Joints are located in areas of the body where two or more bones come together. The knee is the largest joint in our body. It is formed by 3 bones, namely, the thigh bone (femur), the shin bone, (tibia) and the knee cap (patella). The ends of these bones, within the joint, are covered by rubbery cushions known as cartilage. The cartilage acts like “shock absorbers” within the knee joint. The rest of the joint is covered by a smooth membrane known as the synovial membrane. The synovial membrane releases a fluid into the joint cavity. This fluid lubricates the joint.
The knee joint helps in bending and straightening the legs. It helps to perform various daily activities such as standing, sitting, walking, running, jumping, and squatting.
When inflammation occurs in the knee joint, it is refered to as knee arthritis. The knee is the part of the body that is most affected by arthritis.
Knee arthritis can affect both men and women. However, women are more prone to developing arthritis. Arthritis is often seen in people above 50 years of age. You are particularly prone for knee arthritis if you are overweight. Knee arthritis is also more common if you have had any injury to the knee joint. Also, if arthritis runs in you are family, it’s likely that you may be affected by this disease.
The overuse of certain joints can increase the risk of developing arthritis. People in jobs requiring repeated bending of the knee are at increased risk for developing arthritis of the knee.
There are many reasons for knee arthritis. The common types of knee arthritis are described below:
Osteoarthritis: Osteoarthritis is the most common type of knee arthritis. It occurs as we age and is the leading cause of disability among older men and women. Osteoarthritis is related to wear and tear of the knee joint cartilage. The cartilage, a natural cushioning between joints, becomes stiff and loses its elasticity gradually over time. Bones could rub against each other, if the condition worsens. Bits of cartilage may be left to float inside the joint, causing additional pain.
Rheumatoid arthritis: This type of arthritis results from overactivity of our body’s defense system i.e., immune system. The defense cells of the body cause inflammation of the membrane lining the joint and eventually can destroy the joint cartilage. Adjacent bone may also become soft. Rheumatoid arthritis can also affect children and usually involves both knee joints.
Post-traumatic arthritis: This type of arthritis is similar to osteoarthritis. It develops after injury to the knee such as a fracture.
Gout: In this condition, uric acid can get deposited into the joints and can cause inflammation.
The most common symptom of knee arthritis is knee pain that occurs when you perform any daily activities. The pain associated with knee arthritis often develops gradually; however, knee pain associated with arthritis can also have a sudden onset.
Due to damage to the cartilage, the knee joint becomes stiff and swollen. The joint may feel warm, become red, or you may also experience pain by simply pressing on the knee. The pain, swelling and stiffness of the joint make it difficult to bend or straighten the knee. As a result, your range of knee movement becomes limited.
The pain and swelling may become worse in the morning, or after certain activities such as climbing stairs, walking, kneeling or squatting. You may also have a feeling of “giving out” or “bucking” of the knee. Your knee may make a creaking or grating sound.
During the early stages of arthritis, you may have periods of flare-ups, and at other times you may be perfectly normal. However, as the disease progresses, you may start experiencing pain even at rest. You may not be able to move the joint. If you have had knee arthritis for many years, the joint may get deformed making your legs appear to be bow-legged or knock-kneed.
If you think you have any symptoms associated with knee arthritis or experience any discomfort in the knee, you should consult your doctor or see an orthopedic surgeon. Your doctor will examine you thoroughly and will note how you walk, record the range of motion in the limb, and check to see if thre is any swelling or tenderness in the joint. If he suspects arthritis, he will ask you to undergo certain confirmatory tests. These include X-rays. X-rays typically will show a loss of joint space in the affected knee if there is arthritis. If your doctor suspects rheumatoid arthritis or gout, he may ask for some blood tests, urine tests or special imaging tests, such as magnetic resonance imaging (MRI).
A wide range of treatments are available for arthritis of the knee. The main purpose of treatment of knee arthritis is to reduce pain and increase joint strength and function. In the early stages, arthritis can be managed with non-surgical methods, but in late stages, surgery could be required. With your doctor’s help, you have to find out which treatment is most suitable for you.
