Have you been diagnosed with knee osteoarthritis (OA) and wondering what the treatments are and what you can do to reduce pain or if it can be cured completely.
As a diagnosed radiographer I can not count how many x-ray requests I have seen with OA. I have always wondered what really causes osteoarthritis and what kind of treatment options are available.
I spent a lot of time reviewing medical studies published about the subject matter and I will also rely on my education knowledge. Let’s educate ourselves.
Happy reading!😃
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Sept 2024. Written by Juliet Semakula, a diagnostic radiographer.
Summary: There’s no cure for osteoarthritis, but the condition does not necessarily get any worse over time. There are a few treatments to help relieve the symptoms.
▶️What does osteoarthritis of the knee mean?
Let’s clarify the terms we’re discussing:
♦️Tibiofemoral knee osteoarthritis (OA)
♦️Arthritis
♦️Knee arthritis
The terms “osteoarthritis ” (OA) and “arthritis ” are sometimes used interchangeably, but they do not mean the same things.
Arthritis refers to over 100 joint conditions that cause inflammation (swelling) of one or more joints, while osteoarthritis is a type of arthritis that causes joints to become painful and stiff.
Osteoarthritis is a common condition which can affect any joint in the body. For this article we will be looking at knee osteoarthritis.
When your knee joints develop osteoarthritis, part of your knee cartilage will thin, and the surface will become rougher (sometimes called wear and tear). This means the joint doesn’t move as smoothly as it used to be.
▶️ What are the different stages of knee osteoarthritis?
Stage 1️⃣: The cartilage begins to show slight irregularities on the surface, with no significant loss of cartilage thickness yet with narrowing of less than 50% of the joint space.
Stage2️⃣: There is a beginning loss of cartilage thickness, and osteophytes may start to develop with narrowing of more than 50% of the joint space.
Stage 3️⃣: The loss of thickness is more pronounced. There may be more osteophytes taking up more space in the joint and a total loss of joint space.
Stage 5️⃣: There is almost no cartilage left between two bones that are directly in contact (the femur and the tibia).
▶️Diagnosis of knee osteoarthritis.
Over the years of my practice, I have seen and taken so many x-ray requests stating query knee osteoarthritis.
When you first go to the doctors with symptoms related to knee osteoarthritis, you will get an x-ray of your knee to determine if you have signs of osteoarthritis.
X-ray (or CT AND MRI scans) usually show most of the signs of osteoarthritis and allow staging of arthritis. I have seen mild and severe symptoms with little physical change on most x-rays I have taken.
Here are x-rays of the knee showing different degrees, types and location of knee osteoarthritis.
Image A: showing moderate to severe osteoarthritis. The arrows indicate multiple osteophytes, definite joint space narrowing, sclerosis, and possible bony deformity.
The images show severe Osteoarthritis showing large osteophytes (downward arrow at right), marked joint space narrowing (upward arrow at left), severe bone sclerosis (asterisk), and definite bony deformity in medial tibial plateau.
Osteoarthritis has traditionally been defined as a non-inflammatory arthropathy, but today there is compelling evidence to suggest that in addition to being biomechanics, it has inflammatory and metabolic components.
Recent evidence has suggested that knee osteoarthritis is an inflammatory disease of the entire synovial joint, comprising not only mechanical degeneration of articular cartilage but also concomitant structural and functional change of the entire joint, including the synovium, meniscus (in the knee), periarticular ligament, and subchondral bone {Mobasheri 2016}
What you should know is that osteoarthritis affects each person differently. For some people, osteoarthritis is relatively mild and does not affect day-to-day activities. For others, it causes significant pain and disability.
The damage of your joints usually develops gradually over years, although it could worsen quickly in some people.
▶️What are some of the causes of Osteoarthritis knee.
🟠When we grow our bones tend to grow with us and they are bound to normal age-related changes. It has been reported that there is a higher prevalence of OA among elderly women.
🟠When you have had a previous injury in the knee such as a fracture or surgery, the knee can be affected by osteoarthritis.
🟠Your knee can be prone to repetitive activities and physical jobs.
🟠Some knee osteoarthritis is related to certain genetics.
🟠When you are overweight sometimes this can put press on your knees, osteoarthritis and negative effects related to inflammation.
▶️Early knee osteoarthritis symptoms
The damage of your joints usually develops gradually over years, although it could worsen quickly in some people.
The symptoms of osteoarthritis often begin slowly and can begin with only one knee.
🟧The most common symptom of knee OA is pain around the knee joint. Pain can be dull, sharp, constant, or intermittent (off and on).
Pain can vary from mild to agonising. When you have knee osteoarthritis you will always feel pain when using the joint
🟧Sometimes your knee will feel stiff for a short period of time, in the morning or after resting for a period.
🟧Swelling, locking, and giving way of the knee are common problematic symptoms. Your knee will swell in and around the joint, especially if you have been using the knee actively.
🟧You may feel as if the joint is loose or unstable and has a limited range of motion.
🟧Joint changes that can limit joint movement.
▶️What is the best treatment for osteoarthritis in the knee?
While there is no cure for osteoarthritis, the condition can be successfully self-managed in several cases. All treatment is usually driven by your symptoms
Treatment designed for knee osteoarthritis is aimed to relieve pain, improve function, and limit disabilities.
