The knee is the largest and strongest joint in your body. It is made up of the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The ends of the three bones where they touch are covered with articular cartilage, a smooth, slippery substance that protects and cushions the bones as you bend and straighten your knee.
Two wedge-shaped pieces of cartilage called meniscus act as “shock absorbers” between your femur and tibia. They are tough and rubbery to help cushion the joint and keep it stable.
The knee joint is surrounded by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage and reduces friction.
- Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative,"wear-and-tear" type of arthritis that occurs most often in people 50 years of age and older, but may occur in younger people, too.
- In osteoarthritis, the cartilage in the knee joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, and produce painful bone spurs.
- Osteoarthritis develops slowly and the pain it causes worsens over time.
- Rheumatoid arthritis
- Rheumatoid arthritis is a chronic disease that attacks multiple joints throughout the body, including the knee joint. It is symmetrical, meaning that it usually affects the same joint on both sides of the body.
- In rheumatoid arthritis the synovial membrane that covers the knee joint begins to swell, This results in knee pain and stiffness.
- Rheumatoid arthritis is an autoimmune disease. This means that the immune system attacks its own tissues. The immune system damages normal tissue (such as cartilage and ligaments) and softens the bone.
- Post-traumatic arthritis
- Posttraumatic arthritis is form of arthritis that develops after an injury to the knee. For example, a broken bone may damage the joint surface and lead to arthritis years after the injury. Meniscal tears and ligament injuries can cause instability and additional wear on the knee joint, which over time can result in arthritis.
The most common symptom of knee osteoarthritis is pain generally described as a dull ache but can be sharp at times. Usually, the pain develops slowly and worsens over time, although sudden onset is also possible. Pain and stiffness may be worse in the morning, or after sitting or resting for a while. Over time, painful symptoms may occur more frequently, including during rest or at night.
Additional symptoms may include:
- Pain to the inner(medial) or outer knee (lateral)
- Pain that flares up with vigorous activity
- Stiffness in the knee joint that makes it difficult to walk or bend
- "Locking" or "sticking" of the joint
- Grinding noise (crepitus) during movement caused by loose fragments of cartilage and other tissue interfering with the smooth motion of the hip
- Decreased range of motion in the knee that affects the ability to walk and may cause a limp
- Swelling of the knee
- Lifestyle modifications
- Heat and Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
- Weight loss to reduce the stress on the knee joint
- Switching from high impact activities to lower impact activities like swimming and bicycle
- Stabilizing knee brace
- Offloading knee brace if you have one compartment with narrowing of the knee joint
- Quad Strengthening
- Range of motion exercises and flexibility
- Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen, naproxen and celebrex reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
- Topical anti-inflammatories
- Compound Topical Creams
- Dietary supplements, such as glucosamine and chondroitin sulfate may help relieve pain. (Note: There is little scientific evidence to support the use of glucosamine and chondroitin sulfate to treat arthritis. In addition, the U.S. Food and Drug Administration and Health Canada does not test dietary supplements. These compounds may cause negative interactions with other medications. Always consult your doctor before taking dietary supplements.)
- Steroid (Depo-Medrol, Kenalog, Decadron)
- Gel – Hyaluronic acid (Viscosupplementation)
- Blood (PRP – Platelet Rich Plasma)
If you’ve failed conservative treatment, the recommended surgery is a total knee arthroplasty. This option is used for patients with moderate to severe osteoarthritis. Currently this is an surgical procedure with a 3-5 day stay at the hospital with before and after surgery rehab and physiotherapy.