Arthritis is relatively common and can affect people of all ages, however, it is most common in people over the age of 60. Arthritis may affect one or several joints and often affects the weight-bearing joints, such as knees and hips. There are over 100 kinds of arthritis and it is a progressive disease, meaning it cannot be cured and may worsen over time. Osteoarthritis is the most common form of arthritis and is caused by stress on the joints.
Arthritis is relatively common and can affect people of all ages; however, it is most common in people over the age of 60. Arthritis may affect one or several joints and often affects the weight-bearing joints, such as knees and hips. There are over 100 kinds of arthritis, and it is a progressive disease, meaning it cannot be cured and may worsen over time.
The Knee Joint
The knee is the largest joint in the body and is vital for movement. It connects the femur (thigh bone) and tibia (shin bone) and is covered with the patella (knee cap). The tibia also has a smaller bone running beside it called the fibula. The joint is also made up of soft tissue, which adds stability and cushioning to the joint. Tendons connect muscles to bones, ligaments connect bone to bone, providing stability, and cartilage projects the joint by absorbing shock.
Osteoarthritis of the knee
Knee osteoarthritis occurs when the firm, rubbery tissue that coats the knee joint, known as cartilage, becomes worn away. Cartilage, including the menisci, enables the smooth movement of the knee as well as providing a protective cushion to prevent the bones from rubbing together. Cartilage can repair itself to some extent, but it does not regenerate once lost. One of the first signs of osteoarthritis is often stiffness or pain in the knee joint.
What are the risk factors for knee osteoarthritis?
Osteoarthritis is the most common form of arthritis and is often caused by a multitude of factors causing stress on the joint:
- Wear and Tear
- Obesity
- Ageing
- Genetics
- Joint Injuries and Overuse
- Other Medical Conditions
- Hormonal Factors
Wear and tear
Over time, this degenerative process leads to the breakdown of cartilage and the weakening of the joint. The loss of this cushioning between bones causes the bones to rub against each other and leads to pain and stiffness.
Obesity
Extra weight increases stress on weight-bearing joints, particularly the knees and hips, contributing to cartilage breakdown.
Ageing
As well as wear and tear adding up over time, as people age, the ability of cartilage to heal effectively degenerates.
Genetics
There is some evidence that osteoarthritis may have a genetic component. Certain genes may make individuals more susceptible to developing osteoarthritis.
Joint Injuries and Overuse
Injuries such as torn cartilage or ligaments can increase the risk of developing osteoarthritis in the affected joint. Knee injuries are common in certain occupations and sports that involve repetitive stress and can also contribute to the onset of osteoarthritis.
Other Medical Conditions
Diseases like rheumatoid arthritis or metabolic disorders can increase inflammation and damage the knee joint, increasing the risk of developing osteoarthritis. In some cases, bone abnormalities or malalignments can lead to uneven stress on the joint cartilage, which in turn can cause osteoarthritis.
Hormonal Factors
Some evidence suggests that hormones may play a role in the development of osteoarthritis. For instance, reduced levels of oestrogen after menopause have been implicated as a potential risk factor, especially in women.
Treatment Options for Knee Osteoarthritis
Weight Loss and Lifestyle Modification
The first line of defence against knee osteoarthritis often involves making lifestyle changes. Weight loss is particularly effective, as shedding even a small amount of weight can significantly reduce stress on weight-bearing joints like the knee. With getting older, it can be prudent to switch from exercise and sports that are stressful on the knees to low-impact exercise.
It can be a difficult balance to maintain, enjoying sports, maintaining a healthy lifestyle, and keeping muscles strong, which aid in joint stability with the risks of developing/worsening knee osteoarthritis by increasing stress. Exercise such as swimming, cycling, and walking are good ways to follow this while reducing stress on the knees. For an in-depth and tailored plan, a physiotherapist or GP can offer specific advice.
Analgesics
Over-the-counter pain relievers like paracetamol and NSAIDs are commonly used for managing mild to moderate osteoarthritis pain. They are not always suitable for everyone, and they should always be discussed with a healthcare professional before taking them. If pain in the knee is felt, then seeking help and advice prudently is important, as early diagnosis can help manage and slow the progression of the disease.
Walking Aids
Assistive devices such as medical walking sticks, walkers, or orthotic shoe inserts can be helpful in alleviating pain and improving mobility. The use of a walking stick can offload weight from the affected knee, providing relief during walking. Custom-made shoe inserts can also help distribute weight more evenly when walking, reducing stress on the knee.
Physiotherapy
The key to treating knee osteoarthritis should always include physiotherapy. A physiotherapist will focus on improving joint function, increasing range of motion, and building strength in the muscles surrounding the knee. This can not only alleviate some of the pain and stiffness associated with osteoarthritis but also provide greater stability to the knee joint, potentially slowing the disease's progression.
Injections
For more persistent or severe pain, stepping up treatment to injections is often the next step:
Corticosteroid Injections: These can provide rapid relief from inflammation and pain but are generally used sparingly due to potential side effects, including cartilage degradation.
Other injections:
Doctors may recommend treatments such as hyaluronic Acid Injections, which aim to supplement the knee’s natural lubrication and Platelet-Rich plasma (PRP) injections, where a concentration of your own platelets is injected into the affected knee joint to potentially aid in the healing process and reduce inflammation.
These treatments are not always the mainstay of osteoarthritis treatment, and we always recommend discussing the pros and cons with your clinician.
Surgery
In cases where conservative treatments fail, or the osteoarthritis is particularly advanced, surgical intervention may be considered:
Arthroscopy: Knee arthroscopy is a minimally invasive surgical procedure wherein small tools are used to correct the knee by removing loose fragments of bone or cartilage.
However, it is generally not recommended for treating osteoarthritis alone.
Osteotomy: Knee osteotomy is a surgical procedure that reshapes and realigns the bones of the knee. This procedure can be used to avoid a full knee replacement, but it is not a common procedure to be recommended in older patients with osteoarthritis.
Partial and Total Knee Replacement: This is the last resort for severe osteoarthritis of the knee. During this surgery, any damaged bone and cartilage in the knee are replaced with an artificial joint. This can relieve pain and joint stiffness and improve mobility issues related to arthritis or injury.
