Arthritis is a painful condition in which there is breakdown of the articular cartilage (shiny surfaces on the end of the tibia(shinbone), femur (thighbone) and the undersurface of the patella (kneecap) eventually causing widespread damage to the joint. .Normally the articular cartilage is a smooth tough rubbery surface that absorbs stress and reduces friction as the bones in the joint move against each other.
There are many different types of arthritis of which osteoarthritis is the most common. This is often seen with increasing age and is frequently referred to as “wear and tear” of the joint. The articular cartilage is worn away often leaving exposed bone. The bone often becomes hardened, may bulge with osteophytes occurring at the edges (bone spurs) which may catch or pinch the surrounding soft tissues.
Osteoarthritis may have a genetic component running within families but may also occur secondary to an injury to the joint such as a fracture, a ligament injury or meniscus (load sharer) injury or repeated trauma.
Typically patients complain of pain, swelling, stiffness and deformity. It frequently affects activities of normal daily living such as managing stairs, standing from sitting, putting on socks and shoes, kneeling and crouching. It may cause sleep disturbance with patients often sleeping with a pillow between their knees. Patients may notice an inability to straighten the knee (flexion deformity) or becoming knock kneed or bow legged.
The other main group of arthritis are a result of an auto-immune disease in which the body’s immune system (normally responsible for fighting infection) turns on itself attacking healthy joints, tissues and organs. Rheumatoid arthritis is a disease causing inflammation of the synovial lining of the joint causing pain, swelling, deformity and loss of function. This typically affects the wrists, hands and feet and tends to be symmetrical. It is more common in women than men.
Diagnosis is made based on the patient’s symptoms, medical history and physical examination. Weight bearing (standing ) X-rays of the knees are essential and sometimes a computed tomography (CT) scans and magnetic resonance imaging (MRI) scans may also be performed to aid the diagnosis.
Treatment will depend on a number of factors, including the age, activity level and the physical, social and emotional effects that the condition is having on an individual’s life.
It is common to start with the smaller, less-invasive treatments first, before escalating things depending on how the symptoms respond.
Non Surgical (Conservative) Treatments
- Rest and avoidance of vigorous aggravating impact activities such as running on hard surfaces.
- Lifestyle modifications – eating a healthy diet, weight loss, a moderate non-impact exercise programme
- Supplements such as omega oils, glucosamine chondroitin sulphate
- Simple painkillers and/or non-steroidal anti-inflammatories (check with your doctor before taking)
- Physiotherapy, to try and get the muscles as strong as possible, to ‘protect the joint’ and to improve function and pain. Acupuncture.
- Walking sticks
- Knee braces to reduce the weight on one side of the knee (offloader knee braces)
- Intra-articular (Joint) injections, with either steroid (cortisone) or a viscosupplement hyaluronic acid (a synthetic form of synovial fluid that acts as a buffer and lubricant.)
- Platelet Rich Plasma (taking a small volume of patients blood , spinning it in a centrifuge and re-injecting the concentrated suspension of platelets into the joint).
When conservative measures have failed a number of surgical treatments are available depending on the severity and extent of the disease. The aim of the surgery is to relieve pain and restore the function to the joint. These include:
Arthroscopy is sometimes used for focal chondral lesions (small areas of damage to the articular cartilage), for surgical planning, to remove loose bodies (fragments of bone or cartilage which can break off inside the joint and cause locking or jamming of the knee) and to remove torn cartilages if they are causing mechanical problems.
This is applicable if one part of the joint is worn out causing a mild deformity and the other part is well preserved. This reshapes the knee by reducing the deformity and allows the forces across the damaged part of the joint to be redistributed to act through the preserved parts, reducing pain and improving function. This surgery is often appropriate for younger and middle-aged patients with only one part of the joint affected with osteoarthritis.
Arthroplasty (Knee replacement)
This involves removing a thin section of bone from the end of the femur (thighbone) and top end of the tibia (shinbone) and replacing this with a metal implants which are cemented into the bone with a special bone cement. A high molecular weight polyethylene (plastic) spacer is inserted between the metal surfaces. If only part of the knee is affected such as the medial compartment (the inner side of the femur and tibia only) then a partial knee replacement may be appropriate. This involves replacing only one side of the knee joint with meal implants again fixed into the bone with special bone cement and an intervening plastic spacer.
This surgery is usually indicated for early cases of inflammatory arthritis such as rheumatoid arthritis where there is significant swelling and inflammation of the synovium (tissue lining of the joint) called synovitis causing pain or restriction in movement. A synovectomy is the surgical removal of the inflamed synovium and can be performed arthroscopically (through keyhole surgery) performed using arthroscopy.