|Osteoarthritis of the Knee
Knee arthritis is a condition characterized by a degenerative process whereby there is gradual eroding of the surfaces of the knee joint with subsequent inflammation. This may occur following a specific injury or due to repetitive forces going through the knee beyond what it can withstand over a period of time.
Within a joint there is a very smooth fibrous connective tissue, known as articular cartilage. This covers the areas where each bone comes into contact with one another (articular surfaces). In a normal joint this articular cartilage allows for smooth movement within the joint as well as acting as a shock absorber. In addition to this cartilage is another tissue, known as the synovial membrane, which produces synovial fluid that lubricates the joint.
Osteoarthritis (also called degenerative joint disease) is the degradation and degeneration of this articular cartilage. As the disease progresses, the cartilage itself becomes thinner and in some cases may wear away altogether. In addition, the bones themselves become thicker and may form bony “spurs”. Associated with these changes is the inflammation of the synovial membrane or thin lining which surrounds the knee joint to keep the synovial fluid or lubrication in place.
When the knee is damaged or overloaded, particularly with excessive weight-bearing or twisting force, degeneration of the articular cartilage occurs which reduces the knee's shock absorption capacity. As the condition progresses there is eventual wearing down of the bone ends so that the surfaces are no longer smooth and may have small bony processes called osteophytes. This condition is known as knee arthritis.
Arthritis of the knee usually occurs after the age of 50 years. It is more common in those patients who are overweight or have a past history of injury or trauma to the knee.
Signs and symptoms of knee arthritis
Patients with this condition usually experience symptoms that develop gradually over time. In patients with minor cases of knee arthritis, little or no symptoms may be present. As the condition progresses, there may be increasing knee pain with weight bearing activity and joint stiffness - particularly after rest and first thing in the morning. Swelling, decreased flexibility (i.e. an inability to fully straighten or bend the knee), severe joint pain, pain at night and grinding sensation during certain movements may also be experienced. Symptoms can sometimes fluctuate from month to month with patients reporting an increase in symptoms with colder weather. In more severe cases, muscle wasting (especially of the quadriceps), a visible deformity of the knee joint, and a limp may also be present.
Treatment for knee arthritis
Whilst little can be done to reverse the degenerative changes to the knee associated with this condition, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. Treatment should be directed at improving knee range of movement, reducing swelling and pain, and restoring normal function.
Most minor to moderate cases of knee arthritis can be managed with an appropriate physiotherapy program so the patient can remain relatively symptom free and active. The success rate of this program is largely dictated by patient compliance. One of the key components is that patients rest from aggravating activity and balance their weight bearing activity with periods of rest (e.g. sitting or lying) to keep symptoms to a minimum. This prevents further damage and deterioration and allows the body to clear any swelling or inflammation. Continuing to participate in painful weight bearing activity is likely to lead to a poor outcome. It is important, however, to keep as active as possible by choosing activities that do not increase symptoms. Better activities for knee arthritis include swimming, hydrotherapy or bike riding.
It is very important that patients with this condition perform regular movement and strength exercises to prevent stiffness and weakness from developing and to ensure the knee is functioning correctly. Pain relief and anti-inflammatory medication may also assist in managing the symptoms associated with arthritis of the knee.
Physiotherapy & Remedial Massage treatment for patients with this condition is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- the use of a knee brace or compression bandage
- ice or heat treatment
- exercises to improve strength, flexibility and balance
- the use of crutches or other walking aids
- activity and lifestyle modification advice
- biomechanical correction
- anti-inflammatory and supplement advice (e.g. glucosamine and chondroitin)
- weight loss advice where appropriate