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Osteoarthritis in Knee: Overview, Risk Factors and Treatment

OSTEOARTHRITIS IN KNEE
Contents

OVERVIEW:

Osteoarthritis is also known as degenerative joint disease. It is the most common form of arthritis and is a long-term condition marked by the breakdown of joint cartilage and changes in the underlying bone. Women are more likely than men to have osteoarthritis, especially after age 50, and weight-bearing joints such as the knees and hips are among the main joints involved.

About 33 million U.S. adults have osteoarthritis, according to the CDC. It may affect a single joint or several joints, and having it in one joint makes it more likely in others.

Risk Factors for Osteoarthritis:

  • Aging: As the age of advances the tendency to acquire osteoarthritis increases.
  • Genetic factors: osteoarthritis can run in families, so a family history raises your risk.
  • Mechanical stress: joint injuries, repeated knee bending or heavy lifting, and earlier knee surgery can lead to osteoarthritis in the knee.
  • Diabetes: Diabetes has been linked with osteoarthritis in some studies, although the connection is less clear than for age, weight and injury.
  • Alkaptonuria: Ochronosis like Alkaptonuria is a secondary factor for osteoarthritis.
  • Hemochromatosis: iron buildup, as in hemochromatosis, may cause secondary osteoarthritis.
  • Marked obesity: obesity is a major risk factor for knee osteoarthritis because it adds load to weight-bearing joints. Keeping a healthy weight lowers the risk and can ease symptoms.

The pattern of Osteoarthritis in Knee:

Osteoarthritis in the knee often targets the joint between the kneecap and thigh bone (patellofemoral joint) and the inner (medial) part of the main knee joint. Pseudogout crystals are also found together with osteoarthritis most often at the knee. Knee osteoarthritis is often present in both knees.

If the cause is an injury, it may affect only one knee. A painful knee can cause a limp, called an antalgic gait. Over time, osteoarthritis of the inner knee can lead to a bow-legged (varus) shape.

There is a restriction of movements and patients suffer difficulty in extending and flexing knee joints. Coarse crepitations (grating) may be felt or heard when the joint moves. Pain can make people move less, so the thigh (quadriceps) muscles can weaken and waste.

Osteoarthritis in Hip Joint

Hip osteoarthritis usually causes pain deep in the groin. The pain may spread to the buttock, the thigh or down toward the knee.

Clinical Features of Osteoarthritis in Knee:

  • Joint pain: pain on moving the joint as cartilage wears away and the joint surfaces lose their smooth cushioning.
  • Restriction of movement: movement is restricted due to fear of pain on movement.
  • Coarse crepitations: a grating or crackling feeling or sound when the joint moves.
  • Morning stiffness: stiffness after waking or rest usually lasts less than 30 minutes and improves with movement.
  • Weaknesses and wasting of muscles: The patient restricts his movement due to fear of pain on moving the joint surface so the muscles near the joint are weakened and wasted.
  • Bony spurs: bone Spurs are also called osteophytes. These are small bone growths and are formed as a result of the destruction and remodeling of bone and joint surfaces.
  • Asymmetrical gait: pain can cause a limp, also called an antalgic gait.

How to Diagnose Osteoarthritis in the Knee?

Osteoarthritis in the knee is usually diagnosed clinically. Your doctor may take your complete history of the beginning of disease and signs and symptoms you suffer. He will perform your clinical examination to reach the proper diagnosis. Many tests are available for diagnostic uncertainty which of them are

  • Complete blood count: complete blood count of the patient is normal
  • Rheumatoid factor: Rheumatoid factor is absent
  • ESR: erythrocytes sedimentation rate is in normal limits
  • CRP: C reactive protein is in normal limits
  • Aspiration of joint fluid: joint fluid shows no infection and no signs of strong inflammation. Doctors may test it to rule out gout or infection
  • ANA: antinuclear antibody is absent
  • X-ray of joints: x-rays can show uneven joint space narrowing, bone spurs (osteophytes), hardening of the bone under the cartilage and small bone cysts. The joint does not fuse (no ankylosis).

Treatment for Osteoarthritis in Knee

There is no cure, but treatment can ease pain and keep you active. The recommendations below follow the 2019 ACR/Arthritis Foundation osteoarthritis guideline.

1- Pharmacologic Treatment:

  • Acetaminophen: acetaminophen is only conditionally recommended because its benefit is small. People who use it regularly may need liver monitoring.
  • Nonsteroidal anti-inflammatory drugs: topical NSAID gels and oral NSAIDs are strongly recommended for knee osteoarthritis. Topical gels are often tried first because they cause fewer whole-body side effects.
  • Intraarticular steroids: steroid injections into the knee are strongly recommended and can give short-term relief during flares.
  • Intraarticular hyaluronan injection: Intra-articular hyaluronan injection is conditionally recommended against for knee osteoarthritis because studies show little benefit. Some doctors still offer it when other options have failed.
  • Joint replacement: Orthopedic surgery and joint arthroplasty are done if the disease is severe and is refractory to medical therapy.

2- Non-Pharmacological Treatment:

  • weight loss if you are overweight, which can reduce knee pain
  • maintaining a healthy weight
  • regular exercise, including strength training, walking or tai chi
  • patient education about the disease, its treatment, and self-management
  • quadriceps strength training exercises in knee osteoarthritis
  • a cane or knee brace, which can reduce load on the painful joint

When to Seek Medical Help?

Take medical help when osteoarthritis in the knee is causing severe pain and joint disability. Your doctor can confirm the diagnosis and plan treatment that fits your health and goals.

Early treatment and regular exercise can help keep the knee working longer. Treatment manages symptoms rather than reversing the damage, so it is worth starting before pain limits your daily life.

Sources

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