Knee osteoarthritis

Knee osteoarthritis is a common health condition that causes pain and stiffness in your knee. You can get osteoarthritis in other joints too, but osteoarthritis of the knee joint is one of most common types of osteoarthritis.

About knee osteoarthritis

If you have knee osteoarthritis, the structures that make up your knee joint will have been damaged over time. You lose some of the cartilage that normally allows your bones to move smoothly against each other. The shape of your bones can change too, 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. These symptoms can also affect weight-bearing activities such as walking, climbing stairs, and squatting.

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

Causes of knee osteoarthritis

Doctors don’t know why some people develop osteoarthritis in their knee. But there are some things that can increase your risk. You’re more likely to develop osteoarthritis:

• as you get older
• if you’re a woman
• if you’re very overweight
• if you have worked in a manual job such as farming or have always exercised – if you’re a runner, for example

There’s also thought to be a genetic risk because knee osteoarthritis can run in families.

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

Symptoms of knee osteoarthritis

Knee osteoarthritis usually affects both of your knees. Symptoms of knee osteoarthritis include the following.

• You may have knee pain in and around your knee. The pain is worse when you’re active. You won’t usually feel pain in your knee when you’re in bed at night, unless you have severe osteoarthritis.
• Your knee may feel swollen.
• Your knee may be stiff for a while after you’ve been resting or when you first get up in the morning. If you have stiffness in your knee in the morning, it will have gone by 30 minutes after you get up.
• You may find that your knee sometimes gives way. Sometimes it may lock and 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 usually would.
• Your knee may creak or grind when you move it – this is called crepitus.

Diagnosis of knee osteoarthritis

A GP will ask about your symptoms and your medical history and will examine your knee. They’ll usually diagnose knee osteoarthritis from examining you and your description of your symptoms. But they may refer you to have an X-ray and a blood test to help make the diagnosis and to rule out other things.

Treatment for knee osteoarthritis

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

A GP may refer you to various health professionals, including a physiotherapist. If you have severe pain and stiffness, your GP may refer you to an orthopaedic surgeon (a doctor who specialises in bone surgery).

Devices and physiotherapy

A physiotherapist will assess your knee and plan an individual programme of rehabilitation exercises to help strengthen your knee and leg muscles. It’s important to follow these exercises because they may help to keep your knee working well.

Your physiotherapist may suggest you try a transcutaneous electrical nerve stimulation (TENS) machine. This is a device that sends mild electrical currents through your skin to stop or reduce the pain signals that come from your nerve endings. Some people with osteoarthritis find it useful, although it doesn’t work for everyone. You may be able to borrow a TENS machine from your physiotherapist to try before you decide about buying one.

A physiotherapist can also assess whether or not knee braces and supports would be useful for you. You can use these as well as other treatments to help keep your knee stable and provide support.

An occupational therapist is a health professional who can give practical assistance to help you manage everyday tasks. They can advise you on changes you can make to your car, home or workplace to ease any stress on your knee. These changes may include fitting bath aids, chair and bed raisers, grab rails and extra stair rails.

Medicines

Painkillers can help to ease pain and stiffness, and improve your quality of life. Your doctor may recommend them if you’re still in pain after trying self-help measures. Creams and gels are usually the first painkillers that your doctor will suggest. These contain non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or a painkilling substance called capsaicin. You put these creams and gels directly on your knee.

If these medicines don’t work, your GP may suggest NSAID tablets as well as or instead of creams and gels. Your doctor will usually prescribe another medicine to take alongside NSAID tablets to protect your stomach and reduce the risk of side-effects.

If you can’t take NSAID creams, gels or tablets or if they don’t work for you, there are other options. Your GP may suggest you take paracetamol or prescribe weak opioids for you. This will only be for a short time – ask your GP for more information.

Although many people take supplements that contain glucosamine or chondroitin to ease their symptoms, there’s limited evidence that these work. Ask your doctor if you’d like more advice about these.

Another option for treating the symptoms of knee osteoarthritis is to have steroid injections. Your doctor may inject a steroid medicine directly into your knee joint to help reduce swelling and pain.

Surgery

If you have osteoarthritis that causes severe pain or has a significant impact on your daily life, your doctor may suggest you have surgery. This will usually be done only if other knee osteoarthritis treatments haven’t helped.

There are different knee osteoarthritis operations, including the following.

• Knee arthroscopy. This isn’t usually recommended for most people with osteoarthritis because it doesn’t tend to have much benefit and there are some side-effects. But your surgeon may suggest you have this keyhole surgery to remove injured parts such as your meniscus (cartilage). This is more likely if your knee has been locking. Or your surgeon may use another technique called microfracture to help develop new cartilage.
• An osteotomy. In this procedure, your surgeon will cut and re-align your bone to avoid putting stress on the damaged part of your knee. This may be an option if you’re under 60.
• A partial or total knee replacement. Your surgeon will replace damaged parts of your knee joint with artificial parts.

Your GP will refer you to a surgeon to discuss your options. They’ll give you advice on what the best treatment is for you.