Knee Osteoarthritis

Written by Bethany Elliott-Hutton

Osteoarthritis is one of the most common types of arthritis. It is a condition that affects the joints of the body causing pain, stiffness, and inflammation. The knee joint is one of the most common joints to be affected by osteoarthritis.

A joint is where two or more bones meet together to allow for movement. In the knee, the bones that meet together are the thigh bone (femur), leg bone (tibia), and the kneecap (patella). The end of our bones are covered in a connective tissue known as cartilage. Cartilage provides a smooth, lubricated, and cushioned surface to the bone allowing the bones to move against each other without friction as well as protecting the joints from stress. The knee joint also has an additional type of cartilage in the form of two ‘c’ shaped rings known as menisci. These rings play an important role in providing extra support and cushioning to the knee joint, aiding in the equal distribution of weight through the knee joint. There is also cartilage behind the kneecap.

When a knee joint is affected by osteoarthritis the cartilage within the knee joint starts to thin and wear down. This can lead to a reduction in the natural cushioning that supports the smooth movement of the knee joint. As a result, the joint surfaces are closer together which can cause them to rub resulting in pain, stiffness, and inflammation. Over time, the rubbing of the joint surfaces can affect the shape of the bones. Bony growths known as osteophytes or bony spurs can develop.

The main symptoms of knee osteoarthritis are:

• Pain in and around your knee joint. The pain usually gets worse when you are active and reduces at rest.
• Stiffness of the knee joint. You may notice that your knee feels stiff after a long period of inactivity, such as getting up first thing in the morning or after sitting down for a while.
• Swelling around the knee.
• Your knee giving way or locking (the inability to straighten your leg).
• Creaking, knee clicking no pain, crunching, or popping sounds when you move your knee. This is known as crepitus.

The exact cause of osteoarthritis is not known. However there are several factors that can increase the risk of developing knee osteoarthritis:

Age. As you get older you are more likely to develop osteoarthritis. Osteoarthritis is common in people over the age of 50 years. However, it can occur in younger people too.

Gender. Research has suggested that women are more likely to develop osteoarthritis than men, however, it is not clear why this is.

Genetics. Individuals who have family members with osteoarthritis are more likely to develop osteoarthritis due to there being a genetic component to osteoarthritis.

Weight. Excess weight can increase the risk of developing arthritis in a few different ways. Extra body weight puts more stress on all of the joints in the body, especially the weight-bearing joints such as the hips and knees. Also, fat tissue promotes inflammation which can be harmful to the joints.

Joint Injuries. Previous joint trauma or injuries, such as sporting injuries or accidents can increase the risk of developing osteoarthritis.

Metabolic Diseases. A few metabolic diseases such as diabetes and hemochromatosis ( a condition in which there is too much circulating iron in the body) can increase the risk for osteoarthritis. It is suggested that this is due to increased levels of inflammation in the body.

Hormone Levels. Decreased oestrogen levels experienced by women during menopause can be a risk factor for osteoarthritis. Oestrogen is a hormone more commonly known for regulating a woman’s menstrual cycle. However, osteorgen also plays a role in protecting bone health, particularly the articular cartilage. Therefore reduced levels of the hormone can increase the risk for osteoarthritis.

Repeated stress on the joint. Jobs or sports that cause you to perform repetitive movements such as squatting, bending, or kneeling may increase your risk for osteoarthritis. This is due to the repetitive movement and forces being put through the knee joint,

During the initial consultation for your knee pain, your physical therapist will take a thorough case history asking you questions about your symptoms. A physical examination of the knee joint will then be carried out. Your therapist will examine the knee looking for any joint swelling or abnormalities. Active and passive range of motion testing will also be carried out to determine how well the knee joint is moving.

X-ray is the gold standard for determining if a joint has osteoarthritis. The common x-ray findings for knee osteoarthritis are; cartilage loss shown by joint space narrowing, oedema, and bony spur formation. X-rays can also be used to rule out any other causes of knee pain.

MRI is not commonly used for the diagnosis of osteoarthritis however it may be used in more complicated cases.

There are no blood tests that can determine osteoarthritis. However, your doctor may request for you to have a blood test to help rule out any other causes of knee pain such as rheumatoid arthritis.

Joint fluid analysis or arthrocentesis may be used in instances where a joint is particularly swollen. Your doctor will drain the fluid from the joint. The fluid will be sent off to be analysed for inflammation and to help rule out any other causes of knee pain such as gout.

Currently, there is no cure for osteoarthritis, but there are lots of treatment options both conservative and surgical that can help in managing your symptoms and controlling your condition. The main aims of treatment for osteoarthritis are to reduce your pain and improve the function of your knee joint.

Conservative treatments:

Osteopathy and Physiotherapy. A physical therapist such as an osteopath or physiotherapist can help with knee osteoarthritis by helping to reduce your pain and increase your knee function. The treatment would include a range techniques that aim to:

• Strengthen the muscles that surround the knee joint. This will help to offload the knee joint easing the stress on the joint.
• Improve the range of motion of the knee joint using hands-on techniques such as joint mobilisations and exercises. This will help to reduce any stiffness and keep the joints mobile.
• Reduce the inflammation within the knee joint by giving advice on diet and hot and cold therapies. Reducing inflammation will also help to improve the function of the knee.
• Improve balance through exercise prescription.
• Release endorphins and improve blood flow. Endorphins are natural pain relievers and are found circulating the body.

