Osteoarthritis of the knee is the most common form of arthritis and usually occurs most often in people aged 50 or above. The cartilage in the joint can gradually thin over time and this is a normal part of ageing, just as most of us grey hairs and wrinkles! But as the cartilage changes, it can become frayed and rough and so the protective space between the bones decreases. Osteoarthritis develops slowly and the pain it causes can worsen over time.
Do I Have Knee Osteoarthritis?
Well it’s likely you have osteoarthritis if you have a pain in your knee and usually at least three of the following:
Age over 50 years
Morning stiffness that lasts less than 30 minutes
Creaking or similar noises when moving your knee
Bony tenderness when touched
Bony enlargement
No warmth around knee on examination
Do I Need A Scan?
We may look to arrange a scan, such as an x-ray or MRI, to rule out other things going on with your knee. These scans can also give an idea of the degree of osteoarthritis in your knee.
However one review of the research looked at over 63 studies (Culvenor et al., 2019) and found that for people aged over 40, up to 43% of these had signs of osteoarthritis in their knees but had absolutely NO knee pain. They concluded that any treatment should not be driven by scans but should focus on improving symptoms and helping someone carry out daily activities they value and enjoy.
Can Physiotherapy Help?
Verhagen et al. (2019) reviewed over 42 studies involving nearly 7000 patients and found that exercise, supervised by physiotherapists, is an effective intervention in reducing pain for people with knee osteoarthritis and can be ‘accepted as true’. This is a bold statement in the the world of scientific research.
Exercise involves strengthening muscles around and above your knee and/or comfortable aerobic activity. Your physio will be able to start you off with activity suitable for you and over time (ideally over at least 12 weeks) progress the activity so you are getting the most out of the effort you’re putting in. There also appears to be a “sweet spot” of ideal activity and your physio can guide you on this as well.
What About An Injection?
You may be appropriate for an injection and for some people, they can help provide some relief from their symptoms. One study hot off the press in 2020 (Dayle et al.) studied patients who had confirmed osteoarthritis on x-ray and split them into two groups, either having physiotherapy or steroid injections.
After about 4 weeks the improvements were about level between the groups, but reviewing a year later, the group having physiotherapy continued to improve in relation to their symptoms of pain, stiffness and their ability to do every day tasks like managing stairs and walking. The injection group (average of 2.6 injections over the year) didn’t continue to improve and stayed about the same at the end of the year as they were after 4 weeks.
What Other Things Can I Do To Help?
If you haven’t tried pain medication already, get in touch with your GP or pharmacist to see if it’s appropriate for you. Some ice on your knee (frozen peas in a damp tea towel) for 10 to 15 minutes can give some pain relief too. Taking pressure off your joint by either losing a few pounds in weight, putting insoles into your shoes, or using a knee brace or stick can all potentially help - your physiotherapist can guide you on the most appropriate options
Do I Need A Knee Replacement?
Knee replacement surgery is usually necessary when the knee joint is worn or damaged and results in your mobility being reduced, you have pain even while resting and your pain is interfering with your quality of life.
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility. You'll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
One interesting study (Skou et al., 2015) looked at 100 patients who were eligible for a total knee replacement as confirmed by an experienced orthopaedic surgeon. Half went ahead with surgery and 12 weeks of non-surgical treatment (exercise, education, dietary advice, use of insoles and pain medication) while the other half just had the same non-surgical treatment.
After 12 months, the study found those in the surgery group had more pain relief and improved quality of life. However improvements were seen in both groups and only 26% of the non-surgery group went on to have a knee replacement in the following year. Even for patients progressing to surgery, taking part in supervised exercise before surgery has been associated with a faster postoperative recovery.
There are benefits and harms to both approaches and that’s why your preferences and values should be the foundation of any discussion about your treatment .
References
Heidari, B., 2011. Knee osteoarthritis diagnosis, treatment and associated factors of progression: part II. Caspian journal of internal medicine, 2(3), p.249.
Skou, S.T., Roos, E.M., Laursen, M.B., Rathleff, M.S., Arendt-Nielsen, L., Simonsen, O. and Rasmussen, S., 2015. A randomized, controlled trial of total knee replacement. New England Journal of Medicine, 373(17), pp.1597-1606.
Culvenor, A.G., Øiestad, B.E., Hart, H.F., Stefanik, J.J., Guermazi, A. and Crossley, K.M., 2019. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British journal of sports medicine, 53(20), pp.1268-1278.
Verhagen, A.P., Ferreira, M., Reijneveld-van de Vendel, E.A.E., Teirlinck, C.H., Runhaar, J., van Middelkoop, M., Hermsen, L., de Groot, I.B. and Bierma-Zeinstra, S.M.A., 2019. Do we need another trial on exercise in patients with knee osteoarthritis?: No new trials on exercise in knee OA. Osteoarthritis and cartilage, 27(9), pp.1266-1269.
Deyle, G.D., Allen, C.S., Allison, S.C., Gill, N.W., Hando, B.R., Petersen, E.J., Dusenberry, D.I. and Rhon, D.I., 2020. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. New England Journal of Medicine, 382(15), pp.1420-1429.
NHS 2019, Overview knee replacement, NHS, viewed 30 April 2020, <https: data-preserve-html-node="true"//www.nhs.uk/conditions/knee-replacement/>
Mayo Clinic 2020, Osteoarthritis. Mayo Clinic, viewed 30 April 2020 <https: data-preserve-html-node="true"//www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930>
Orthoinfo 2020, Arthritis of the Knee, Orthoinfo, viewed 30 April 2020 <https: data-preserve-html-node="true"//orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-knee>