Osteoarthritis Knee

Arthritis is a painful, degenerative, inflammatory condition of the joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis is very common, and approximately 46 % of people experience it during their lifetime. Osteoarthritis of the knee is a “wear and tear” type of arthritis where the cartilage of your knee joints breaks down, allowing the bones to rub against each other. The knee joint becomes very stiff and swollen, leading to a lot of pain.

Osteoarthritis of the knee can be classified into two types - primary and secondary osteoarthritis.

1. Primary osteoarthritis occurs due to degeneration of articular cartilage without any clear underlying cause.
2. Secondary osteoarthritis occurs as a result of either abnormal articular cartilage or due excess force across the joint due to an injury.

Osteoarthritis (OA) of the knee can be a painful condition not just while moving, but also when you are sitting. You should watch out for some symptoms in the knees that might indicate OA: 

1. Puffiness and swelling
2. Stiffness and pain when you wake up in the morning, or after prolonged sitting (resting) or lying
3. A grinding or cracking noise from the joints when you move
4. Wobbly feeling in the knee as if they may bend and give away 
5. Locked up or feeling of being stuck
6. Pain after vigorous activity
7. Pain that increases with the changes in the weather

Osteoarthritis develops when the cartilage of your knee breaks down. There are two types of cartilage in your knee joint that help it move freely namely the articular cartilage (the smooth, slippery flexible bone-like structure that provides lubrication and cushioning in the knee joint) and the meniscus (shock-absorbers in between your shin bone and thigh bone).

Some of the causes of this wear and tear of cartilage are:

1. Knee injury 
2. Extensive use of knee joints like by playing sports or while working
3. Crooked bones or joints like in the case of knocked knees (knees bend inwards when a person is in a standing position)
4. Being overweight, if your body mass index (BMI) is over 30
5. Inheritance of osteoarthritis due to family history.

Some of the factors that increase your chances of developing osteoarthritis are:

1. If you are a woman 
2. Age over 40 years
3. Knee injuries 
4. Family history of osteoarthritis
5. Weakness of muscles or imbalance
6. Being overweight or obese
7. Underlying health issues, such as metabolic syndrome

Your doctor will perform a series of evaluations that include: 

1. Patient History: The doctor will enquire about 
   1. Your medical history
   2. Your family history of arthritis or osteoarthritis
2. Clinical Examination: After a detailed medical history, the doctor will perform the following physical examinations:
   1. Checking your range of motion, which will evaluate your ability to move your knee
   2. Evaluating if the joint is stable, and inquiring if you have a feeling of your knee being “loose”
   3. Observing the way you walk (gait analysis)
   4. Looking for the signs of injury on your knee
   5. Looking for redness or soreness of your knee
3. Investigations: Finally, your doctor may prescribe diagnostic tests to confirm the diagnosis and the extent of wear and tear of the cartilage. Some of the tests are:
   1. Blood tests
   2. X-ray
   3. Joint aspiration is also known as arthrocentesis (removing the fluid from the joint to relieve pain and analyse in a laboratory)
   4. Magnetic resonance imaging (MRI)
4. Based on X-ray imaging: Your doctor will classify your grade of osteoarthritis of knee using a Kellgren and Lawrence (KL) classification system:
   1. Grade I - unsure narrowing of the joint space with likely formation of osteophytes (bony bumps that grow on bones)
   2. Grade II - possible narrowing of joint space with marked formation of osteophytes
   3. Grade III - definite narrowing of joint space with some hardening of bones, moderate formation of osteophyte and possible deformation of bony ends
   4. Grade IV - severe narrowing of joint space combined with a large formation of osteophyte and extensive hardening of bones and marked deformity of bony ends

Though there is no cure for arthritis, many different treatments may help soothe the symptoms and help you lead a normal life. Some of them are as follows:

Non-surgical treatments: 

Your doctor may advise you a set of treatments to halt the progress of osteoarthritis like:

1. Lifestyle changes: Your doctor may advise you to practise the following: 
   1. Maintaining a healthy weight
   2. Reducing high impact activities like running or tennis 
   3. Including more low-impact activities like swimming or cycling
   4. Avoiding activities that put more strain on your knees, like climbing stairs
2. Medications: There are many different medications available to relieve the pain. Your doctor will evaluate your condition closely and prescribe medicines that may alleviate your difficulty. Your doctor may prescribe:
   1. Over-the-counter non-steroid pain medications, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
   2. Anti-inflammatory medications
   3. Injections to enhance the quality of joint fluids
   4. Glucosamine and chondroitin sulphate as dietary supplements
3. Home remedies: There are a variety of home remedies like: 
   1. Applying ice or heat pack
   2. Pain-relieving ointments or creams to massage over the joint
   3. Elastic bandages for knee support
4. Physical Therapy: Your doctor may evaluate the severity of your condition and choose a set of exercises for you to improve your knee’s flexibility. A physical therapist or your doctor will help you develop an exercise plan customised for your condition
5. Assistive devices: Your doctor may advise you to use specific assistive devices to support you while moving like:
   1. Cane (walking stick)
   2. Wearing a pair of shock-absorbing shoes
   3. Knee braces for stability and support

Surgical treatments:

When none of the above listed non-surgical treatments work and your pain due to osteoarthritis causes disability, your doctor may resort to surgical options. Depending on the severity of your condition, your doctor will discuss all the pros and cons of the surgery. Some of the options available for a person suffering from osteoarthritis are:

1. Knee osteotomy is chosen when you are at the early stages of osteoarthritis and have one side of the knee damaged. In this procedure, your doctor will cut either your shin bone (tibia) or thigh bone (femur) and reshape your knee to relieve the pressure on the joint.
2. Partial or total knee replacement is another procedure chosen when your knee is damaged completely. In this procedure, your doctor will remove the damaged cartilage and bones completely and replace them with a new plastic or metal joint (implant) to restore the function of your knee.
3. Cartilage grafting is a procedure mainly used for younger patients where normal, healthy cartilage is taken from another part of your body or from a tissue bank to fill a hole in the existing articular cartilage.
4. Arthroscopy is a procedure where your doctor will use small cuts and a thin instrument attached to a camera to see and diagnose and treat joint problems involving torn meniscus.

Osteoarthritis of the knee is a progressive disease that worsens over time. If left untreated, the knee pain, stiffness and swelling may eventually lead to mobility restriction and disability.[3] It can change the shape of your knee joint and make you feel wobbly and unstable.