is the largest joint in the body and is the joint most commonly affected by
are many factors that contribute to the development of osteoarthritis. These
include injury, obesity, overuse, poor alignment, certain sporting activities
and family history.
Treatment for osteoarthritis of the knee depends on the
stage and severity of the condition and the age and physical requirements of
general, the initial treatment for early osteoarthritis is non surgical. As the condition progresses (which it invariably
does) surgical treatment may be required. This ranges from minor procedures
such as arthroscopy to major operations involving total joint replacement.
treatment that is recommend to help manage the painful, arthritic knee has been
carefully chosen based on the patient’s symptoms, needs and requirements. As
the response to the treatment is noted the treatment required may change to
take this into account.
To view the animation of Knee Arthritis please see the video below
| Normal Knee
||Osteo-arthritis of the medial or inside compartment of the knee
|| Bowing of the legs
Treatment of the arthritic knee
Treatments for the arthritic knee include the following:
This is always a good place to start and if in the early
stages of arthritis can give good results for long periods of time. Successful
conservative treatment can delay the need for surgery for months or years.
Building up your thigh muscles allows the shock to pass
through the muscle rather than through the inflamed joint and relieves your
pain. You can achieve this by doing regular quadriceps (thigh muscle)
strengthening exercises. Leg raising or leg extension exercises using ankle
weights to strengthen the quadriceps muscle group can help support the knee
joint during load and lead to better function and reduce symptoms. 240
repetitions per leg per day (8 sets of 10, three times per day) are required.
Have a course of physiotherapy. A good physiotherapist can help with
strengthening exercises and other physical techniques to help maximise knee
function and mobility.
Take up a low impact exercise programme. Swimming, walking
and stationary cycling are excellent ways to keep mobile and retain function of
the knees. Joint surface cartilage is nourished by synovial fluid which
requires movement for optimal penetration to the cartilage cells in the deeper
layers. Movement is vital for joint function.
Reduce weight if required. More
than half of Australian adults are overweight and excess weight places enormous
stress on the knees and leads to early arthritis. A GP will give advice on dieting, exercise,
and possibly medication. It may be helpful to seek advice from a dietician. Approximately
three times your body weight goes through each knee with each step you take. Sensible
weight reduction will definitely reduce the pain of osteoarthritis.
Try a course of cartilage supplements. There is very little
science behind the use of supplements for arthritis. Some people find that they
work very well and some people find that they do not work at all.
If trying a
supplement I suggest using it for a month
and then stop it. Once stopped look for a worsening or deterioration in
symptoms. If symptoms are the same on and off the supplement then it is almost
certainly not helping. If symptoms
become worse after stopping then start
the supplement again. I am not aware of
any evidence that any supplement can actually reverse the arthritic process or
be helpful as a preventative agent. There are many reports of patients
benefiting from taking these compounds and the chance of suffering side-effects
appears to be very small. The exact mechanism of action of these compounds
Anti-inflammatory medications are very useful in
treating the symptoms of arthritis although they do not appear to affect the
underlying condition. It is reasonable to take anti-inflammatories as long as
complications and side effects do not occur. Common side effects of
non-steroidal anti-inflammatory drugs (NSAID’s) include dyspepsia, reflux
oesophagitis, stomach and duodenal ulcers, fluid retention, hypertension, and
asthma in susceptible individuals (heartburn, reflux and kidney problems). Some
patients tolerate NSAID’s for years without suffering complications.
Cox 2 inhibitors are a relatively new
class of NSAID that gives relief of pain and symptoms of arthritis but has
fewer of the side effects of traditional NSAID’s.
delivered by injection
Cortisone injections into the arthritic
knee may reduce inflammation and relieve symptoms for a while but do not affect
the underlying disorder. The injections do not cause skin problems or thinning
of the bones like cortisone tablets and can give good pain relief for a period of time.
