Osteoarthritis (OA) or wear and tear is the most common form of arthritis affecting the knee. In a healthy knee the ends of the bone are capped with a smooth articular cartilage which acts as a cushion and smooth surface for easy range of motion. Arthritis is the destruction of this cartilage which alters the underlying bony surfaces and ligaments of the knee. This results in a painful knee which is still and difficult to move.
The exact cause of OA is not always known and can be multi-factorial. Ultimately it is progressive wear and tear of the joint which may be accelerated in some patients due to trauma, infection or abnormal alignment in their lower limbs.
Patients most commonly present with knee pain. The character of the pain may differ from patient to patient. Typically the pain will worsen during the day or during certain activities. It may keep you from getting to sleep or wake you at night with a dull throbbing ache. Some patients may experience stiffness and unable to fully straighten or bend their knee, swelling or instability and a feeling the knee is giving way.
A thorough history and examination is enough to raise suspicion of OA but diagnosis is confirmed using simple X-rays of your knees. On occasions additional imaging in the form of a MRI may be requested looking for other causes of pain around the knee.
Unfortunately progressive damage to the articular cartilage of the knee is irreversible. We cannot undo the damage already been done. In that sense there is no “cure” to OA. However there are a number of treatment options available that can help to manage your symptoms.
Non-Operative:
Initially OA can be managed non-operativly with a combination of physiotherapy, exercise therapy, medication and lifestyle changes.
Simply put, maintain a healthy weight, keeping strong around the knee and avoiding aggravating factors is a good starting point.
Low-impact activities such as swimming, cycling, pilates and yoga can all be extremely beneficial and effective in reducing stress across the arthrtitic knee and strengthening the mucles. Medication such as Paracetamol and anti-inflammatories (if indicated) may also assist in alleviating symptoms.
** Please see the link for effective methods for managing Knee Osteoarthritis conservatively **
Surgery:
In more advanced cases of OA or in patients where non-operative management is not enough, you may consider surgery. There are a number of surgical options (listed below) to treat Osteoarthritis but the decision on which is best for you is made with the surgeon and is determined by the extent of wear and tear in the knee.
The prognosis for knee osteoarthritis is progressive and predictable. Given the degenerative and irreversible nature of the condition symptoms can worsen over the years. This does not mean that everyone will reach the point where they must have a knee replacement as this relates more to the functional limitations you are experiencing. some patient are able to live with their arthritis knees for many years.
The long-term outcomes of Total Knee Replacements are great with the Australian Joint Registry reporting that 92% of knee replacements are still functioning well after 15 years. With modern implant designs and surgical techniques you can expect a knee replacement to last you well over 20 years.
There are risks and complications associated with joint replacement surgery and Dr Shales will discuss these with you.
Preventing knee OA is difficult as it is a wear and tear / degenerative condition. However there are recognised things you can do to minimise the damage or progression of the disease. These include:
In conclusion, knee osteoarthritis presents a significant challenge both for patients and due to its debilitating effects on mobility and quality of life. While current treatments focus on symptom management and improving function, ongoing research into disease-modifying therapies offers hope for more effective long-term management. A holistic approach that integrates pharmacological interventions, lifestyle modifications, and surgical options tailored to individual patient needs remains paramount in optimising outcomes.
