Osteoarthritis of the knee is often referred to as “wear and tear” arthritis and affects the cartilage that covers the ends of the bones and would normally allow smooth pain free movement. Osteoarthritis is thought to affect more than 8.5 million people living in the UK and is the most common reason for joint replacement surgery.
The treatment of knee arthritis is multi-modal and includes :
Simple pain relief and anti-inflammatories for mild to moderate arthritis can often get people through the early stages and prolong the time before resorting to more invasive treatments.
Weight loss can significantly improve the symptoms for patients with BMI >25. Interestingly 7 times body weight is transmitted through the kneecap joint when performing a squat or going up stairs, whilst 3 times bodyweight is transmitted through the main knee joint (tibiofemoral joint) during normal walking. This results in a dramatic decrease in forces passing through the joint with relatively modest weight loss and with this, symptoms of pain and stiffness can improve.
Topical Capsaicin cream is currently recommended in NICE guidance for knee arthritis and can sometimes be effective enough to avoid resorting to surgery. Capsaicin is a chemical derived from chilli’s and causes a burning sensation that helps to modulate pain signals coming from knee arthritis.
Steroid injections to the knee may provide relief of symptoms. This may be transient, but can be performed on multiple occasions and may be all that is necessary to maintain acceptable symptom control.
Knee Braces can sometimes be used to “offload” a worn area of the knee and protect it from the forces of bodyweight if only one part of the knee has arthritis (usually the inside or medial compartment of the knee). In selected cases these can sometimes offer a number of years relief prior to resorting to more invasive treatments such as surgery.
Surgery for early knee arthritis depends on the pattern on wear within the knee and the symptoms that the patient is experiencing. Where patients are experiencing frequent episodes of the knee collapsing, giving way or locking in certain positions there may be some merit in Knee Arthroscopy (key hole surgery) to remove any loose fragments of bone or cartilage, or tidy up a torn meniscus that is getting stuck in the knee. In general knee arthroscopy is no longer recommended for knees with established arthritis as often the symptoms respond only transiently to surgery.
In early knee arthritis it may be possible to re-align the knee to protect the worn out area of the joint and encourage weight bearing through the healthy part of the knee. This is called osteotomy and is most commonly performed on the tibia (High Tibial Osteotomy). This form of surgery will not be appropriate for all patients as it depends on the pattern of arthritis within the knee.