Knee Arthritis

The knee is the most complex joint in your body and uses a delicately balanced system of bones, ligaments, and other structures to allow you to run, jump, perform cutting movements, and other advanced activities. The knee is made up of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). The two joints of the knee are the tibiofemoral joint (between the femur and tibia bones, this is the main knee joint) and the patellofemoral joint (between the kneecap and the trochlea, a groove on the front of the femur). The fibula bone is a thin bone on the outside of your lower leg that does not contribute to the knee joint, but is important to ankle stability.  

Cartilage is present in all joints, where it’s called articular cartilage, and covers both ends of the bones in the joint. Cartilage allows the bones to glide easily as the joint is moved. Injury to cartilage can be due to an acute process or a chronic, long-standing process. Acute cartilage injury is associated with other injuries to the knee (meniscus, ACL, etc.), while chronic injury is due to arthritis, wear and tear of the knee, or history of infection of the knee.

The most common type of arthritis is osteoarthritis and can occur in any of the three compartments of the knee:

• Medial compartment: The compartment on the inside of the knee

• Lateral compartment: The compartment on the outside of the knee

• Patellofemoral compartment: The compartment between the kneecap and the trochlea (the groove for the kneecap)

Patients can have arthritis of one or multiple of the knee compartments.

Symptoms & Diagnosis

Patients with knee arthritis with have knee pain with activity, but may experience dull, achy pain at rest. The knee will be painful with specific activities, such as walking, climbing stairs, or after resting for a period of time. Patients may also notice knee swelling or feel crepitus, or cracking, with bending or extending the knee.

Knee arthritis is diagnosed using physical examination and imaging studies to confirm the diagnosis. The physical examination is used to identify areas of pain, changes in range of motion, or knee swelling.. X-rays help evaluate for the presence of arthritis by looking for narrowing of the knee joint space or bone spurs. MRI (magnetic resonance imaging) is usually not required, but may be used in early arthritis that is not detected on X-rays yet.

Treatment

Patients with early or moderate knee arthritis can be treated with non-surgical measures. These include:

• Rest, activity modification: Patients will see an improvement in symptoms by avoiding activities that worsen knee inflammation, such as squatting, lunging, running, or climbing stairs.

• Low-impact activities: Activities such as biking, rowing, swimming, or using an elliptical can help you remain active, while decreasing the load on the knee

• Non-steroidal anti-inflammatory medications (NSAIDs): These medications can help decrease inflammation in the knee. These medications should be taken with food if they are taken for long periods of time. If you experience any stomach upset, you should stop taking these medications and contact your primary care doctors.

• Use of heat/ice: Using heat before activity and using ice after activity can be beneficial to decrease inflammation

• Injections:

  • Steroid injections can help decrease inflammation in the knee and can be given every 3-4 months. Steroid injections can be beneficial, but will decrease in effectiveness as the arthritis worsens. Platelet-rich plasma injections have been found to improve symptoms and can be considered if symptoms continue

  • Viscosupplementation injections provide a lubricant to the knee joint and are made by several different manufacturers. These injections are typically given as a series of 3 injections, 1 per week. They are typically covered by insurance, but need to be ordered and we will schedule a visit to administer them once they arrive.

PRP injections use a sample of your own blood that is spun down to isolate the plasma layer. This injection has recently been shown to improve symptoms in patients with knee arthritis. We do not yet have a way to reverse the damage in a knee with arthritis, but PRP can provide symptom relief.

Patients with severe knee arthritis or those who have tried non-surgical treatment for an extended period of time (6-12 months) may be a candidate for a knee replacement surgery. Our office would be happy to refer you to trusted colleague to continue your care.