Knee osteoarthritis


Expert reviewer Elisabeth Morgans, Bupa Physiotherapist
Next review due April 2021

Osteoarthritis is a disease that causes pain and stiffness in your joints. Your knee is one of the joints that’s most commonly affected.

If you have osteoarthritis in your knee, the different structures that make up your knee joint become damaged. You lose some of the cartilage that normally allows your bones to move against each other. The shape of your bones can change, and they may develop bony growths, called osteophytes (bone spurs). The membranes that line your knee joint can also become inflamed. These changes affect how well your knee works and can lead to symptoms such as pain and stiffness.

Osteoarthritis mainly affects people over 50, and you’re more likely to have it the older you are.

An image showing the different parts of the knee

Symptoms of knee osteoarthritis

If you have osteoarthritis of the knee, it usually affects both knees, although you may only notice symptoms in one.

  • You may have pain in and around your knee, which becomes worse when you’re active. You don’t usually feel pain in your knee when in bed at night, unless you have severe osteoarthritis.
  • Your knee may be stiff for a while after you’ve been resting or when you first get up in the morning.
  • You may find that your knee sometimes gives way, or locks (you can’t straighten it).
  • Because of the pain, stiffness and swelling, you might not be able to move your knee as much or as easily as you would usually.
  • Your knee may creak or grind when you move it – this is called crepitus.

Causes of knee osteoarthritis

It’s not clear exactly why some people develop osteoarthritis in their knee. However, there are certain risk factors that are known to increase your risk. You’re more likely to develop osteoarthritis as you get older, if you’re a woman and if you’re overweight. There’s also thought to be a genetic factor, as it can run in families.

Osteoarthritis seems to develop after an injury, or a series of minor injuries to your knee joint. It may be that a number of the factors above combine to make your knee more susceptible to injury, or to developing osteoarthritis afterwards.

Treatment for knee osteoarthritis

There’s no cure for osteoarthritis, but, there’s much you can do to manage the condition and control your symptoms. The main aim of treatment is reducing your pain and stiffness, which will improve the way your knees function and restore your quality of life.

Your GP may refer you to various other health professionals including a physiotherapist (a health professional who specialises in maintaining and improving movement and function). If you have severe pain and stiffness, your GP may discuss referring you to an orthopaedic surgeon (a doctor who specialises in bone surgery).

Self help

There are many things you can do to reduce the pain and stiffness in your knee, and to make day-to-day life easier. Some of the main ones are listed below.

  • Try to maintain a healthy weight for your height. This may mean losing weight if you’re overweight because it puts more stress on your joints and can make osteoarthritis worse.
  • Exercise regularly. Exercise can help to strengthen your joints and improve your general fitness. Your doctor or physiotherapist will talk to you about the best type of exercise to do.
  • Use a walking stick to ease any stress on your knee joint.
  • Make sure you’re wearing appropriate shoes – preferably with a soft, thick, cushioned, shock-absorbing sole.
  • Use a heat pad or an ice pack to help ease pain. Don’t put either of these directly onto your skin as they may cause burns – wrap them in a towel or dishcloth first.

Medicines

Painkillers can’t cure osteoarthritis but they can help to ease pain and stiffness, improving your quality of life. Your doctor may recommend them if you’re still in pain, after trying other measures. Creams and gels are usually the first painkillers that your doctor will suggest. These may contain non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or a painkilling substance called capsaicin. You can put these directly onto your knee. Your doctor may also suggest taking paracetamol if creams and gels aren’t enough. You’ll probably need to take paracetamol regularly, rather than just when you’re in pain.

If these medicines don’t work, your GP may suggest taking NSAID tablets as well as or instead of paracetamol, creams and gels. You shouldn’t take NSAID tablets for too long, due to the risk of side-effects. Your doctor will usually prescribe another medicine to take alongside NSAID tablets, to protect your stomach and reduce the risk of side-effects. Occasionally, if you have severe symptoms and other medicines aren’t helping, your GP may suggest a stronger type of painkiller called an opioid.

If you have a particularly painful, swollen knee joint, your GP may be able to offer you a steroid injection directly into the joint. The injection usually works within a few days and can last for weeks or months.

Although many people take supplements containing glucosamine or chondroitin to ease their symptoms, there is limited evidence for their use. Doctors don’t usually recommend taking them.

Devices and therapies

If you see a physiotherapist, they may suggest giving a TENS machine a try. TENS stands for Transcutaneous Electrical Nerve Stimulation. It’s an electronic device that sends pulses through your skin to stop or reduce the pain signals coming from your nerve endings. Some people with osteoarthritis find it useful, although it doesn’t work for everyone. You can often borrow a TENS machine from your physiotherapist to try, before you decide to buy one.

A physiotherapist can also assess whether knee braces and supports would be useful for you. These can be used in addition to other treatments to help keep your knee stable and provide support.

You might also see an occupational therapist. This is a health professional who can give practical assistance to help you manage with everyday tasks. Your occupational therapist can advise you on changes you can make to your car, home or workplace to ease any stress on your knee. These may include fitting bath aids, chair and bed raisers, grab rails and additional stair rails.

Surgery

If you have osteoarthritis that causes severe pain or which has a significant impact on your daily life, your doctor may suggest surgery. This will usually only be after you’ve tried other non-surgical treatments, and they haven’t helped.

There are a number of different types of surgery which can help for knee osteoarthritis. They include the following.

  • Knee arthroscopy. Your surgeon may recommend this to ‘wash out’ the joint, particularly if your knee has been locking. An arthroscopy involves inserting surgical tools through a small insertion in your knee. It generally isn’t recommended for most people with osteoarthritis as it doesn’t tend to have much benefit and there are some side-effects involved too.
  • An osteotomy. In this procedure, your surgeon cuts and refixes your bone to avoid putting stress on the damaged part of your knee.
  • A partial or total knee replacement, where your surgeon replaces parts of your joint with artificial parts.

Your GP will refer you to a surgeon, who will discuss your options with you and what is best in your particular circumstances.


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  • Reviewed by Pippa Coulter, Freelance Health Editor, April 2018
    Expert reviewer Elisabeth Morgans, Bupa Physiotherapist
    Next review due April 2021



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