Osteoarthritis of the Knee, Relieve a Common Cause of Knee Pain
Osteoarthritis of the knee is a common cause of knee pain
, especially in middle aged to older people. Treatments include surgery, exercise, injection, TENS.
Osteoarthritis is a degenerative disease which can affect any joint in the body. Osteoarthritis of the knee is one of the most common causes of knee pain in middle aged to older adults.
Osteoarthritis of the Knee
In the body the surface of joints are protected by a shiny smooth surface called articular cartilage. In osteoarthritis this cartilage is gradually eroded thus exposing the bone underneath.
Osteoarthritis is classified as either primary or secondary in nature. Primary osteoarthritis starts for no identifiable reason, whereas the onset of secondary arthritis can be attributed to a previous injury that damaged the joint surface.
The knee joint has three parts to it: the patella femoral; the medial tibial femoral and the lateral tibial femoral. The patella femoral is the joint between the patella (knee cap) and femur (thigh bone). The tibial femoral joint make the "hinge" of the knee, it is the joint between the tibia (shin bone) and femur (thigh bone) The inside part of the tibial femoral hinge is known as the medial tibial femoral compartment and the outside the lateral. In reality the three compartments are not separate entities and together they make up the knee joint. Osteoarthritis of the knee may affect any one or all of the compartments of the knee.
The symptoms of osteoarthritis of the knee vary depending on how severe the changes to the joint are, but generally people experience some or all of the following:
Knee pain comes on over time not suddenly
Crepitus (creaking and cracking) on movement
Stiffness after rest, both after sitting for a while and first thing in the morning
Pain on activity especially activities when weight bearing such as walking, standing and going up or down stairs.
Swelling at the back of the knee, this is known as a Bakers cyst
A diagnosis of osteoarthritis is based on the symptoms that a person reports, x rays are also useful and blood tests can be taken to rule out other kinds of arthritis or disease.
The Best Treatment for Osteoarthritis of the Knee
The National Institute for clinical Excellence (the government body in the UK who reviews research and evidence and makes guidelines for the most effective treatment) published guidelines in 2008 outlining the best treatment of osteoarthritis in adults. They split treatments into core treatments which they suggest are essential for people who are suffering with osteoarthritis and adjunctive treatments which have some evidence to support their use:
Core treatments
1.Exercise:
Both general aerobic exercise and specific strengthening work on the muscles around the knee are essential. Specific strengthening work decreases the amount of translational movement in the knee limiting further degeneration. It also alters the area of contact between the knee cap and the thigh bone thus changing the loading pattern and decreasing pain.
2. Weight loss:
Decreasing general body weight lessens the stress through the knees.
3. Medication:
NICE recommends paracetamol and an anti inflammatory cream, progressing to anti inflammatory tablets if needed. (If other medical conditions allow)
Adjunctive treatments
1. Tens
A tens machine is a small portable device that inputs a pins and needles sensation over the painful area. Put simply the nerves are too busy conducting the pins and needles they cannot transmit pain. Additionally tens stimulates the production of endorphins which are the body's natural painkillers giving some longer lasting pain relief after the machine is switched off.
2. Shock absorbing inner soles/ shoes
Reducing the shock forces that are experienced by the joints can reduce pain. Sometimes specially made insoles, called orthotics, which change foot position can help, these are provided by a podiatrist.
3. Hot/ cold
The application of either heat or ice can give temporary pain relief.
4.Injection
An injection of a local anesthetic and a cortico steroid directly into the joint can give medium term pain relief. This is not a cure but can give a window of reduced pain during which time it is possible to increase exercise levels, decrease weight if appropriate, and strengthen specific muscles to help the joint in the longer term.
5. 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.
6. Other Treatments
There are may other treatments marketed 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.
Osteoarthritis of the Knee, Relieve a Common Cause of Knee Pain
By: Dr. Prateek Gupta
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