Osteoarthritis of the knee

If your knee hurts when you move it and the pain does not subside after resting it, this may be an indication of osteoarthritis.

Osteoarthritis occurs when the articular cartilage becomes thinner and no longer protects the joint. If left untreated, osteoarthritis of the knee can have a significant impact on your quality of life.

Symptoms

The first signs of osteoarthritis in the knee only appear when bearing weight on it. Over time, these become more severe and more frequent. Eventually the patient will suffer from what is known as ‘rest pain’, where pain suddenly appears in the knee during sleep or periods of rest. There are other symptoms that occur as osteoarthritis of the knee progresses, such as stiffness in the joints or severe pain in the morning and evening.

The pain feels dull and is located on the inside or the outside of the knee, depending on which area of the knee is affected. 

As the condition progresses, the knee becomes stiffer and more sensitive to pressure. This leads to muscle weakness and gives the patient a sense of instability in the knee joint.

In certain cases, pain comes in spurts and is accompanied by swelling and burning pain.

Causes

Osteoarthritis occurs when the cartilage tissue in the knee becomes damaged. When the cartilage is damaged, the joint is unable to move smoothly, which causes pain.

Cartilage damage can arise as a result of an injury to the knee joint, such as a torn cruciate ligament or a broken bone near the knee. It can also be the result of anatomical misalignment of the knee, or having one leg longer than the other. In some cases, osteoarthritis of the knee occurs as a result of the individual carrying a lot of excess weight, which can also damage the cartilage.

Diagnosis

If pain in the knee joint is so severe that it impedes movement, it is important to have the cause of the pain investigated.

During the examination, the patient is asked a series of questions to find out when and how the pain presents itself.

This is followed by a comprehensive clinical examination to assess the restrictions to movement in more detail and to localise the pain.

An X-ray of the knee joint is then taken, as well as an X-ray of the full leg in a standing position to determine the load-bearing axis and the position of the knee joint.

If there are any uncertainties, an MRI (magnetic resonance imaging) may also be carried out. This allows the doctor to make a better assessment of the cartilage in and around the knee joint. Once all these tests have been carried out, the results are discussed with the patient and a decision is made as to how to proceed.

The cartilage damage is divided into different stages of osteoarthritis, according to the extent of the wear.

Superficial damage (small tears) of the articular cartilage can occur, but there are also types of damage that affect the entire cartilage. This damage exposes the surface of the bone and causes pain.

Cartilage damage is divided into four stages:

  • Stage 1: soft cartilage
  • Stage 2: rough surface with cracks
  • Stage 3: deep cracks in the cartilage that go to the bone
  • Stage 4: complete deterioration of cartilage with exposed bone

Treatments

Conservative therapies

If the osteoarthritis of the knee is still in the early stages, non-surgical treatment is possible.

Special shoe inserts and medication (for pain relief and cartilage strengthening) can be used to alleviate knee strain and to protect and repair the cartilage. In certain cases, it may be necessary for the patient to lose weight in order to relieve pressure on the knee.

Treatment options

  • Anti-inflammatory and pain-relieving medications
  • Medication and substances for strengthening the cartilage
  • Medical training therapy/physiotherapy
  • Injection of lubricants (hyaluronic acid or autologous blood) and anti-inflammatory drugs (cortisone) into the joint
  • Aids such as walking sticks, insoles, orthopaedic shoes
  • Lifestyle changes relating to exercise, obesity, nutrition, etc.
  • These measures can reduce osteoarthritis pain and slow down the progression of cartilage wear. Unfortunately, the osteoarthritis itself cannot be stopped or cured.

Hyaluronic acid injections

Hyaluronic acid can reduce friction in the surface of the cartilage in the affected knee. The preparation of hyaluronic acid used for this treatment is a synthetically manufactured lubricant, which is injected directly into the affected joint. After the injection, the patient is able to move the joint more easily. The extra ‘lubrication’ means that the joint is less irritated, which prevents inflammation and reduces osteoarthritis pain.

The outcome of the lubricant injections depends on the stage of the osteoarthritis. Most patients not only report a reduction in pain, but also an improvement in their overall quality of life. The treatment comprises three injections, the effects of which last for a certain period of time. It can be repeated at any time.

Surgical treatment

If conservative treatments do not have the desired outcome, knee surgery may be required to treat the osteoarthritis.

The use of a knee prosthesis is not always necessary; adjusting or stabilising the knee joint can also provide the patient with relief.

When adjusting the knee joint, the axis of the legs is corrected, as osteoarthritis of the knee can be a result of knock knees or bow legs. The correction normalises the stability in the knee, which slows down the wear of the joint.

Where the osteoarthritis is caused by injured or unstable ligaments, joint stabilisation is carried out. During this procedure, the ligaments are operated on in order to stabilise the knee.

If conservative therapies, joint adjustment or joint stabilisation are not able to be used or do not produce the desired outcome, the only option is to use an artificial knee joint. This operation takes about an hour and the patient is able to leave the clinic after just a few days.

Aftercare

Depending on the procedure, aftercare may be provided on an outpatient or inpatient basis. The aim of aftercare is to stabilise the new joint and to teach the patient a series of exercises. It should also give the patient the chance to learn about things to consider when they return to everyday life. Rehabilitation takes three weeks and consists of movement therapy, gait training and physiotherapy.

FAQs

Can osteoarthritis of the knee be completely cured?

Osteoarthritis of the knee is a chronic disease and cannot be cured. All the treatment methods are designed to relieve pain and to enable those affected to live as normal a life as possible.

What helps against osteoarthritis of the knee?

Joint pain can be alleviated by strengthening the muscles. There are plenty of exercises for this that are easy to do. The important thing here is regularity – if you want to improve joint function, then regular exercise is a must.

How long does it take before you can move normally again?

The muscles recover within six weeks of the operation, at which point the joint has adequate support. In normal cases, it is possible to return to work and resume light exercise after three months.

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