Osteoarthritis of the Knee

Man walking up stairs rubbing his arthritic knee in pain.

Osteoarthritis is a disease commonly affecting 32.5 million adults, mostly the middle age and elderly population. This disease affects the entire joint and involves the joint lining, cartilage, ligaments, and bone. It is characterized by the breakdown of the cartilage, bony changes of the joints, deterioration of the tendons and ligaments, and various degrees of inflammation of the synovium (the lining of the joint cavity). Osteoarthritis, or degenerative joint disease of the knee, is a progressive disease that affects functional activities and may even be disruptive to one’s sleep. The diagnosis is made through and new patient consultation in which a physical exam will be performed on the affected knee. Your Physician will then order and Plain Film Radiograph, or X-ray, to evaluate the boney structures. After reviewing the X-ray findings, an MRI of the knee may then be ordered to further assess degeneration and the soft tissue structures of the joint (meniscus, ligaments and tendons).

Risk Factors

  • Advanced Age - The risk of osteoarthritis increases with age.
  • Obesity - Increased weight adds stress to the weight-bearing joint of the body, like the hips and knees. This will increase the risks of developing osteoarthritis.
  • Sex – Women are more likely to develop Osteoarthritis of the knees than men.
  • Previous joint Injuries – Prior injuries from an accident or playing sports predisposes the affected joint to developing osteoarthritis, even several years after the event.
  • Repetitive Joint Stress – Occupations or sports placing repetitive stress on joints may eventually predispose that joint to osteoarthritis
  • Genetics – Patients with a family history of osteoarthritis are more susceptible to developing degenerative joint changes.
  • Congenital Deformities – Some patients are born with misaligned joints or defective cartilage that may increase their risk of osteoarthritis.

Symptoms

  • Pain - The affected joints may hurt during or after movement. Patients commonly report pain when standing from a seated position or when climbing stairs.
  • Stiffness – Many patients notice joint stiffness that is most noticeable upon awakening in the morning or after periods of inactivity.
  • Tenderness - The joint may feel tender to light tough or pressure.
  • Loss of flexibility - The joint becomes less flexible and patients will report not having a full range of motion
  • Grating sensation - Patients will report “popping” sounds or sensation of cracking/grinding when moving the joint.
  • Swelling - The joint may become noticeably swollen because of fluid accumulation due to the inflammation.
  • Joint instability – Patients report episodes of the knee joint buckling or “giving out” during weight bearing activities.

Conservative Treatments

  • A variety of treatment options are available for the management of osteoarthritis of the knee. Medication management is targeted at reducing inflammation while providing pain relief for improvement in function.
  • Oral non-steroidal anti-inflammatory drugs (NSAIDS) - These may be used cautiously in patients with gastrointestinal risks and the elderly.
  • Topical creams - Lidocaine, topical anti-inflammatories, and topical neuropathic pain creams such as capsaicin may be applied to the affected knee 2-3 times daily for pain relief.
  • Medical equipment - TENS units (Transcutaneous electrical nerve stimulation) can improve the pain associated with osteoarthritis and improve strength in the quadricep muscles on the front of the thigh. Knee braces will provide support for the knee by decreasing the load on the painful joint.
  • Topical Therapy - Cold therapy with ice is useful in reducing inflammation and swelling. Heat therapy will increase blood flow and improve joint stiffness.
  • Physical therapy – With Degenerative joint disease, maintaining flexibility of the knee will increase mobility. Exercises that strengthen the muscle groups in the thigh will help reduce the pain of osteoarthritis.
  • Hydrotherapy (aqua therapy) – Patients often utilize this alternative exercise method as it provides a weight-less environment.
  • Weight management - An essential part of living with Osteoarthritis is weight management through a healthy diet. Being overweight or obese will increase the pain and loss of function, as well as accelerate the degenerative changes in the joint.

Interventional Treatments

  • Intra-articular Steroid Injections – Degenerative joint disease causes joint inflammation that will benefit from injections with steroids. This is performed under sterile conditions in the office setting. Onset of relief occurs with 3-7 days and may last 3 months.
  • Intra-articular Viscosupplementation injections – During viscosupplementation treatment for arthritis, your healthcare provider injects hyaluronic acid into your joint. Hyaluronic Acid is found in the fluid coating the cartilage surface of your bones. It acts as a lubricant and shock absorber. In osteoarthritis, the cartilage becomes worn and the increased joint friction results in pain and inflammation. This injection may be repeated every 6 months and is performed in the office setting.
  • Platelet Rich Plasma (PRP) Injections—An emerging treatment for knee arthritis whereby the patient’s blood is withdrawn, spun down, and then a portion of the blood plasma including anti-inflammatory products is injected into the knee. This therapy has been shown to have an anti-inflammatory and possibly regenerative quality for knee arthritis and is used in many types of tendinitis, bursitis, and arthritis of many types of joints. Initial results studying knee arthritis have been very promising. PRP injections are used quite frequently in Sports Medicine and Orthopedic practices for athletes of all ability levels. Many professional athletes have used PRP to promote healing and get back onto the court or the field more quickly. Although the therapy holds promise, it is currently only approved by Medicare for certain types of burns and wounds, and it is not covered by most insurance plans.
  • Genicular Block (Extra-Articular Block) and Radiofrequency ablation – The genicular nerves of the knee are sensory nerves that send pain signals to the brain secondary to osteoarthritis joint destruction. The treatment involves a two-step process that involves a diagnostic and therapeutic block that anesthetizes (numbs) these nerves. Resulting pain relief that is >50% is considered successful. In step two, the patient receives an ablation of these nerves using either cooled RF or thermal radiofrequency ablation. The ablation will provide 6 months, or longer, of pain relief for patients suffering from degenerative joint disease of the knees. Early intervention and multimodal treatment can improve the quality of life for patients living with knee pain secondary to osteoarthritis. See your healthcare provider for a treatment plan tailored for the management of the degenerative joint disease of the knee.