Introduction

Arthritis is a disease of the joints which presents with pain and damage to the joints. There are many types of arthritis with osteoarthritis being the most common. Approximately 23 million people around the globe have some form of arthritis, making it one of the leading causes of disability worldwide. (1), (2)

The knee joint is a hinge-like, weight-bearing joint that is formed by the femur (thigh bone), tibia (shin bone), and the patella (knee cap). It is one of the largest joints of the body and one of the most common joints affected by various types of arthritis (3).

Knee arthritis is a painful condition that is severely debilitating and can greatly compromise the affected individual’s life.

Risk Factors

Several factors can increase the risk of developing arthritis, they are as follows:

Causes

The following types of arthritis can involve the knee joint:

1. Osteoarthritis (OA):
2. Rheumatoid Arthritis (RA)
3. Gout and Pseudogout
4. Reactive Arthritis
5. Septic Arthritis (Arthritis caused by infection)

Osteoarthritis and rheumatoid arthritis are two of the most common forms of arthritis that can involve the knee joint. (4)

Rheumatoid Arthritis (RA)

Rheumatoid arthritis or RA is an autoimmune, symmetric joint disease that mainly involves small joints of hands and feet but 30% of the patients can present with involvement of the knee joint. The immune system attacks the synovial lining of the joints and causes the destruction of the cartilage and bone. (4),(5) This can lead to pain, stiffness, swelling, and difficulty walking or weightbearing.

Osteoarthritis (OA)

Osteoarthritis, or OA is a wear and tear joint disease caused by age-related degenerative changes in the joint and is the most common form of arthritis. It usually affects older individuals but can be seen in younger active individuals as well. Repetitive or traumatic joint injuries, obesity, or high impact repetitive activities can put one at increased risk of developing OA.

Osteoarthritis occurs due to degeneration of the joint cartilage which lines the bones in the knee because of wear and tear and can result in swelling of the joint, formation of bone spurs, and loss of joint space. OA symptoms can develops gradually and the pain generally worsens over the course of time (2).

Signs and Symptoms of Osteoarthritis

Pain is one the most common and sometimes the only presenting complaint in individuals with arthritis (7). The pain in osteoarthritis worsens with activity and is relieved after rest.

Other signs and symptoms of knee arthritis are as follows:

●      Swelling

●      Redness

●      Joint Stiffness

• Decreased range of motion
• Deformity- Knees bowing more in one direction or another.
• Weakness
• Instability
• Feeling of warmth
• Crepitus (Creaking sound when joint moves)

How to Diagnose Osteoarthritis

Diagnosis of arthritis is based on detailed history and examination followed by laboratory investigations. A patient’s history and physical exam findings can be highly suggestive of arthritis. The onset and pattern of disease guide treatment options. OA can be diagnosed by the following imaging tests:

1.    X-ray

X-rays are performed to assess damage to the bones, cartilage and to identify the presence of bony spurs. Significant lack of joint space due to severe loss of cartilage can give a bone-on-bone appearance on X-ray in advanced cases.

2.    MRI

MRI’s can be performed to visualize and assess the degree of bony and cartilage involvement. MRI is very helpful in also assessing associated ligament injuries in certain scenarios.

Treatment Options

The goals of the treatment for knee joint arthritis are as follows:

1. Provide symptomatic relief
2. Limit the disease progression
3. Restore joint function as much as possible

Conservative Management

Lifestyle Modification

Following are some conservative treatments:

1. Maintain their weight according to the recommended BMI
2. Exercise regularly
3. Avoid high impact activities
4. Avoid activities that tend to cause one’s symptoms
5. Applying intermittent heat or ice before and after planned physical therapy for patients suffering from arthritis can also provide some pain and symptom relief

Medications

Pain is one of the most decapacitating symptoms and adversely affects the quality of life.

Oral and Topical (skin-based) non-steroidal anti-inflammatory drugs (NSAIDs) can be effective. Always check with your physician before starting any new medication or treatment regimen.

If one’s symptoms are not controlled with these measures, knee joint injections are additional treatments that can also be considered but should be discussed further with your physician.

Exercises

Your doctor may offer or recommend some low-impact activities that help the knee to maintain motion and help strengthen the surrounding muscles. Physical therapy can sometimes be recommended to aid with knee muscle strengthening and range of motion.

Surgery

Knee joint replacement may be considered in patients with refractory disease and can be an effective treatment for end-stage arthritis that does not respond well to conservative treatments. In certain specific conditions arthroscopic minimally-invasive surgery or partial joint replacement may be considered for certain situations but should be discussed with your orthopedic surgeon.

At Ascend Orthopaedics and Sports Medicine we offer advanced treatments for Knee Arthritis. Please call us to see how we can help.

References

1. Zelman, D. (2019, June 20). Knee Osteoarthritis: Causes, Symptoms, Treatments. Retrieved June 22, 2020, from https://www.webmd.com/osteoarthritis/ostearthritis-of-the-knee-degenerative-arthritis-of-the-knee
2. Arthritis of the Knee - OrthoInfo - AAOS. (n.d.). Retrieved June 22, 2020, from https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee/
3. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best practice & research Clinical rheumatology. 2006 Feb 1;20(1):3-25.
4. Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2020 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK518992/
5. Corey Whelan, David Heitz, and Valencia Higuera. Everything You Need to Know About Osteoarthritis. Health-line. Obtained from: https://www.healthline.com/health/osteoarthritis
6. Nevitt MC, Felson DT. Sex hormones and the risk of osteoarthritis in women: epidemiological evidence. Annals of the rheumatic diseases. 1996 Sep;55(9):673.
7. Kean WF, Kean R, Buchanan WW. Osteoarthritis: symptoms, signs, and source of pain. Inflammopharmacology. 2004 Feb 1;12(1):3-1.
8. Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A, Bolton J, Bland M. Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clinical rheumatology. 2010 Nov 1;29(11):1277-83.
9. Chappell AS, Ossanna MJ, Liu-Seifert H, Iyengar S, Skljarevski V, Li LC, Bennett RM, Collins H. Duloxetine, a centrally acting analgesic, in the treatment of patients with osteoarthritis knee pain: a 13-week, randomized, placebo-controlled trial. Pain. 2009 Dec 5;146(3):253-60.
10. Czyżewska A, Glinkowski WM, Walesiak K, Krawczak K, Cabaj D, Górecki A. Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement. Archives of medical science: AMS. 2014 Oct 27;10(5):985.

Author

Amun Makani, MD Dr. Makani is a double board-certified orthopedic surgeon and sports medicine specialist. He is President of Ascend Orthopaedics and Sports Medicine, P.A.