Knee osteoarthritis is a progressive degenerative condition of the knee joint, characterized by the gradual wearing away of the cartilage that covers the ends of the femur (thigh bone), tibia (shin bone), and patella (kneecap). This cartilage deterioration leads to rough bony surfaces rubbing together, resulting in pain, inflammation, stiffness, and loss of knee function over time.

Knee Anatomy

The knee is a complex hinge joint formed by the femur, tibia, and patella. The ends of these bones are covered with smooth cartilage that allows the bones to glide over each other with minimal friction. Additionally, two wedge-shaped pieces of cartilage, called the menisci, act as shock absorbers between the femur and tibia, stabilizing the joint and protecting the cartilage. Ligaments and muscles around the knee provide support and facilitate movement.

Causes

Knee osteoarthritis may develop as part of the natural aging process, where cartilage softens and eventually deteriorates. Other factors that contribute to knee osteoarthritis include:

   - Prior Injuries: Past knee injuries, such as meniscal tears, ligament injuries (e.g., ACL tears), or fractures around the knee, can increase the risk of early cartilage wear.

   - Genetic Factors: Family history of osteoarthritis can predispose individuals to earlier onset of knee arthritis.

   - Anatomical Differences* Variations in knee alignment, such as being bow-legged or knock-kneed, can place uneven stress on the knee joint, leading to cartilage wear.

   - Medical Conditions: Conditions such as rheumatoid arthritis, gout, or other inflammatory diseases can cause early cartilage damage and increase the likelihood of developing osteoarthritis.

Non-Operative Treatment

Knee osteoarthritis can often be managed non-surgically, especially in cases where symptoms are mild and do not significantly interfere with daily function. It is important to note that knee osteoarthritis is a progressive condition, meaning symptoms such as pain and stiffness are likely to worsen over time.

Non-operative treatments aim to manage symptoms and delay progression:

   - Physiotherapy: Strengthening exercises, especially for the quadriceps and hamstrings, are essential to support the knee joint and reduce stress on the cartilage.

   - Weight Management: Maintaining a healthy weight or losing weight can reduce the load on the knee joint, significantly decreasing pain and slowing the progression of arthritis.

   - Activity Modifications: Avoiding high-impact activities (e.g., running or jumping) and incorporating low-impact exercises, such as swimming or cycling, can reduce strain on the knee.

   - Walking Aids: Using a cane or walking stick in the hand opposite the affected knee can reduce load and alleviate pain.

   - Medications: Pain relief can be achieved with medications such as paracetamol and NSAIDs (e.g., ibuprofen, celecoxib). However, these should be used with caution, particularly with regular use, and under the guidance of a healthcare professional. There is no strong scientific evidence to support the use of stronger pain medications (such as opioids) or supplements like glucosamine or chondroitin in treating knee osteoarthritis.

Operative Treatment

For severe cases of knee osteoarthritis where conservative treatments fail to provide adequate relief, surgery may be considered. The most definitive surgical solution for knee osteoarthritis is a total knee replacement (TKR).

Total Knee Replacement (TKR)

TKR is a procedure in which the damaged cartilage and bone in the knee joint are replaced with artificial components made of metal and plastic, restoring knee function and reducing pain. Total knee replacement has shown excellent results in terms of patient satisfaction, pain relief, and functional improvement, consistently rated as one of the most effective surgical procedures.

Please see Total Knee Replacement summary for more detailed surgical information