Medication. Your doctor may advise certain medications to help alleviate the pain and inflammation caused by osteoarthritis. Common medications include:

• Analgesics. Also known as painkillers, these medications help to reduce pain. Paracetamol is available over the counter. Stronger analgesics such as opioids must be prescribed by your doctor.
  Nonsteroidal anti-inflammatory drugs (NSAIDs). These are commonly used to help ease pain and inflammation. Drugs such as ibuprofen and naproxen can be bought over the counter or can be prescribed at higher doses by your doctor. It is important not to take NSAIDs for too long as they can upset your stomach. Usually, your doctor will prescribe you another medication alongside the NSAID to help protect your stomach.
• Cortisone Injections. If your knee joint is particularly swollen your doctor may recommend a steroid injection directly into the knee joint. This injection helps to relieve the pain. Your doctor will numb the area around the knee joint and place a needle into the joint space, the steroid will then be injected into the joint. The number of steroid injections is limited as too many can worsen the joint over time and cause your bones to become weaker.

Surgical interventions:

Surgical interventions for osteoarthritis are only required in a small number of patients where conservative therapies have not been successful or in cases where the joint is severely damaged.

Your doctor will refer you to an orthopedic consultant who will discuss the different surgical options available to you. Surgery can help with improving your mobility and quality of life. However, having surgery can not guarantee a full reduction in your symptoms. It is possible that you may still experience pain and stiffness. Your orthopedic consultant will discuss all of the risks, benefits, and outcomes of the different surgical interventions. Below are several different types of surgery for knee osteoarthritis.

Knee arthroscopy. This is a type of keyhole surgery where a tube is inserted into the knee joint. The surgeon can insert a small camera into the tube to inspect the knee joint. Small tools can then be passed through the tube to help remove damaged cartilage, remove cysts, and help to smooth out the bone.

Knee osteotomy. This surgical procedure is used in patients who have arthritis in one knee. The procedure involves adding or removing part of your tibia or femur. This helps to shift the bodyweight off the damaged part of the knee, altering how the weight is distributed through the knee joint.

Knee arthroplasty. This is also known as joint replacement surgery. During the arthroplasty, the orthopedic surgeon will remove the affected knee joint and replace it with a prosthesis (artificial joint).

Not all types of knee osteoarthritis can be prevented, but there are many ways to reduce your risk and protect your knees from future injury.

• Maintain a healthy weight. Losing and maintaining a healthy weight can help relieve pressure on your knee joints.
• Exercise regularly. Exercise is a great way to keep your joints mobile. Low impact exercises such as cycling can help to increase the strength of the muscles surrounding your joint, helping to support the knee joint. Swimming or water aerobics are great non-weight bearing activities. They enable you to take the joint through its full range of motion with limited pressure on the knee joint.
• Improve your posture. Poor posture can increase the stress on your knee joints. Exercises such as Pilates can help with educating you on how to improve your posture.
• Eat a healthy diet. Reducing the quantity of refined sugars in your diet can help with reducing inflammation as well as increasing your consumption of anti-inflammatory foods such as green leafy vegetables and oily fish.

Maintaining movement is essential for people suffering from knee osteoarthritis. Exercise and movement help with; strengthening muscles, reduces knee stiffness, and increases blood flow around the body.

Below are a couple of simple exercises to do if you are experiencing pain from knee osteoarthritis*.

Knee flexion and extension. Lie on your back or sitting up with your legs stretched out long. Inhale, on the exhale slide one heel up towards your bottom. Inhale to slide the heel back to the starting position. Repeat this exercise 8 times, and remember to repeat on the opposite leg.

Inner range quadriceps. Lie on your back or sitting up with your legs stretched out long. Place a rolled-up towel or cushion underneath your knee. Inhale, on the exhale squeeze your knee into the towel and straighten the leg. Hold this position for 5 seconds. Inhale to relax the leg. Repeat this 8 times and remember to repeat on the opposite leg.

Half squat (mini squat). Hold onto a handrail or chair, make sure it is sturdy and won’t move. Place your feet hip-distance apart with your toes facing forward. Inhale, as you exhale, bend your knees slightly and push your hips backward to perform a mini squat. Inhale and squeeze your bottom muscles to come back up to straight standing. Repeat this exercise 8 times.

Clam. Lie on your side with your knees bent at 45 degrees and your ankles stacked on top of each other. Inhale, on the exhale lift the top knee up to separate your knees, making sure to keep your ankles together. Inhale to lower the knee back down. Repeat this exercise 8 times and make sure to repeat on the opposite leg.

* It is recommended to get the OK from your osteopath, physiotherapist, or GP before trying out any of these exercises.

The primary objective for both Osteopaths and Chiropractors is, most frequently, to relieve aches and pain. However, osteopaths also treat a broader range of functional problems, such as disorders of the respiratory or digestive systems. Both Osteopaths and Chiropractors treat more than just bones joints and soft tissues. By working with the nervous system and blood supply they are able to influence all of the bodies systems, making them capable of alleviating the symptoms of a number of diagnosed medical conditions, such as; asthma, stress, digestive disorders, period pain, migraine and many more.

In many cases, patient experiences with osteopaths and Chiropractors will be very similar; however, there are some differences. When diagnosing patients, osteopaths and Chiropractors both use visual inspection (observation) and palpation (touch). Chiropractors frequently rely on more diagnostic procedures, such as X-rays, MRI scans, blood tests, and urine tests. Osteopaths tend to place more emphasis on the physical examination and will generally refer patients on for more diagnostic procedures if required.

Would you like to know whats the difference Osteopathy, Physiotherapy and Chiropractic?

Read our Ultimate Guide to Osteopathy, Physiotherapy and Chiropractic here!