Visco-supplementation (‘tricking’ the body into thinking it
has normal joint lining fluid again) with hyaluronic acid based fluid
substitutes may give relief of symptoms
of arthritis for several months and may put off the need for surgery in some
As the arthritis in your knee progresses the non surgical
treatments become less effective in relieving symptoms. In such instances
surgical treatments may be required.
Surgical options range from minor operations conducted on
an outpatient basis to major procedures such as total knee replacement. The
main surgical procedures used to treat osteoarthritis of the knee are:
Arthroscopy (keyhole surgery – no overnight stay
involves inspection of the inside of the knee joint with a small telescope and
camera. The image is projected onto a
television monitor via a fibre optic cable and allows me to fully inspect all
of the interior structures of the knee joint without needing open surgery. Despite the fact that the incisions are
quite small, a large amount of surgery can be performed within the knee. Arthroscopic
surgery is usually performed on a ‘day only’ basis (an outpatient procedure). The aim of this procedure in the arthritic
knee is to examine the specific location and severity of the arthritis. I then
remove loose bodies and floating cartilage, treat meniscal tears, remove excess
and inflamed synovium and wash out debris from the knee.
Satisfactory results are achieved in about 60% of patients.
The results of arthroscopy in the arthritic knee are difficult to predict
pre-operatively and can be disappointing. It is possible for symptoms to increase following arthroscopy for a few months and if a
satisfactory result is not achieved further surgery may be required.
Arthroscopic view of an arthritic knee.
The joint surfaces are rough and the meniscus is torn.
Unicondylar Knee Resurfacing (Partial Knee
This operation is suitable for patients who have moderately
severe arthritis affecting one side of the knee joint. The procedure involves removal
of some bone and replacement of the damaged joint surfaces with metal and plastic
implants. The operation is more conservative than total knee replacement, has a
shorter hospital stay and faster recovery. The implant may not last as long as
a total knee replacement and may need to be changed to a full knee replacement
after 8 to10 years.
Patients who have had this
operation usually report excellent function and a more natural feeling knee
than those with a total knee replacement.
|Partial or unicondylar replacements preserve the intact joint surfaces and only replace the damaged area.
High Tibial Osteotomy
means cutting of bone. During an osteotomy the bone is cut and its position is
changed in order to shift the pressures from one part of a joint to another.
The idea is that the bone is cut and realigned to take pressure off the
affected part and put onto a better part of the joint.
Patients are generally young (under 55
years of age) and active
- They have arthritis affecting one part
of the joint
- They have a good range of motion of the
- They have good bone quality
- They are able to non weight bear on crutches
- They are committed to rehabilitation
- Inflammatory arthritis
- More than one compartment involved
- Over 65 years of age
Opening wedge osteotomy
Closing wedge osteotomy
For more information on Osteotomy please click here
Total Knee Replacement
As the arthritis progresses and the entire joint becomes
involved it may be necessary to consider a total knee replacement. This
operation involves removal of about 1cm of bone from the end of the thigh bone
(femur) and a similar amount from the top of the shin bone (tibia) to allow insertion
of the metal and plastic components. This procedure is a major operation and
requires about a week in hospital and about 2 weeks in a specialist
rehabilitation facility. The physiotherapy in the first month is very demanding
and it can take 6 months to be totally satisfied with knee function (Satisfactory
results are seen in 90-95% of cases). Unfortunately the plastic can wear out so
your knee replacement may not last a lifetime. Some people need a second
operation 10 or 15 years after their first one but there are many reports in
the literature of 15 years or more satisfactory function following total knee
knee replacements can be inserted with or without bone cement.
Cemented total knee replacement
Cementless total knee replacement
In a total knee
replacement all of the damaged joint surfaces are replaced with the metal and
polyethylene prosthetic components.
For more information on Total Knee Replacement please click here
Revision Total Knee Replacement
If a knee replacement wears out a revision replacement will
be required. The operation involves removing the old implants and replacement
with a new knee and may require bone grafting or other specialised techniques to
achieve a satisfactory result. This is a major surgical undertaking but with
careful planning a successful result can be anticipated in over 90% of cases.
Revision knee replacements involve larger implants and require more bone removal.