Knee osteoarthritis

Osteoarthritis is a painful condition caused by a gradual loss of cartilage from the joint surfaces. Healthy cartilage allows bones to smoothly glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint.

 changes in the arthritic knee

Factors leading to osteoarthritis:

Age: Although osteoarthritis becomes more common with age, younger people can develop it, usually as the result of a joint injury, a joint malformation, or a genetic defect in joint cartilage. 

Gender: Both men and women have the disease. Before age 45, more men than women have osteoarthritis; after age 45, it is more common in women. 

Weight: It is also more likely to occur in people who are overweight 

Increased knee stresses: jobs that put excessive stresses on the knee e.g. jobs that required prolonged squatting or excessive stair climbing.

Chondromalacia patella, a condition that occurs in adolescents and young adults does not lead to osteoarthritis of the knee.

 

Symptoms

The severity of osteoarthritis is variable. In some patients it may be relatively mild and interferes little with day-to-day life; in others, it causes significant pain and disability. 

Pain: Early in the disease, your joints may ache after physical work or exercise. Later on, joint pain may become more persistent even during rests. 

Stiffness: particularly when you first wake up in the morning or have been in one position for a long time.

Swelling: this is due to collection of increased amount of synovial fluid inside the joint (effusion) and due to inflammation of the synovial membrane.

Limited range of movement: in advanced cases the patient may not be able to fully extend of bend his knees.

Deformity: in advanced cases the patient may have bowed legs due to excessive erosion of bone and cartilage and due to laxity of the ligaments.

 

Diagnosis:

In most cases examination of the knee will be enough to reach the diagnosis. However, your doctor may ask for X-rays to determine the severity of the disease. X rays of the affected joint can show cartilage loss, bone damage, deformity and bone spurs.

xray of knee osteoarthritis

Doctors may ask for MRI tests if there is pain while the x-ray findings are minimal; and if the findings suggest damage to other joint tissues such as a the menisci or ligaments.

 

Treatment of Osteoarthritis

 

Non-surgical treatment:

This is the first and main line of treatment of most cases of knee osteoarthritis. This includes:

1. change of life style: (Read in details on this page)

  • exercise
  • weight control
  • rest and relief from stress on joints
  • nondrug pain relief techniques and alternative therapies

 

2. Medications to control pain and inflammation: 

 

The following types of medicines are commonly used in treating osteoarthritis.

Oral pain medications, such as paracetamol, are often a first-line approach to relieve pain in people with osteoarthritis

NSAIDs (nonsteroidal anti-inflammatory drugs): A group of drugs useful against both pain and inflammation. Aspirin, ibuprofen and diclofenacs are examples of NSAIDs. They are often the first type of medication used. NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects. To help reduce the risk of side effects associated with NSAIDs take these drugs with food and avoid stomach irritants such as alcohol, tobacco, and caffeine. For unknown reasons, some people seem to respond better to one NSAID than another.

Corticosteroids: These are powerful anti- inflammatory drugs. They may be injected into the affected joints to temporarily relieve pain. This is a short-term measure, generally not recommended for more than two to four treatments per year. Oral corticosteroids are not routinely used to treat osteoarthritis. 

Hyaluronic acid substitutes: Sometimes called viscosupplements, hyaluronic acid substitutes are designed to replace a normal component of the joint involved in joint lubrication and nutrition. 

Topical pain-relieving creams are applied directly to the skin over painful joints. They contain ingredients that work by stimulating the nerve endings to distract the brain's attention from the joint pain and by blocking chemicals called prostaglandins that cause pain and inflammation.

Nutritional supplements such as glucosamine and chondroitin sulfate have been reported to improve the symptoms of people with osteoarthritis, as have certain vitamins. It is unknown whether they might change the course of disease.

 

 

Surgery:

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to achieve one or more of the following:

• Removal of loose pieces of bone and cartilage from the joint if they are causing symptoms of buckling or locking (arthroscopic debridement).

• Realigning the bones (osteotomy).

• Joint replacement

 

 

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