Osteoarthritis (OA) is the commonest form of chronic arthritis to affect joint function and is often simply referred to as “wear and tear”. This means that the normal smooth and low friction surfaces of the joint have steadily worn down and the natural ability of the joint to share and absorb shock and loads decreases. If progressive, often the knee becomes gradually more painful and restricted, particularly as the joint surfaces become bare and bone rubs against bone. The process often involves the development of other typical symptoms such as stiffness and swelling and then begins to interfere with quality of life. The chances of developing OA in the knee increase steadily with ageing and it is predominantly a gradual and degenerative process. Ageing is the primary determinant for the risk of developing OA.
There are also patients who seem more susceptible and there is likely a genetic component that plays a role although at this point it is not fully understood. There are also individuals who have clear risk factors for developing OA and in particular we are seeing more patients presenting with troublesome joints as our life expectancy improves and demands into older age increase. The role of obesity is also now clear and this is directly linked to the premature development and acceleration of OA in the knee. Overweight patients will tend to be presenting with their OA problems earlier on life and this is becoming an increasing burden on healthcare systems worldwide. We also see individuals who biomechanically have overloaded their knees with physiologically determined alignment issues or because of an old injury e.g. fractures/ligament injuries/ previous cartilage surgeries.
The end result is generally the same, as pain, stiffness and swelling start to impede on desired activities and can eventually cause pain to be present at rest, night and an inability to function properly in simple day to day tasks. Symptoms are often intermittent and variable in severity with occasional flare-ups.
OA is usually best assessed with a straightforward X-ray. I would suggest that most first presentations of knee pain are initially assessed with an X-ray in patients over the age of 55. At SSC most of our knee X-Rays will be performed weight bearing to replicate the day to day loading situation. MRI scans can be useful with inconclusive X-rays, in atypical presentations of pain or to help determine what surgical options may be appropriate.
Osteoarthritis, for the moment, has no ‘cure’ and the majority of patients initially can be successfully managed without surgery. We have several scientifically supported methods to help manage OA: weight loss if BMI is >25 (body mass index – weight in kg divided by height in metres2), muscle strengthening, staying physically active, improving aerobic fitness, use of painkillers and anti-inflammatories. Less robust options with inconclusive or weak supportive scientific evidence include arthroscopic key hole surgery, orthotics / insoles, joint injections (steroid/hyaluronic acid/platelet rich plasma -prp/stem cell), glucosamine, chondroitin, fish oils, supplements, acupuncture, electrotherapy, manual therapy.
The potential ways to help control symptoms and maintain activities will be discussed on an individual basis and this will allow most patients to initially manage. However, OA is a chronic condition and will often slowly progress to the point where surgery needs to be contemplated. The most definitive option is likely to be an artificial joint replacement although there are a few other surgical alternatives that can be discussed.
Please follow the links to more information on the specifics of a total knee replacement (TKR) / partial knee replacement (PKR) / osteotomy (HTO).