OSTEOARTHRITIS (OA) KNEE Arthritis is a common cause of knee pain that usually starts to cause problems in ‘middle age’. It is more common in people who have sustained previous injury to the knee (cartilage problems, ligament injuries) or who have undertaken lots of weight-bearing sporting activities (e.g. football) or occupations.
Symptoms
Although OA is a progressive disease the symptoms do not worsen consistently through time. Some people experience a ‘flare up’ and then do not encounter any problems for years afterwards. For others the problem gets more frequent and the need for treatment increases.
When the condition worsens the time between each ‘flare’ decreases and they can get progressively more intense. The dynamic stability provided by the muscles surrounding the joint decreases over time as well and muscle wasting of the quadriceps particularly is noticeable and this can lead to more pain as even more strain is put on the ligaments and joint surfaces. In the later stages, if there is pain at rest and during the night, as well as problems with mobility, then joint replacement surgery is appropriate.
Treatment
1. Patient education
Understanding the nature of the problem - that too much activity or too little activity can make the problem worse – will enable each person to learn the optimum level of activity for their affected joint.
2. Conservative Treatment
During the early phase, ‘flare ups’ are best treated symptomatically with anti-inflammatory medication (if you are able to take this) which can be effective in relieving pain. Medical advice is needed to choose the best drug or the one with the least side-effects as there can be severe side effects on the gastrointestinal system from these drugs. An ice pack may be used to relieve a hot painful knee joint. Ice packs can be applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin as it can cause an ice burn so wrap a damp towel around the ice pack to prevent this). The ice packs relieve pain and reduce swelling within the joint. Some people find that wearing a knee brace can help provide support and reassurance as well as warmth during the colder months. Weight reduction will also reduce the risk of developing OA of the knees as well as helping reduce pain and improve function in older people with the condition. This can be hard to achieve though as the condition itself limits the amount of exercise that can be done.
3. Physiotherapy
Physiotherapy is an essential part of successful management of this problem. Strengthening of the muscles around the knee particularly the quadriceps muscles has shown to be effective in reducing pain and improving function in knees as has carefully graded aerobic and resisted exercises but these should be undertaken under the supervision of our physiotherapist. Maintaining range of movement is also essential and the physiotherapist uses different techniques to achieve this. Pain relief is achieved through mobilisation techniques, ice and electrotherapy.
4. Injection
Injection of corticosteroids into the joint is an effective treatment should the knee prove resistant to other treatments and this can produce significant relief for a number of months. Some people report longer term improvement in their pain after injection but there is no guaranteed way of telling which people will respond well to the treatment. The use of Viscosupplementation has increased over the past ten years. This is where the joint is injected with a synthetic copy of the normally produced synovial fluid (hyaluronic acid) and this provides some protection to the joint. Again benefit has been demonstrated in the short-mid term.
5. Surgery
Arthroscopy and washing out the joint with saline solution can be effective in knee OA should other treatments fail but most surgeons would consider joint replacement (arthroplasty) if the pain and disability warranted it.
A list of references is available below.
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