Different methods are used to treatment knee OA, usually through education, self-management, exercise, and weight reduction
There are multiple therapeutic options.
When you go to the doctor with knee pain and signs of osteoarthritis, your doctor will try multiple approaches until finding the most suitable therapy for you.
1️⃣Exercises
Exercises that help in strengthening your muscles around the knee will be encouraged by your physiotherapist after assessing your knee.
You will be given a plan which is an individual programme of rehabilitation exercises to help strengthen your knee and leg muscles.
It’s important to follow these exercises because they may help to keep your knee moving well.
Some of the moderate intensity exercises recommended for OA patients
swimming, walking, or cycling may diminish stress on the knee and improve the symptoms.
2️⃣A Transcutaneous electrical nerve stimulation (TENS) machine
Your physiotherapist may suggest you give a transcutaneous electrical nerve stimulation (TENS) machine a try.
It’s a device that sends mild electrical currents through your skin to stop or reduce the pain signals that come from your nerve endings.
3️⃣Knee brace
An assessment will be done to see if a knee brace and support would be useful for you to help keep your knee stable.
4️⃣Heat and cold treatments are effective pain relief methods. Heat treatments enhance circulation and soothe stiff joints and tired muscles, whereas cold treatments slow circulation, which reduces swelling, thus alleviating acute pain
5️⃣Make some adjustments to your lifestyle.
You can try to make changes at your home or workplace to ease any stress on your knee. These may include reducing weight if you are overweight, fitting bath aids, chair and bed raisers, grab rails and extra stair rails.
6️⃣Pain treatments
You may be given painkillers to help ease pain and stiffness and improve your quality of life. Creams and gels are usually the first painkillers that your doctor will suggest.
These contain non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or a pain killing substance called capsaicin. You put these creams and gels directly on your knee.
7️⃣Intra-articular injections into the knee.
Knee injections present a low risk of harm while providing potential pain reduction and improvement in physical function
8️⃣Surgery
If you have osteoarthritis that causes severe pain or has a significant impact on your daily life, your doctor may suggest you have surgery. This will usually only be after you’ve tried the other treatments, but they haven’t helped.
▶️How can I stop my osteoarthritis knee pain from getting worse?
While it is not possible to reverse and regrow cartilage, it is possible to limit the worsening of wear and tear by addressing what we call modifiable risk factors for arthritis.
♦️Weight loss:
Losing weight if you are obese or overweight will help to keep pressure off your knees, hence avoiding symptomatic arthritis.
♦️Exercise using low-impact activities (swimming, cycling) instead of high-impact activities (jogging, tennis)
♦️Changing your lifestyle:
It is important to adopt a more active and less sedentary lifestyle which allows you to maintain a healthy weight.
♦️ Control your blood sugars.
High blood sugar (glucose) levels speed the formation of certain molecules that make cartilage stiffer and more sensitive to mechanical stress.
Diabetes can also trigger systemic inflammation that leads to cartilage loss.
{Hollander 2019}
Of course, addressing these factors is not an “obligation.” It’s up to you to weigh the potential benefits against the constraints of adopting these behaviours or measures.
▶️What not to do with osteoarthritis?
Physical activity is essential for optimal health. But there is some exercise and physical activity in the prevention and management of OA.
Vigorous intensity exercises that are not suitable for patients with established OA
There is increasing good evidence through different studies that suggest that long-distance running might have a protective effect against joint degeneration then other intensive exercises.
▶️Points to keep in mind about osteoarthritis.
1️⃣Imaging and other examinations can show joint wear however some people may have joint wear without pain regardless of x-ray. Which does not provide additional treatment perceptions.
2️⃣You may have knee osteoarthritis and pain, but it does not necessarily worsen. The discomfort and pain can even decrease over time without treatment.
3️⃣There are many medical, surgical and natural treatments for knee osteoarthritis. But none of them can regenerate damaged cartilage. Most of them can relieve symptoms though it can be challenging to identify those that are truly effective.
4️⃣Regular physical exercises and weight loss are the treatments most likely to be effective according to medical studies.
We have come to the end of this article, hope we have educated ourselves about osteoarthritis, wishing you a quick recovery.🙋
Below are all the references I have relied on for this article.
📚SOURCES:
Kan HS, Chan PK, Chiu KY, Yan CH, Yeung SS, Ng YL, Shiu KW, Ho T. Non-surgical treatment of knee osteoarthritis. Hong Kong Med J. 2019 Apr;25(2):127-133. doi: 10.12809/hkmj187600. Epub 2019 Mar 28. PMID: 30919810.
Mobasheri A, Batt M. An update on the pathophysiology of osteoarthritis. Ann Phys Rehabil Med 2016;59:333-9.
Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J. 2017;21:16-183. doi: 10.7812/TPP/16-183. PMID: 29035179; PMCID: PMC5638628.
Hollander JM, Zeng L. The Emerging Role of Glucose Metabolism in Cartilage Development. Curr Osteoporosis Rep. 2019 Apr;17(2):59-69. doi: 10.1007/s11914-019-00506-0. PMID: 30830516; PMCID: PMC7716749.