Knee Arthritis

Knee arthritis is a term usually referring to the degenerative condition ‘osteoarthritis’ which is characterised by stiffness, swelling, and pain. Knee arthritis can significantly impact daily activities and quality of life. Treatment typically involves a combination of physical therapy, lifestyle modifications, medication, and in some severe cases, surgical intervention. Physiotherapy plays a crucial role in managing knee arthritis by providing exercises and treatments tailored to enhance flexibility, reduce discomfort, and improve overall joint function.

This is not to be confused with Rheumatoid Arthritis which is an inflammatory disease requiring different therapy and medical management.

• Osteoarthritis (OA): The most common form of knee arthritis, OA is the degeneration of the articular cartilage, leading to pain and stiffness.
• Rheumatoid Arthritis (RA): An autoimmune disorder that can affect the knee joint, causing inflammation and potentially leading to joint deformity.
• Post-traumatic Arthritis: Following a knee injury such as a fracture or ligament tear, OA can be exacerbated in the affected joint.
• Gout: This form of arthritis occurs when uric acid crystals accumulate in the joint, causing inflammation and intense pain. Although more common in the big toe, it can affect the knee.
• Psoriatic Arthritis: Associated with the skin condition psoriasis, this type of arthritis can affect the knees along with other joints.
• Obesity: Obesity contributes to higher systemic inflammation which can contribute to worsening OA and RA symptoms. Being overweight also puts extra pressure on the knees, contributing to knee pain.

• Pain: Pain in the knee during or after movement is often the first noticeable symptom. It can be sharp and intense or dull and aching.
• Stiffness: The knee may feel stiff, especially after periods of inactivity, such as upon waking in the morning or after sitting for an extended time.
• Swelling: Inflammation in the joint can cause noticeable swelling, leading to further discomfort and limited range of motion.
• Decreased Mobility: Range of motion may be reduced, making it difficult to fully straighten or bend the knee.
• Crepitus: A grating or crackling sensation may be felt or even heard when moving the knee.
• Deformity: In more advanced cases, the knee joint may take on a deformed appearance, such as a bowing inward or outward.
• Muscle Weakness: Surrounding muscles may become weak and/or wasted, contributing to instability in the knee joint.
• Locking or giving way: The knee may lock up or give way unexpectedly, potentially causing falls or further injury.

• Age: As people grow older, it is thought that the cartilage in the knee becomes more susceptible to wear and tear, leading to osteoarthritis.
• Genetics: Some individuals may be genetically predisposed to arthritis, making them more likely to develop the condition.
• Obesity: Obesity contributes to increased background inflammation in some people and extra weight can put additional pressure on the knee joints.
• Injury: Previous injuries to the knee, such as fractures or ligament tears, can lead to post-traumatic arthritis later in life.
• Occupational Hazards: Jobs or activities that involve repetitive twisting can increase wear and tear on the knee joint.
• Metabolic Disorders: Conditions like hemochromatosis, where the body absorbs too much iron, can lead to arthritis.
• Autoimmune Disorders: Rheumatoid arthritis in the knee is caused by an autoimmune response that attacks the synovial membrane surrounding the joint.
• Joint Infections: In some cases, an infection within the joint can lead to the development of arthritis.
• Physical Inactivity: Lack of exercise can lead to weakening of the muscles that support the knee, leading to increased stress on the joint.

The best treatment for knee arthritis often involves a multifaceted approach tailored to the individual’s specific condition, symptoms, lifestyle, and overall health. There is no one-size-fits-all solution, but common treatment strategies may include:

• Physiotherapy: Physiotherapy plays a crucial role in managing knee arthritis. Therapists create individualised exercise programs to strengthen muscles around the knee, improve flexibility, and enhance joint function.
• Pain Management: Over-the-counter pain relievers like paracetamol or non-steroidal anti-inflammatories can help manage pain. In more severe cases, prescription medications or corticosteroid injections may be utilised.
• Weight Management: If obesity is a contributing factor, losing weight can reduce stress on the knee joint and alleviate symptoms.
• Lifestyle Modifications: Avoiding activities that exacerbate pain and implementing joint-friendly exercises can be beneficial. 
• Assistive Devices: Braces, orthotics, or walking aids such as canes may be recommended to provide support and stability.
• Joint Injections: In some cases, hyaluronic acid injections, which supplement the natural joint fluid, may be administered to improve lubrication and reduce pain.
• Surgical Options: If conservative treatments are ineffective and the condition is significantly impacting quality of life, surgical options such as arthroscopy, osteotomy, partial knee replacement, or total knee replacement may be considered.
• The optimal treatment approach will depend on various factors including the type of arthritis, severity of symptoms, patient’s age, activity level, and overall health. Collaborative care involving a team of healthcare professionals such as rheumatologists, orthopaedic surgeons, physiotherapists, and occupational therapists is often the most effective way to manage knee arthritis. Regular follow-up and ongoing communication between the patient and healthcare providers are crucial in ensuring the success of the treatment plan.

