Knee Osteoarthritis Symptoms, Diagnosis and Treatment
Knee osteoarthritis is a very common cause of knee joint pain. It is a major cause of disability in the elderly population.
Onset of the disease occurs, usually after the age of forty. It is more common in obese people. Usually both the knee joints are involved. One joint is more symptomatic than the other.
Symptoms that you will have in early stages of knee osteoarthritis
- mild to moderate deep pain in the knee joint
- pain is increased by movement and relieved by rest
- your knee may have swelling
- stiffness may be present
- pain is localised depending on what part of the knee is affected by the disease
- pain is in front of the knee joint in patellofemoral disease (osteoarthritis of the part of knee joint between the knee cap and thigh bone)
- pain may be in the inner side of the knee in medial compartment disease (inner half of the knee joint)
- outer side of the knee in lateral compartment (outer half of knee joint) disease
- if all three compartments are diseased then pain involves the whole joint
In advanced disease
- you may also develop bow legs or knock knee
- movement of the knee joint may produce crepitus (feeling and sound of bone rubbing against bone)
- movement can be restricted
- muscles of the thigh may become weak and thin
- your joint may also be tender
Sometimes you may hear a sudden cracking sound, following which there is sudden swelling and decrease in movement. This is caused by a fractured osteophyte (bony growth). Don't worry about it. It will gradually subside. You shouldn't have severe fatigue, weakness, weight loss or fever. If you have any of these then it's not Osteoarthritis.
Most of the times the diagnosis of knee osteoarthritis does not require any investigations. Its pretty straightforward. But your doctor may request a few investigations. These are usually to document the stage of your disease and general health.
X rays are taken in two planes, in the standing and lying down positions. X rays (radiograph) will show a decrease in joint space (thinning of the cartilage), along with various areas of increase or decrease in density of bone, and new bone formation (Osteophytes). Wrong alignment of the bones can also be seen.
Radiograph of Knee Osteoarthritis.
Radiograph of normal Knee for comparison.
As osteoarthritis is an incurable disease hence the goal of treatment is to reduce pain and maintain mobility.
The guidelines of treatment are determined by the
- severity of the disease
- presence of associated diseases and
- your expectations
General Treatment of Knee Osteoarthritis
For patients with mild disease
- simple reassurance
- easy lifestyle modifications
- mild occasional analgesics
- proper joint care are usually sufficient
If you have moderate to severe disease then a more comprehensive approach will be required.
This includes reducing load on your joint
. Load can be reduced by
- reduce your weight if you are overweight or obese. Even a reduction of 5 to 10 kg will give you significant improvement. I know that's easier said than done. But it's the best thing you can do. There is an excellent resource that you can use to get rid of those extra pounds. You may have tried to lose weight before only to find that you were unable to or regained those lost pounds.
I have tried this method my self and on my patients and it has led to a permanent reduction in weight. It may seem too good to be true. That's what I thought until I under stood the science behind it and used it. You can see more about it by Clicking Here!.
- other ways to reduce load on the joint are to avoid
using a stick or tripod while walking can reduce load. It should be held in the opposite hand (if right knee is involved then hold stick in left hand)a lateral shoe raise (increasing the hight of the sole on the outer side as compared to the inner side) can off load the medial compartmentthis can also be done surgically by tibial or femoral osteotomyuse of a knee brace can also decrease load on your joint. The brace should be worn lying down or sitting with the knee extended. It should fit snugly and allow easy movement of the knee.
- standing for a long time
Applying heat to the joint causes vasodialtation (increased blood flow). This washes away the inflammatory mediators causing a decrease in pain and swelling. You should use heat carefully as it can cause burns, especially in patients with decreased sensation.
Exercise has been shown to improve health even when started later in life. Aquatic exercises are the best for you because water gives buoyancy. This reduces the load on your joints and simultaneously builds your cardiovascular reserve. Exercising 30 mts to 1 hour three to four times a week is sufficient. If you can do more then its better. But don't overdo it. Maintaining activity should be your primary goal because active people, even though they may have other lifestyle diseases tend to out live inactive ones.
Awareness about your disease (knee osteoarthritis), understanding how it effects your life, and interaction with other people who have the same disease, provides you with immense benefits that you can never have with medication alone. More awareness leads to proper management and better communication with your doctor. Participation in community based health care programmes will help you a lot. If there are no programmes in your neighbourhood, search out people who have the same problem as you and interact with them. Think like this, if you are alone in a stuck elevator you might panic. But probably not when there are other people with you.
I have used creams containing salicylic acid along with oral drugs. Later on I have withdrawn the oral drug and continued with the cream. Most patients report continued relief for a few weeks. Capsiacin cream is equally effective, but few patients have complained of burning sensation.
NSAIDS (non steroidal anti-inflammatory drugs as aspirin, diclofenac, ibuprofen). As the name suggests the main role of drugs is to reduce inflammation and provide pain relief. They do not in any way alter the progression of hip or knee osteoarthritis. As they have many side effects, so they should be used as sparingly as possible. Most dangerous is Gastric ulceration and bleeding. I routinely prescribe proton pump blockers (reduce the chances of ulceration) along with NSAIDS to my patients. If I don't prescribe proton pump blockers then eventually almost all patients do complain of stomach pain, burning and nausea.
