What is Knee Osteoarthritis (OA)
Arthritis is commonly known as joint inflammation, and is associated with “wear and tear” of the tissue surrounding joints of the knees, hips, spine and fingers.
All of us have a layer of firm, rubbery tissue known as cartilage. This cartilage lines the ends of each bone, which reduces friction between them and allows the bones to glide over each other smoothly.
Accidents, old age or heavy use of these joints may wear out the cartilage, leading to pain at the joint area and a decreased range of motion. As deterioration continues, bits of bone wear off, leading to the development of bone spurs (osteophytes), which are uneven surfaces on the affected bones.
Small fragments of bone and cartilage that have been chipped off might end up around or in the joint space, causing pain or sometimes “jamming” the joint”. In the later stages of OA, the joint space will be reduced, and bones end up rubbing against each other, causing severe pain and stiffness.
The following illustration indicating the various stages of knee OA as time passes, without some form of treatment.
Stages of Osteoarthritis. Digital image. Pt Health. 12th July 2017. https://www.pthealth.ca/blog/knee-osteoarthritis-my-knees-hurt-do-i-have-oa/
OA can affect people of all ages, but tends to occur most commonly in people aged 50 to 55 or older. Pre-existing injuries such as ligament tears, or previous fractures, may also accelerate the rate of OA development.
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Sign and Symptoms
Signs and Symptoms of Knee Osteoarthritis vary based on the severity:
Pain and stiffness is the most common symptom. Typically worse on waking up in the morning or after a long period of inactivity.
A “grinding or cracking” sensation can be heard or felt when moving the knee
Limited range of motion
Locking or stiffness of the joint
Swelling after a period of overuse
The mobility and quality of life for patients with knee OA can be very low at the later stages in life due to its debilitating nature. They may find it increasingly difficult to enjoy any sports or physical activities that they normally enjoy doing. Even simple daily tasks, like climbing up and down the stairs, becomes painful and difficult. OA can also impact one’s work and lifestyle significantly, causing patients to sometimes switch jobs or even stop working.
There are a number of factors that could contribute to OA. Below are some of them:
Age: The risk of OA occurs with an increase in age.
Gender: Females are more likely to develop OA than males, especially after menopause.
Obesity: Extra weight puts extra stress on load-bearing joints, causing the cartilage to break down even faster. Excess tissue also produces inflammatory proteins known as cytokines that may cause further damage to joints.
Genes: Certain inherited genetic traits predispose some people to developing OA
Joint injury: Fractures, ligament or meniscal tears, or previous septic arthritis, can lead to the development of OA. Sometimes, previous orthopaedic operations performed to treat such injuries could also be a risk factor.
Occupation: Physically demanding jobs that require regular manual labour, climbing tasks, long durations of walking predispose patients to OA.
Underlying medical conditions: Diabetes, rheumatoid arthritis and gout are just some of the many medical conditions that could alleviate and contribute to OA development.
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Consult your doctor to verify the condition of your joint problem. Blood tests may not necessary in confirming a diagnosis of knee OA. However, some of the following tests may be necessary:
X-ray: The images can reveal joint space narrowing. This is an indication of cartilage degeneration, and bone spurs or osteophytes. Your doctor may need to X-ray the unaffected joint as well for comparison to get some form of affirmation.
Arthrocentesis, or knee joint aspiration: A needle is inserted into the knee joint in order to withdraw some joint fluid. This sample is sent to the lab for examination for evidence of inflammation. It is useful in ruling out other possible diagnoses.
Magnetic resonance imaging (MRI) scan: MRIs is not usually required to diagnose OA, but may have to be performed in complex cases, as they provide detailed images of the knee joint that include the soft tissue structures.
OA is a chronic degenerative condition which may not be cured. It is important to adjust parts of your lifestyle. For example, maintaining a healthy weight, engaging in simple exercise, continuing to be physically active, and performing muscle strengthening exercises to ease the burden on your knee joints. One can also consider joint bandages or support, and/or walking aids.
What are the Treatments For Knee Osteoarthritis (OA)?
Numerous treatments are available to help manage the symptoms:
Oral / topical analgesics eg. nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol or opioids
Oral supplements containing natural products that help to reduce inflammation, slow down cartilage degeneration and promote collagen formation
Corticosteroid injection: Steroids have powerful anti-inflammatory effects and are useful for short term, immediate pain relief.
Hyaluronic acid (HA) injection: HA is a natural component of joint synovial fluid, and is broken down in OA. HA injections can help to improve joint lubrication and movement, and provide medium term relief.
In serious cases and the late stages of OA when joints are severely damaged, surgery may be an option. Surgical procedure include: arthroscopy, knee osteotomy, partial or total knee replacement.