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Knee arthritis

In the early stages of knee arthritis, the two most common symptoms are knee pain and stiffness. We look at available treatments.

The knee  is one of the most complex joints in the body. It is commonly referred to as a hinge joint due to the way it bends. It is made up of several components:      

  • The lower end of the thigh bone (femur)
  • The upper end of the shinbone (tibia)
  • The kneecap (patella)

The ends of the bones in the knee joint are covered with a smooth tissue called articular cartilage, which helps to cushion the bones during movement.

Within the joint, two crescent-shaped pieces of cartilage, called the lateral meniscus and medial meniscus, sit between the thigh bone and shinbone. This rubbery material acts as a shock absorber as well as keeping the joint stable.

Finally, a thin lining, called the synovial membrane, surrounds the joint. This helps to lubricate the cartilage and reduce friction.

Arthritis is a condition that causes pain and inflammation in the joints of the body. It affects millions of people in the UK, and while arthritis becomes more likely as we age it can occur in people of all ages, including children. There are several different types of arthritis, however, the most common types of arthritis in the knee are:

Osteoarthritis (OA)

This is the most common type of arthritis in the UK. Osteoarthritis of the knee causes a breakdown of the articular cartilage on the surface of the bones.

Rheumatoid arthritis (RA):

The immune system itself attacks the joints in the body. This causes swelling, damage and sometimes a noticeable change in the shape of the joint itself. In the knee, rheumatoid arthritis affected joints may appear deformed and become harder to bend.

While osteoarthritis is the most common cause of knee pain, treatments and medical support are available for other types of arthritis as well. There is currently no known cure for arthritis, but a range of treatments can help reduce symptoms and manage pain.

In a healthy knee joint, the articular cartilage that covers the ends of the bones in the kneecap is smooth. Osteoarthritis causes this articular cartilage to weaken and become thin. Over time, it may become so thin that it cannot prevent friction between the bones from occurring.

Normally the body is very good at repairing the damage. However, osteoarthritis causes the articular cartilage to break down much more quickly than the body can repair it. In addition, the healing process itself can sometimes create new bony growths called osteophytes. These osteophytes can cause additional pain and stiffness in the knee.

In more severe cases of osteoarthritis, the protective layer of articular cartilage in the knee will have worn away completely. This means that the bones start to rub directly on one another as the knee joint moves. The friction causes can cause severe, chronic pain as well as extreme stiffness in the knee.

The other common type of arthritis to affect the knee is rheumatoid arthritis. This is an autoimmune condition, which means that the immune system attacks healthy tissue. It is still not known what triggers this.

The immune system makes antibodies to attack bacteria and viruses. This helps the body to fight infections. If you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.

When the immune system attacks the knee, it causes the thin layer of cells (synovium) that cover the knee joint to become inflamed. This causes chemicals to be released that damage nearby bones, cartilage, tendons and ligaments.

If rheumatoid arthritis is left untreated, it can cause the joint to become deformed and harder to bend. Eventually, it may destroy the knee joint completely.

In the early stages of arthritis, the two most common symptoms are pain and stiffness in the knee. As the disease develops, these symptoms gradually worsen, affecting everyday activities and exercise. The joint pain is usually felt over the whole of the knee rather than confined to one specific area.

As the disease develops, more of the articular cartilage breaks down. Ultimately, this will allow the bones to rub against one another. At this point, the pain in the knee will become very severe. The pain may be so intense at times that it will prevent you from sleeping at night.

Eventually, as the disease progresses, the bones in the knee can be forced out of their normal position. This can lead to a deformity of the knee. However, these changes will happen very slowly so you may not notice the change in the knee until at an advanced stage.

Other symptoms of knee arthritis include:

Reduced movement

As the disease progresses, you may find certain movements become more difficult, such as standing up or sitting down, without aid.

Weakness in the knee

You may notice that your leg feels weaker or that the muscles have lost some of their strength and tone. On some occasions, the knee may give way without warning.

Swelling

Over time the joint may become swollen. Joint inflammation can be caused by rheumatoid or psoriatic arthritis in the knee.

Noisy knee

You may hear or feel creaking or cracking noises when bending or straightening the knee. This is called crepitus.

For knee arthritis diagnosis, your doctor will look for stiffness and structural changes in the joint. Other indicators of knee arthritis will be swelling and reduced movement in the affected leg.

Diagnosis will often be made from a physical examination and an x-ray of the knee. Occasionally an MRI scan may be helpful, especially if the arthritis is not at an advanced stage.

At present there is no cure for arthritis in the knee. However, there some effective arthritis knee treatments available that will help you to reduce pain and improve your range of motion in the joint. In the early stages of disease, your doctor will recommend non-surgical therapies. The types of knee arthritis treatments available include:

  • Pain relief: Over-the-counter pain medication can help give some arthritis knee pain relief. ·       
  • Physiotherapy: Knee arthritis exercises can help improve your mobility. ·       
  • Weight loss: Losing weight can help reduce the weight-bearing load on the knee.
  • Steroid injections: You doctor may recommend a course of knee injections for arthritis.

In some circumstances, you may find a knee support for arthritis, such as a compression sleeve, or a knee brace for arthritis, such as a knee unloaded brace, as a method of providing support for the joint and managing pain.

For more advanced arthritis, your doctor may recommend keyhole surgery (called a laparoscopy) and partial or total knee replacement.

Living with long-term arthritis can be difficult. You may be in considerable pain and you may be concerned about the gradual loss of mobility. As the disease develops, these levels of pain and discomfort will only increase, which in the long term may affect you mental and physical wellbeing.

Rheumatoid arthritis of the knee brings its own challenges. As it is an autoimmune disease, other areas of the body can be affected. For example, rheumatoid arthritis may cause other autoimmune problems like inflammation of the heart, lungs or eyes.

Specialists Offering Knee arthritis

Mr James Oliver Smith

Consultant Orthopaedic Surgeon

BM BSc DM FRCS (Tr&Orth)

BMI The Winterbourne Hospital

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Mr Magdi El-Guindi

Consultant Orthopaedic Surgeon

MBBch FRCS

BMI The Chiltern Hospital 1 more BMI The Shelburne Hospital

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Mr Robin Strachan

Consultant Orthopaedic Surgeon

BSc Hons Physiol MB ChB FRCS

BMI The Clementine Churchill Hospital

View profile Book online

Mr Winston Kim

Consultant Orthopaedic Surgeon, Specialist in Hip and Knee Surgery

MBChB, MSc, FRCS (Tr & Orth)

BMI The Alexandra Hospital

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Mr Satyajit Naique

Consultant Orthopaedic & Trauma Surgeon

FRCS (Tr&Orth), MS, FRCS, FCPS, Dip (Orth), DNB, MBBS

BMI Bishops Wood Hospital 1 more BMI The Clementine Churchill Hospital

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Mr Nick Kenny

Consultant Orthopaedic & Trauma Surgeon

FRCS FRCS(Orth)

BMI The Alexandra Hospital

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