Non-surgical treatments of knee arthritis include lifestyle modifications, exercise, supportive devices, and medications. Your treatment plan may involve more than one of these options.
Lifestyle modifications: The lifestyle modifications include
Exercise: Exercises help to increase flexibility of the joint and strengthen the muscles of the leg. Exercises are effective in reducing pain and increasing the range of joint movement. Among the various exercises, walking is one of the most helpful. The use of a cane or crutch in the opposite hand while walking would help decrease the pressure on the arthritic joint. Aquatic exercises such as swimming and heat/cold physiotherapy are also helpful. Pain in the knee joint can lead to weakness of the thigh muscles. Pendular exercises (gently swinging the foot back and forward) to encourage knee movement may also be helpful.
You can develop an individualized exercise program that suits your needs and lifestyle with the help of physician or physiotherapist.
Supportive devices such as holding a cane in your hand, wearing shoes that absorb energy, or wearing a brace can support the knee by shifting the weight of the body from the affected Joint. Using these devices can decrease the pain in your knee and can help you walk and move.
Numerous drugs are used to treat knee arthritis. Your physician or orthopedic surgeon will tailor the treatment thats suitable for you.
Anti-inflammatory drugs: These are the most common medications prescribed for knee arthritis. They can provide relief from pain and joint swelling. COX-2 inhibitors are a special type of anti-inflammatory drug that are often given for knee pain. There are many pain medications that can be obtained over-the-counter, however, these medications can have potential side-effects. It is wise to consult your doctor before taking any medication for arthritis of your knee.
Glucosamine and Chondroitin: Glucosamine and chondroitin sulfate occur naturally in our joint cartilage. Hence, synthetic formulation of these can be used as oral supplements for arthritis. They are found to be effective in early stages of knee arthritis. They reduce pain, swelling, and improve joint function and mobility. Though available as over-the-counter preparations and used as food additives, these substances can also have side-effects.
Hyaluronic Acid: Hyaluronic acid is also a natural substance occurring in our joint cartilage and joint fluid. Your doctor may inject this supplement into your joints to improve the quality of the joint fluid.
Corticosteroids: Steroids are substances that are known to reduce inflammation. If required, your doctor would inject steroids directly into the joint. After the steroid injection, you will find significant relief in pain and swelling. However, these effects would last only for few months and you may need repeat injections.
Gold Salt Injections: This is a special treatment that your doctor would suggest if you have rheumatoid arthritis.
Immunotherapy: Certain anti-cancer drugs such as methotrexate would be given to you in low doses if you have rheumatoid arthritis.
As knee arthritis is very common and affects people among all races, many alternative therapies are also available with variable results. These include acupuncture and magnetic pulse therapy. While opting for alternative therapy, you should have this treatment performed by a qualified practitioner and keep your doctor informed.
Your doctor may advise surgery if your arthritis does not respond to nonsurgical treatments or if you have severe pain, lack of joint movement or extreme deformities. There are a number of surgical options available. The success rate of these operations is more than 90%. The various surgical options available for knee arthritis include arthroscopic surgery, osteotomy, and knee replacement.
Arthroscopic surgery: In this operation, the surgeon uses fiber optic technology to see inside the joint and clears the joint of debris or repair torn cartilage.
Osteotomy: In this surgery, the surgeon would cut the shinbone (tibia) or the thigh bone (femur) to improve the alignment of the knee joint. This is an alternative to knee replacement in young people with limited arthritis of the knee. While this procedures provides relief from pain, most of the people will eventually require knee replacement.
Knee replacement: Knee replacement can be performed in two ways,namely, total or partial knee replacement. In total knee replacement the surgeon exposes the knee joint, removes the ends of the tibia and femur, and replaces the damaged joint cartilages with metal and plastic. These replacement components are cemented into place in most cases. In partial knee replacement, either the outer or the inner compartment of the knee, whichever is severly damaged is replaced. The advantage of partial knee replacement is that the recovery time is shorter and the patient may obtain an improved range of movement.
