Osteoarthritis is the most common form of arthritis; it is the wearing down of articular cartilage down to the bone.There are also a number of forms of arthritis where excessive inflammation of the joint occurs first (with swelling and pain), followed by wearing away of the gristle layer (rheumatoid arthritis and psoriatic arthritis are two examples).

Osteoarthritis cannot be prevented totally but some lifestyles changes, avoiding trauma and injury, losing weight if necessary reduce stress and weight on joints and will help preserve knee function. Healthy levels of exercise can help maintain muscle strength+++.

Causes : age of course but also injuries and obesity. Knock knee will give outer knee wear and bow leg will give inner knee wear .

Symptoms : Pain, stiffness, swelling and often deformity are the main symptoms. The join pain may remain constant or recur, along with tenderness. Patient may feel as if there is no support within the leg. Stifness may be experienced when patient wake up in the morning ; it may last for up to an hour. Swelling may be associated to redness and/or warmth in the knee.

Deformity : a medial joint arthritis will lead to a bow-legged deformity, an lateral joint arthritis to a knock-kneed deformity.

Diagnose : Weight-bearing X-rays will show bone spurs and a reduced gap between the bones because of the worn cartilage. Deformity will be assessed by long X-rays of both legs.

The treatment is first a medical treatment.

Physiotherapy :

• Cold therapy relieve pain and reduces swelling .
• Exercises and in particular stretches are important to help maintain movement in an arthritic joint and delay the progression of the disease.

Medication :

• Acetaminophen may relieve pain.
• Intermittent Anti-inflammatory medication (non steroidal)
  • reduce pain and inflammation .
  • They may affect renal or gastrointestinal function (to be discuss with your physician).
• Corticosteroids : may be given as injection into the knee. They must not be repeated too many times (to be discussed with your physician).
• Your physician may prescribe supplements of glucosamine and chondroitin sulfate (not regulated by US FDA). The scientific studies found that these supplements may help relieve pain but overall may be no more effective than a placebo.
• Viscosupplementation
  • is a way of adding fluid to lubricate the joint and make it easier to move.
  • These substances are a concentrate of hyaluronic acid, a molecule found in the joints.
  • Several preparations of hyaluronic acid are now commercially available.
  • One to three weekly injection in the cavity of the joint are needed to reduce the pain but the pain relief is not immediate and not permanent.
  • Many patients (but not all) experience improvement for months and find the process worthwhile.

After these treatments, if your knee keeps being painful your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you could benefit from a knee replacement. Alternatives include a unicompartimental knee replacement or an osteotomy.

Reasons that you may benefit from knee replacement despite a good medical treatment commonly include :

• Severe knee pain that limits your everyday activities (walking, climbing stairs, and getting in or out of chairs.
• Knee pain while resting, either day or night.
• Swelling
• Knee deformity
• Knee stiffness : inability to bend or straighten your knee.

Docteur Jean Etienne Perraudin; last reviewed 1 09 2012.