Osteoarthritis is the most common form of arthritis; it is the
wearing down of articular cartilage down to the bone.There are also
a number of forms of arthritis where excessive inflammation of the
joint occurs first (with swelling and pain), followed by wearing
away of the gristle layer (rheumatoid arthritis and psoriatic arthritis
are two examples).
Osteoarthritis cannot be prevented totally but some lifestyles
changes, avoiding trauma and injury, losing weight if necessary
reduce stress and weight on joints and will help preserve knee function.
Healthy levels of exercise can help maintain muscle strength+++.
Causes : age of course but also injuries and obesity. Knock knee
will give outer knee wear and bow leg will give inner knee wear
Symptoms : Pain, stiffness, swelling and often deformity are the
main symptoms. The join pain may remain constant or recur, along
with tenderness. Patient may feel as if there is no support within
the leg. Stifness may be experienced when patient wake up in the
morning ; it may last for up to an hour. Swelling may be associated
to redness and/or warmth in the knee.
Deformity : a medial joint arthritis will lead to a bow-legged
deformity, an lateral joint arthritis to a knock-kneed deformity.
Diagnose : Weight-bearing X-rays will show bone spurs and a reduced
gap between the bones because of the worn cartilage. Deformity will
be assessed by long X-rays of both legs.
The treatment is first a medical treatment.
- Cold therapy relieve pain and reduces swelling .
- Exercises and in particular stretches are important to help
maintain movement in an arthritic joint and delay the progression
of the disease.
- Acetaminophen may relieve pain.
- Intermittent Anti-inflammatory medication (non steroidal)
- reduce pain and inflammation .
- They may affect renal or gastrointestinal function (to
be discuss with your physician).
- Corticosteroids : may be given as injection into the knee. They
must not be repeated too many times (to be discussed with your
- Your physician may prescribe supplements of glucosamine and
chondroitin sulfate (not regulated by US FDA). The scientific
studies found that these supplements may help relieve pain but
overall may be no more effective than a placebo.
- is a way of adding fluid to lubricate the joint and make
it easier to move.
- These substances are a concentrate of hyaluronic acid, a
molecule found in the joints.
- Several preparations of hyaluronic acid are now commercially
- One to three weekly injection in the cavity of the joint
are needed to reduce the pain but the pain relief is not immediate
and not permanent.
- Many patients (but not all) experience improvement for months
and find the process worthwhile.
After these treatments, if your knee keeps being painful your physician
may refer you to an orthopaedic surgeon for a thorough evaluation
to determine if you could benefit from a knee
replacement. Alternatives include a unicompartimental
knee replacement or an osteotomy.
Reasons that you may benefit from knee replacement despite a good
medical treatment commonly include :
- Severe knee pain that limits your everyday activities (walking,
climbing stairs, and getting in or out of chairs.
- Knee pain while resting, either day or night.
- Knee deformity
- Knee stiffness : inability to bend or straighten your knee.
Docteur Jean Etienne Perraudin;
last reviewed 1 09 2012.