It affects millions of people around the world and is a major cause of lost work time and serious disability.
Knee pain can severely impact the way we go about our daily lives. Daily activities such as walking, running, or sitting down can be challenging due to severe pain. There are many ways to manage knee pain; this includes conservative as well as surgical techniques. Accurate diagnosis and prompt treatment are important to prevent escalation of simple injuries into complex ones.
Osteoarthritis in general is a degenerative wear of the protective cartilage that protects the ends of long bones. Damaged joints and the loss of cartilage in our knees are especially painful and debilitating as the stress is directly transmitted to our bones. This gives the sensation of pain and stiffness when we put weight on our legs.
Rheumatoid and Other Inflammatory Arthritis
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects the joints of patients and a variety of other body systems as well. The immune system attacks the body’s own tissues, compromising their function, leading to pain and significant disability. Unlike the degenerative damage in osteoarthritis, RA affects the lining of joints (synovial lining) which results in bone erosion and joint deformity.
Patients with RA are managed by rheumatology specialists who prescribe medication (DMARDS Disease Modifying Anti-Rheumatic Drugs) to stop or slow the disease process. Physiotherapy and occupational therapy are also important to help patients maintain function of their joints.
Other types of inflammatory arthritis which affects knees, hips and other joints include psoriatic arthropathy, gout and ankylosing spondylosis. If their knee or hip joints have badly eroded or damaged, orthopaedic surgeons would replace these joints e.g. total knee replacement.
How is knee arthritis diagnosed?
Most patients have knee pain related to daily activities such as walking, climbing or coming downstairs and standing from a sitting position. These symptoms may even be present at rest, or at the end of the day. Pain which is not better with rest, changes in activities and simple medication should be managed by a doctor or specialist.
Your orthopaedic surgeon will assess the condition of your knee and would start with a simple x-ray of both knees while you are standing. This gives the orthopaedic surgeon an idea about the alignment of both knees under your body weight as well as how your knee cap (patella) behaves when you bend your knee. If your arthritis is moderate or severe, the diagnosis can be made from just x-rays alone. In early arthritis where x-ray changes are not so obvious, an MRI scan of the painful knee may be required.
How is knee arthritis treated?
Most patients with knee arthritis may manage their symptoms conservatively without surgery. These techniques include activity modification, weight loss, being involved in moderate physical activities and simple medication.
If symptoms of knee arthritis persist despite this, injections such as hyaluronic acid lubrication, local anaesthetic, steroid or blood may be considered.
Patients with moderate to severe arthritis, those with significant malalignment of their limbs and those who have failed conservative methods may be considered for knee replacement surgery. This may include both partial and total knee replacement surgery. The aim of these surgeries is to help patients regain their quality of life and resume their active and healthy lifestyles. We do not encourage patients to be bedbound or immobile after their surgeries. Our team of physiotherapists will ensure patients are on their feet starting their physiotherapy and rehabilitation a day after surgery.
Can I prevent knee arthritis?
This is a common question among younger adults who witnessed parents or older relatives with arthritis. Genetics can play a part in arthritis; one can be predisposed to certain conditions and there may not be much that can be done about it. But there are some ways that can deter degeneration of the knees, such as maintaining a healthy weight to reduce stress on the knees.
Traditionally, glucosamine and chondroitin were regularly prescribed for the prevention of knee arthritis. However, the latest guidelines from the American Association of Orthopaedic Surgeons (AAOS) do not support this for the treatment of arthritis.
Intra-articular injections with visco-supplementation may provide a temporary relief from arthritis. With these injections, no downtime is involved, no risk of scars, and they provide a symptomatic relief to patients.
The newer intra-articular injections with patients’ own blood (platelet-rich plasma and autologous protein solution) are currently the topic of discussion and research for symptomatic arthritis. These new treatments are aimed at inflammatory cytokines and chemicals in the knee that promote the breakdown of cartilage.
While they are safe and have been shown to improve pain scores in arthritis, further research is currently being done to determine the true effects of these blood injections for knee arthritis.
What are some knee preservation techniques?
In the early stages of arthritis, much can be done to try and preserve the knee. Multiple surgeries have been done over the years to either replace focal loss of cartilage or help in its regeneration. These include transplanting cartilage from other parts of the knee into the defect (OATS: osteochondral autograft transfer system) or harvesting and growing a small piece of cartilage in a lab before re-implanting it into the knee (ACI: Autologous chondrocyte implantation).
A common procedure is microfracture of the knee. While the cartilage has no blood supply of its own and therefore cannot regenerate, the bone beneath it does. During a keyhole (arthroscopic) procedure, a long and sharp instrument is used to penetrate the surface of the femur bone. This induces bleeding from the bone, and stem cells in the blood can develop into cartilage (fibrocartilage) over time.
Although this new fibrocartilage is not as robust as the native cartilage (hyaline cartilage), this faux cartilage can help to reduce the pressure and pain of arthritis. In cases where the cartilage loss is very diffuse and widespread, knee preservation techniques may prove ineffective.
Speak to our orthopaedic surgeon if you are having pain and trouble with your knees. We are here to help you on your journey.
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