Osteoarthritis of the Knee - Orthopaedic Services
by David F. Martin, MD
Professor of Orthopaedic Surgery
Wake Forest Baptist Health
The knee joint is the largest joint in our body. When healthy, its bones and network of ligaments and muscles work together in harmony, making an active lifestyle comfortable. Knee pain and stiffness as a result of osteoarthritis (OA) can interfere with this active lifestyle and progress to make countless activities of daily living difficult.
What is osteoarthritis of the knee?
Osteoarthritis of the knee is a disease process that involves all of the structures that comprise the knee. It begins with the breakdown of the smooth connective tissue, called articular cartilage, which covers the ends of joint bones, acting as a shock absorber, preventing the bones from grinding together. It progresses to the thinning and loss of cartilage, the formation of bone spurs and the development of inflammation, stiffness and pain in the joint. In advanced cases, the bones rub directly against each other and wear away, making normal activity very painful.
What causes osteoarthritis of the knee?
Many factors increase your risk of developing primary OA, including age, gender, inherited characteristics that affect the shape and stability of your joints, obesity, and an inactive lifestyle.
Osteoarthritis (OA) of the knee may result from an injury, which disturbs the joint's alignment and causes the smooth cartilage to become grooved and rough. This is known as traumatic OA.
OA is associated with aging, and we see it increasingly in patients in their 50s and 60s.
Can playing sports or exercising increase my risk of developing osteoarthritis?
Yes and no. You can't control your genetics or your age, but staying in shape is one way you can protect yourself from developing arthritis. I encourage patients to maintain a healthy weight, keep their muscles in shape and their bodies flexible. The specific sport or exercise is not as important as staying with an activity. Orthopaedic Services patients who have OA in their knees may find that pounding activities such as running may make their symptoms worse, but long-term studies show that the benefits of appropriate exercise far outweigh the risks of further injury.
How about supplements?
Some orthopaedic services patients experience positive results from alternative therapies such as glucosamine and/or chondroitin sulfate. Research studies, however, have not shown any demonstrable benefit from these supplements.
What are the symptoms of Osteoarthritis?
Symptoms include pain, swelling, and loss of motion.Stiffness after inactivity is one of the first symptoms you may notice. The cartilage in our joints is like a sponge. It needs lubrication to expand and cushion our joints. That stiffness will gradually disappear if you move and get the fluid in your joints circulating.
What can I do at home to treat my Osteoarthritis?
Over-the-counter anti-inflammatories may be helpful. You can also use moist heat before exercising and ice after exercise to relieve discomfort.
Try mild exercise and gradually increase it each day. If your current exercise is causing symptoms, try switching to a lower impact activity such as walking on a treadmill or using an elliptical machine.
When should I go to the doctor?
If you find that pain is causing you to avoid physical activity and that the steps above are not controlling your discomfort, it's time to call your doctor.
How is Osteoarthritis treated?
There's no known cure for osteoarthritis, but treatments can help reduce your pain and maintain joint movement. A medical history, physical examination and X-rays help determine the best treatment plan for each patient.
Treatment options include:
- Losing weight, increasing exercise and physical therapy. A physical therapist can design an exercise regimen that will strengthen the muscles around your joint, increase your range of motion and reduce your pain.
- Prescription drug therapy, including nonsteroidal anti-inflammatories as well as stronger drugs such as opiates.
- Injections of lubricating medications directly into the joint, known as viscosupplementation, offer pain relief by adding cushioning material similar to a component found in your joint fluid.
- Corticosteroid injections to relieve inflammation and joint pain. The number of cortisone shots you can receive is limited, because the medication can cause further damage.
- Arthroscopy, which is a minimally invasive procedure that enables a surgeon to trim damaged cartilage and remove loose debris from the joint through small incisions. Arthroscopy can be helpful if joint pain results from a tear in the cartilage or meniscus, or if bits of debris are causing problems bending or straightening the joint.
- Partial joint replacement for patients with limited OA of the knee, a less invasive partial knee resurfacing may be an appropriate solution.
- The most common surgery for severe OA is total knee replacement in which the natural joint surfaces are removed and replaced with smooth artificial implants.
- Experimental investigations into the use of cellular material such as human growth factor and stem cell therapy may offer some promising options for OA patients.
Learn more about osteoarthritis in our Health Encyclopedia.
Request an appointment online to address your osteoarthritis or call 336-716-WAKE (toll-free 888-716-WAKE) or learn more about Orthopaedics: Knees & Hips.