If someone suspects they have knee arthritis or is experiencing symptoms associated with the condition, they should seek professional medical help. The journey to diagnosis and treatment might involve seeing various healthcare providers, including:

• Physiotherapist: A Physiotherapist can design an individualised exercise and rehabilitation program to improve strength, flexibility, and function of the knee, often working closely with other healthcare providers. Quality, evidence informed Osteopaths, Chiropractors, Sports Therapists and Sports Rehabilitators who specialise in Musculoskeletal care work in a similar way to Physiotehrapists are also well placed to assess knee arthritis.
• General Practitioner (GP): A general practitioner or family doctor is often the first point of contact. They can conduct an initial evaluation, provide a preliminary diagnosis, and refer the patient to specialists if necessary.
• Orthopaedic Surgeon: An orthopaedic surgeon specialises in the musculoskeletal system, including the knees, and can provide a thorough evaluation, diagnosis, and treatment plan if surgical options are indicated.
• Rheumatologist: If there’s a suspicion of inflammatory arthritis like rheumatoid arthritis, a rheumatologist, who specialises in autoimmune and inflammatory diseases, may be involved.
• Dietitian or Nutritionist: If weight management is part of the treatment plan, working with a nutrition professional may be beneficial.
• Podiatrist: In some cases, foot mechanics might contribute to knee problems, and a podiatrist can assess and address these issues.

Yes, exercise is generally considered an essential component of managing knee arthritis. It can provide several benefits for individuals with this condition:

• Strengthens Muscles: Exercise helps strengthen the muscles around the knee, providing better support and stability to the joint. This can reduce strain and pressure on the affected area.
• Improves Flexibility: Regular exercise can increase the range of motion and flexibility in the knee, helping to alleviate stiffness that often accompanies arthritis.
• Reduces Pain: Exercise stimulates the production of endorphins, the body’s natural painkillers, helping to reduce pain.
• Supports Weight Management: If obesity is a contributing factor to knee arthritis, exercise, in conjunction with a healthy diet, can aid in weight loss, reducing the load on the knee joint.
• Enhances Overall Function: An appropriate exercise regimen can improve overall joint function, making daily activities easier and more comfortable.
• Promotes Joint Health: Low-impact exercises help maintain joint health by promoting blood flow and nourishing the joint cartilage.

Surgery for knee arthritis is generally considered a last resort and is usually not the first line of treatment. It may be recommended when other conservative treatments such as physical therapy, medication, weight management, and injections have failed to provide sufficient relief, and the arthritis is significantly impacting the patient’s quality of life.

Here’s when surgery might be considered:

• Severe Pain: When pain is constant or so severe that it interferes with daily activities, sleep, and overall well-being, and conservative treatments have not alleviated it.
• Significant Loss of Function: If the arthritis has progressed to the point where mobility is severely restricted, and basic activities such as walking or standing become highly challenging.
• Structural Damage: In cases where there is significant structural damage to the joint that can’t be addressed through non-surgical means.
• Failure of Other Treatments: When a comprehensive non-surgical approach, including Physiotherapy, medications, and lifestyle changes, has been tried without success.
• Patient’s Lifestyle and Goals: The decision may also be influenced by individual factors such as the patient’s age, activity level, occupational demands, and personal preferences.

Common surgical options for knee arthritis include:

• Arthroscopy: A minimally invasive procedure to clean the joint of damaged tissue, though this is typically more useful in earlier stages or for specific problems.
• Osteotomy: Realignment of the bones around the knee to take pressure off the damaged part of the joint.
• Partial Knee Replacement: Replacement of only the damaged part of the knee joint with a prosthesis.
• Total Knee Replacement: Removal of the entire damaged knee joint and replacement with an artificial joint.