Arthritis of the knee is a common problem. The term arthritis literally means inflammation of a joint. Most often when using the term we are referring to some wearing away of the joint surface. This can lead to inflammation, pain, and a sense that the knee is not working properly.

Osteoarthritis is by far the most common form of arthritis. Causes of osteoarthritis can vary, and there are often multiple causes. The wear and tear of arthritis often is a part of the aging process. Past injuries, excessive weight, family history, and abnormal alignment of the leg all can be factors in the development of arthritis.

The primary symptom of arthritis is pain. It can be dull and achy or sharp and quick. The pain often intensifies after long periods of standing or walking, but patients also note stiffness when inactive for long periods. Some people notice that weather changes can affect their symptoms. Swelling can be present, as can clicking or popping.

The diagnosis of arthritis is made by careful review of the symptoms and performing a physical exam. It is usually confirmed with X-rays, which can show narrowing between the femur (thigh bone) and tibia (shin bone). This represents the wearing down of the cartilage that serves as a smooth gliding surface on the end of each bone. When it is worn completely, the X-ray will show the bones to be touching. This is generally referred to as bone-on-bone arthritis. X-rays also can find spurs on the margins of bones, another common sign of arthritis. Magnetic resonance imaging (MRI) can help diagnose other difficulties but is usually not necessary if arthritis is felt to be the main problem.

Arthritis of the knee is a progressive problem. It tends to worsen as the years pass. Sometimes it progresses slowly, while other times it does so quickly. The treatment of arthritis depends on how severe it is and how much it compromises a patient's lifestyle.

In its earliest stages, treatment for arthritis may involve simply modifying the actives that aggravate the problem. It also is common to take over-the-counter anti-inflammatory medications or acetaminophen. These measures can be employed as long as they provide sufficient relief.

If a patient is overweight, weight loss can help at any stage of arthritis. While arthritic knees do not handle excessive exercise very well, they can usually do well with moderate exercise. Knee-friendly exercises include walking, using an exercise bike or an elliptical walker, and water exercises.

As the arthritis progresses, these treatments might not provide as much relief. If a patient notices a decrease in their ability to perform normal activities after having tried the above treatment options, physicians often consider cortisone injections and hyaluronic acid injections. Cortisone works as a strong anti-inflammatory when injected directly into the joint, sometimes providing months of relief. Hyaluronic acid injections are given to lubricate the joint.

If the symptoms of arthritis become severe and dramatically interfere with the patient's ability to perform day-to-day activities, it is then time to consider surgery. The most common surgical procedure for arthritis is joint replacement. Arthroscopy may be considered if there are other problems besides the arthritis that need to be addressed, but it will rarely offer long-term benefits for arthritis sufferers, particularly if the arthritis is severe.

Joint replacement has been very successful in treating arthritis of the knee. It involves removing the worn surfaces of the joint and replacing them with artificial surfaces. Patients sometimes think large amounts of bone are removed, but typically it is a half inch or less. Most knee replacements are total knee replacements in which the "total" joint is resurfaced. There also are partial joint replacements, or "unicompartmental" replacements, some patients who have arthritis in only one area of the knee.

Implant manufacturers are starting to market directly to patients. It is important to recognize marketing for what it is. Patients should always discuss their individual situations with their physicians.

Although surgery has inherent risks, the risks for complications in knee replacements are relatively low. After a short hospital stay, patients generally continue recovery with home therapy services or with a short stay in a rehabilitation center. Most patients who undergo knee replacement obtain great pain relief and are able to resume activities previously hampered or prevented by arthritis.

If you have arthritis of the knee, talk to your physician about your options. If you need a physician, contact my office.
© 2016 Robert Steensen, MD