Also known as Osteoarthritis, Rheumatoid Arthritis, Post-traumatic Arthritis, wear and tear.
Arthritis gradually causes disintegration of the joint, leading to pain and disability. Osteoarthritis, which can occur either of its own accord or as a result of an accident, tends to be a wear and tear disease, whilst Rheumatoid Arthritis affects multiple joints in the body as a result of inflammation of the joint.
Osteoarthritis occurs usually in patients over the age of 40 and becomes particularly prevalent over the age of 60, while rheumatoid arthritis can occur at any age. However Rheumatoid Arthritis is now controlled very well by medication and is seen less commonly. Arthritis as a result of traumatic injuries to the knee can occur at any age but does occur more commonly in younger age groups of patients.
Irrespective of the type of arthritis, the knee tends to feel painful and stiff with deteriorating symptoms that often lead to pain at night. Patients’ quality of life is reduced as day-to-day activities become more difficult, such as walking to the shops or going up and down stairs.
The arthritic change can lead to the deformities in the leg, such as the knees coming together (knock-kneed) or moving apart (bow-legged). There can be an accumulation of fluid within the knee on a permanent basis, which leads to the knee appearing much bigger than the opposite knee.
Patients often present to their general practitioner or allied health professional with symptoms of pain and limitation of movement within the knee. The doctor or health care professional will often ask a number of questions regarding pain, particularly pain at night, together with the restriction of activities the pain produces in day-to-day activity. The patient’s joint will be examined for signs of osteoarthritis, including pain on movement and restriction of movement. The patient’s hips may also be examined to make sure there is no element of osteoarthritis. Often plain x-rays of the knee are taken. It is very rarely necessary to do an MRI scan to rule out additional injuries to the knee.
There are a number of treatment options for patients with osteoarthritis of the knee:
Take painkillers and adapt lifestyle
Patients may only need to take painkillers and adapt their life styles if the arthritic knee is not significantly impairing their quality of life or other medical conditions preclude them from having further intervention. The focus of this treatment is to adapt the patient’s lifestyle to allow the knee to cope whilst taking painkillers as, and when, needed or on a regular basis. Diet and weight loss may be a key consideration in this approach.
Steroid injections and artificial Hyaluronic Injections
For a small number of patients, steroid or artificial Hyaluronic Acid Injections into the knee joint can prove beneficial. However, their effects are usually short-term rather than long-term.
Arthroscopic Keyhole Surgery
This can be beneficial in an osteoarthritic knee if patients also have symptoms of mechanical catching or meniscal (cartilage) injuries.
Joint Replacement Surgery
Joint replacement surgery is a standard treatment for arthritic knees irrespective of the cause. It is usually considered when the quality of life of a patient is severely affected by the arthritic knee, either through pain or a reduction in their mobility and activity levels.
The type of joint replacement depends on the area of the knee that is arthritic. Joint replacement surgery can either be in the form of a partial knee replacement (Unicondylar Knee Replacement), replacing the knee-cap alone (Patellofemoral Knee Replacement) or total joint replacement surgery (TKR), where the entire knee is replaced.
Partial knee replacement and patellofemoral knee replacements are for a selected group of patients who have arthritis affecting isolated parts of the joint. Patients will be advised of this option if they are suitable. This surgery is often performed through small incisions to speed recovery and regain function.
Total joint replacement surgery involves removing the diseased portion of the joint and replacing it with an artificial joint, which allows pain-free movement.
Most knee replacements are made of Cobalt Chrome Titanium alloys with a high-density Polyethylene plastic insert. The majority of knee replacements have good, fifteen year survival rates.
Computer guided techniques have now advanced the way that total joint replacement surgery is done. The surgeons at Spring Orthopaedics pioneered this technique worldwide.
Post operative total knee replacement physiotherapy mainly involves quadriceps, gluteal and hamstring strengthening exercises. There occasionally is the need to improve range of movement and manual therapy (hands on stretches) as well as further stretching exercises is required. Once the knee has gained full strength and movement then activity related exercises can be taught to restore the knee to full function.