Tramadol hydrochloride is a centrally acting analgesic (it acts on the central nervous system). It is useful in patients of hip or knee osteoarthritis in which NSAIDS are contraindicated. It does not cause gastric ulceration, bleeding and kidney damage. Its has significant drug interactions hence should be used under careful medical supervision. I have found its combination with paracetamol to be as effective as NSAIDS.
Steroid injections in the joint are an absolute 'no no' for me in knee osteoarthritis. I never use them. The potential risks of joint destruction and infection out weigh the relief provided. Even joint fusion is extremely difficult in a joint destroyed by repeated injections of steroid into the joint. What to talk about replacement.
Specific Treatment for Knee Osteoarthritis
Hyaluronan injections are beneficial in those patients of knee osteoarthritis who have not had significant relief from the above treatment methods. I use three injections at weekly intervals. I have found all preparations of Hyaluronan to be equally effective. Relief usually lasts for 3 to 6 months.
I have used glucosamine in knee osteoarthritis, and have had good results in patients who have taken it regularly for at least 6 months to 1 year. They are slow acting. Relief is not immediate. They are the only drugs (along with diacerein) available that have shown to reduce the progression of the disease. They have no side effects and so you can take them continuously.
Doses I have used are 1500 to 3000mg of glucosamine per day. In the same dose glucosamine can be also used for hip osteoarthritis with good results.
Diacerein is a new drug introduced for the treatment of knee osteoarthritis. It has been shown to reduce cartilage destruction. Used alone it is not very effective. But when used in combination with NSAID's or glucosamine or both, the results I have had are near fantastic. It has no significant side effects. It has been found to inhibit the function of a compound called Interleukein 1, which has a role in the inflammatory process. Dosage I have used is 50mg twice daily. Should be taken regularly for 6 months to 1 year. It is also effective in hip osteoarthritis. Dosing is the same as in knee osteoarthritis.
Arthroscopy is a procedure in which a scope is inserted into the joint to inspect the joint from inside. Arthroscopy is done when we suspect that your joint has loose bodies (pieces of bone and cartilage) that are producing symptoms. These pieces can become entrapped between the bones causing locking, catching and pain in the joint. By arthroscopy these can be removed. It is a minor procedure and has minimal complications.
Corrective osteotomy is a surgical procedure that is used in patients that have medial (bow legs) or lateral (knock knee) compartment disease. The deformity (knock knee or bow legs deformity) is corrected. This shifts the mechanical axis of the limb back to its normal position. It gives good results.
It preserves your natural joint, and you may never even require joint replacement. It is not a substitute for joint replacement and even after corrective osteotomy you can under go joint replacement.
It is a technically demanding procedure hence should only be done by a surgeon who has had experience with deformity correction. Best age to have this surgery is between 40 to 50 years.
Knee joint replacement is only indicated in patients of knee osteoarthritis who have advanced disease and all non-surgical methods of treatment have failed. In this surgery all the diseased cartilage is removed and artificial joint made of steel and polyethylene is attached to the bone. It is a major surgery and has many complications. Most complications can be easily prevented or treated so relax and don't be afraid. Relief from pain is excellent and mobility is enhanced.
towards your disease, and life in general is very significant. People who are optimistic have quicker improvement and a better outcome to treatment. By remaining positive you will not only add more years to your life, but also more life to those remaining years. So relax, be easy, you're going OK.
Frequently Asked Questions
If I reduce my weight will I still need to take medicine?
What ever amount of weight you reduce you will have improvement in your symptoms. If you are able to attain your ideal body weight (height in centimeters minus hundred, for example if your height is 165cm then your ideal body weight is 165 - 100 = 65kg) then you may not require any medicine. I suggest that you should still take calcium and vitamin supplements to prevent osteoporosis.
There are many conflicting reports about the effect of glucosamine in knee osteoarthritis what is the truth?
Yes, many clinical trials have found glucosamine to be effective and many have found it ineffective. Current Medical Diagnosis and Treatment 2007 clearly writes that, "Glucosamine not only reduces the symptoms of osteoarthritis but may also slow the progression of the disease." On reading further it is clearly evident that symptom improvement was only seen in patients taking good quality glucosamine. So my recommendation is
- take a very good quality glucosamine
- take it in the right dose (at least 1500mg per day)
- take it for years not months
Almost all the studies undertaken attempt to analyse glucosamine when taken alone and compare it to other drugs. In clinical practise glucosamine is usually given along with diacerein and other vitamin and mineral supplements. These additional supplements may work to enhance the effect of glucosamine.
How long can I expect my artificial knee to last after knee joint replacement surgery?
If the joint has been fitted properly with no wrong alignment, you do not have diabetes and are not over weight then you can expect it to last for 10 to 15 years or more.
This is a x ray of a 65 year old male with osteoarthritis of the right knee joint. You can see the absence of joint space between the femur and tibia on the right side, where as the joint space is clearly seen in the left side.
He was reluctant for surgery and was therefore prescribed analgesics, glucosamine and a knee brace.
I hope the information provided was useful. If you have any query you can ask me at the contact me page.
This page was last updated on 23rd January 2011.
Other causes of knee pain include...
Tibial Plateau Fracture
Osgood Schlatter Disease
Knee Replacement Surgery
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