Knee fusion: This procedure is rarely indicated. With this operation, the shin and thigh bones are completely joined leading to permanent knee stiffness and loss of all range of motion of the knee.
Knee pain due to arthritis is a very common finding in orthopedic clinics. Many patients get relief with rest or by taking anti-inflammatory medications. Sometimes a steroid injection can help in relieving pain, but these medications are not safe for everyone and have potential side effects. If these conservative treatments do not work and your pain still persists, then PRP therapy (platelet rich plasma therapy) may be an effective treatment option for you.
From a historical perspective, PRP was widely used in dentistry with great success. However, its use today has greatly increased in sports medicine and various orthopedic conditions. Some studies have proved its efficacy in relieving pain associated with an arthritic knee. There are currently many studies underway involving a large number of patients who have knee arthritis, but doctors have already started treating patients with PRP therapy to relieve pain from knee arthritis.
PRP has growth factors in the form of proteins that play a role in the natural process of healing, therefore injecting concentrated growth factors to the site of injury can indeed cause new cell growth and promote healing.
Before visiting the doctor’s clinic on the day of the procedure, you must drink plenty of water. This method uses the patient’s own blood, approximately 20cc, which is collected by a nurse or perfusionist. The blood is then placed in a disposable and put in a machine called centrifuge and spun for approximately fifteen minutes.
Blood contains plasma, red blood cells, white blood cells and platelets. After spinning, the centrifuge has separated the components of your blood. The platelet rich plasma that contains concentrated growth factors is then extracted from the container in the centrifuge. The physician will now have around 3-4ml’s of PRP to be injected into the injury site.
This process takes a few minutes, but it actually increases the concentration of platelets by up to 5 times compared to your normal blood. Before injecting, the area of injury may need to be locally anesthesized so that the PRP injection is only slightly uncomfortable.
To ensure the accuracy of the placement of the platelet rich plasma, a diagnostic ultrasound is used. A 25 gauge needle is then attached to a syringe containing the PRP and is then guided by ultrasound into the areas of injury. After the procedure, a simple Band-Aid is applied. Because there is no surgical incision involved in this treatment, you experience little or no pain immediately after the procedure. Since a local anesthetic is given, the area will be numb for two to four hours after the procedure.
After the anesthetic effect is over, you may resume normal activities, but you if normal activity is causing pain, you may have to rest. You may experience some pain 3-5 days after injection. This mild pain is normal because the PRP has jumpstarted the normal healing process. You will most likely notice an inflammatory response around this time frame.
Anti inflammatory medications are not to be taken for four to six weeks after the procedure since the objective of the treatment is to set off an inflammatory response to aid in healing. If pain persists, the area can be iced three to four times a day for 15 to 20 minutes.
PRP treatment for knee arthritis has many advantages. It is an outpatient procedure, no hospitalization is required therefore you do not need to take time off work. Next, it does not require general anesthesia. In this treatment, you not only get temporary relief, but you also get healing of the condition since the tissue is regenerated. If compared to the cost of the surgery, it is much less. Always talk with your physician to see if PRP therapy is right for you.
This treatment may not work for someone who is older with total osteoarthritis. But it has the potential to do wonders for patients who have early arthritis, who have good knee alignment, or who have small arthritic areas.
Although it is still in nascent stage, many patients across the country have been treated with PRP and they have shown significant improvements in pain and ability to carry out most movements of their everyday lives. Most insurance companies will not reimburse for this treatment, as it is still considered experimental by the FDA.
It is an exceptionally safe procedure and complications are rare. Since it uses your own blood, there is no risk of a transmissible infection or allergic reaction. Pain is actually resolved through healing.
Many orthopedics clinics have practiced this therapy with no complications.
Although development of knee arthritis cannot be totally prevented, following certain things would help in slowing or preventing permanent damage to the knee joint. These include