Knee Arthritis

Arthritis is one of the most common conditions to affect the knee.

This is typically osteoarthritis, although other forms such as rheumatoid arthritis are also prevalent.

This is characterised by pain and stiffness due to cartilage degrading away, leaving the bone exposed underneath. Cartilage is soft, well lubricated and has no nerve supply. A normal joint is supple and due to the lack of nerve supply, weight-bearing is painless. As that cartilage degrades, the exposed bone underneath bears the weight and the exposed nerves cause pain. It is like rubbing your knuckles together with your entire body-weight.

Stiffness usually results in an inability to straighten the knee completely, or bend it deeply. There are usually mechanical symptoms with arthritis such as clicking and catching in certain movements.

Importantly, the menisci are a form of cartilage in your knee, and are always torn and degraded with the arthritic process. Often the first sign of arthritis is a meniscus tear diagnosed on an MRI, which is distinctly different from a normal meniscal tear amenable to repair.

Knee arthritis is unique in that it can selectively affect only part of your joint, such as the medial half or under the patella.

Arthritic knee pain tends to manifest deep in the knee, or sharply localised to part of the knee, and occasionally down the shin. Spinal conditions like sciatica and hip arthritis can masquerade as knee pain, so it is important to be assessed properly before considering treatment.

Knee arthritis in its mild forms should be managed first with the following measures:

• Weight management
• Physical therapy
• Pain management with non-opiate medication such as non-steroidal anti-inflammatory medication
• Corticosteroid Injections

In its more severe form, knee arthritis has a myriad of surgical interventions. This is in part because total knee replacement is not as rewarding or successful as hip replacements, particularly in certain disease states or patient populations. Severe knee arthritis in older patients is treated successfully with total knee replacement. Those that have arthritis localised to certain parts of the knee may benefit equally from a partial knee replacement, or a realignment osteotomy to offload the area of the knee causing pain, particularly in the younger patient below fifty.

Due in part to the lower satisfaction and survivorship of knee replacement in certain populations, there is a lot of business in alternative interventions for knee arthritis. This regards radiofrequency ablation, biological treatments, augmenting injections, cartilage preservation surgery and stem cell ideas.

Coupled with advancements in pharmacological therapy, this remains an important area for us to investigate to improve outcomes. However, the success of many of these interventions is extremely tenable compared to the expectations of those delivering or receiving them. Many of these alternative treatments simply do not work, and benefit the provider financially while not benefiting the recipient at all.

There are select situations in which cartilage preservation surgery, meniscal preservation or transplant surgery, osteotomy and radiofrequency ablation may help people with knee arthritis.