women are more likely than men to develop knee osteoarthritis, especially after menopause. Other factors that increase the risk of knee osteoarthritis include:

  • Obesity:

    Excess weight puts extra stress on the knee joint.
  • Previous knee injuries:

    Injuries to the knee, such as meniscal tears, cruciate ligament rupture, fractures or dislocations, can increase the risk of developing osteoarthritis later in life.
  • Family history:

    Having a family history of osteoarthritis increases your risk of developing it yourself.
  • Certain occupations:

    Jobs that require repetitive knee movements or heavy lifting can increase the risk of developing knee osteoarthritis.

What are the main symptoms of knee osteoarthritis?

 

The main symptoms of knee osteoarthritis include:

Pain

Pain in the knee, especially when walking, climbing stairs, or getting in and out of chairs.

Stiffness

Stiffness in the knee, especially in the morning or after periods of inactivity.

Loss of range of motion

Difficulty bending or straightening the knee fully.

Creaking or popping sounds

Crepitus, or grating or clicking sounds, when moving the knee and particularly when walking up and down stairs, and with squats or lunges.

Symptoms may worsen gradually over time and may fluctuate depending on the level of activity. Activities that involve weight-bearing, such as walking, climbing stairs, or standing for long periods, can aggravate the pain and discomfort.

How is knee osteoarthritis diagnosed?

Diagnosis of knee osteoarthritis typically involves a physical examination, medical history review, and imaging tests.

  • Physical examination:

    The doctor will carefully examine the knee, checking for pain, tenderness, range of motion limitations, crepitus, and swelling. Specific tests may be performed to assess the severity of the osteoarthritis and rule out other causes of knee pain.
  • Medical history:

    The doctor will inquire about the patient's symptoms, activities, any previous knee injuries, and family history of osteoarthritis.
  • Imaging tests:

    X-rays are often used to visualize the bones in the knee joint, identifying any narrowing of the joint space, osteophytes (bone spurs), or other signs of osteoarthritis. An MRI scan may be recommended to provide more detailed images of the soft tissues, including the cartilage, in the knee joint.

How is knee osteoarthritis treated?

 

Treatment for knee osteoarthritis focuses on managing symptoms, slowing the progression of the condition, and improving function. Non-surgical treatments are usually tried first, and surgery is considered if non-surgical measures fail to provide adequate relief.

Non-surgical treatments:

  • Weight management:

    Losing weight can help reduce stress on the knee joint and alleviate pain.
  • Exercise:

    Low-impact exercises, such as walking, swimming, or water aerobics, can help improve range of motion, strengthen the muscles around the knee, and reduce pain.
  • Over-the-counter pain relievers:

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate mild to moderate pain and inflammation.
  • Physiotherapy:

    Physiotherapy can provide exercises and stretches to improve range of motion, strengthen the muscles around the knee, and promote normal knee movement patterns.
  • Assistive devices:

    Using assistive devices, such as a frame or stick, can help reduce stress on the knee joint and alleviate pain.
  • Injection options:

    There are several injection options available for knee arthritis depending on the severity of arthritis, location of cartilage wear, degree of inflammation etc. These include corticosteroid injections,

    platelet-rich plasma, hyaluronic acid, arthrosamid

    (see separate article on knee injection options)

Corticosteroid injections can be an effective way of reducing inflammation and pain in the knee joint. At The Joint Injection Clinic, corticosteroid injections are performed after a thorough consent process, where the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a lying position with the knee bent to 90 degrees.  The skin is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The knee joint injection is performed with a small dose of steroid and local anaesthetic, targeting either an area above the kneecap, called the suprapatellar recess, or on the inside of the knee joint, underneath the kneecap.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

Surgical treatments:

If non-surgical treatments fail to provide adequate relief, surgery may be considered. Surgical options for knee osteoarthritis include:

  • Osteotomy:

    This procedure involves cutting and realigning the bones in the knee joint to improve alignment and reduce stress on the damaged cartilage.
  • Arthroscopy:

    Used in the earlier stages of knee arthritis to trim any damaged cartilage, remove loose bodies (floating cartilage in the knee) and wash the knee out.
  • Knee replacement:

    This procedure involves replacing the damaged knee joint with an artificial joint made of metal, plastic, or ceramic.

Surgery is typically considered for patients with severe knee osteoarthritis that significantly impacts their quality of life and limits their ability to perform daily activities, who have failed conservative management.

  • Avoid wearing tight clothing or heavy belts.
  • Maintain a healthy weight to reduce pressure on the LFCN.
  • Consider using a pillow between your knees when sleeping on your side.