Knee osteoarthritis is a relatively common condition, affecting up to 45 per cent of people during their lifetime. 19 percent of people over 45 have some degree of osteoarthritis in the knee, and that figure increases to 37 per cent in the sixty plus age group.
However, despite its prevalence, people are often unsure why they developed the condition, and wonder if they need surgery for knee osteoarthritis. Mr Punwar sees a lot of patients that have suffered with knee pain for a long time before seeking treatment. In this article we will be clearing up some confusion around knee osteoarthritis.
Osteoarthritis is often termed non-inflammatory (‘wear and tear’) cartilage damage separating it from the inflammatory joint conditions such as rheumatoid arthritis which is increasingly treated with modern drugs. There is some overlap between the two types of joint arthritis.
What causes knee osteoarthritis?
The exact cause of knee osteoarthritis is not yet known, but we do know of some things that can increase your risk of developing the condition:
The more weight there is to carry, the greater the stress placed through the knees. In a normally aligned leg 60% of weight is carried through the inner part of the knee explaining why the inner (medial) part of the knee often degenerates first. Your risk of developing joint pain and osteoarthritis increases with weight.
There’s not a lot you can do about this one but knee cartilage, like most collagen based connective tissues in the body, articular cartilage tends to get weaker over time, which can lead to damage from minor injuries.
This could be one big accident, like a broken bone, or a series of mini traumas (from a high impact sport such as football), which over time can lead to widespread osteoarthritis
Lack of exercise
In case you were thinking you’d better pack away your running shoes to save your knees, conversely too little exercise can also cause problems. Poor muscle tone puts extra stress on the knee, and lack of movement prevents joint (synovial) fluid from circulating. Lack of movement also leads to stiffness which can affect function.
If anyone in your family has had osteoarthritis in the knee, your chances of developing the condition are increased.
Women are 40 per cent more likely to develop osteoarthritis than their male counterparts. Female knees often start to bend outwards (knocked knees) leading to pain on the outer part of the knee joint, which is particularly painful. Men are more likely to develop the pattern of osteoarthritis where the knees bend inwards (bow legs) putting stress on the inner aspect of the knees.
Overall a combination of genetic and lifestyle factors affects your risk of developing knee osteoarthritis (OA).
What are the symptoms of knee osteoarthritis?
If you’re not sure whether you’ve got knee osteoarthritis, these are the symptoms to look out for:
- knee pain that is worse when you are moving it
- a warm feeling in the knee joint
- less movement in the knee
- a creaking or cracking sound when you move the knee
How should knee osteoarthritis be treated?
How you treat the problem very much depends on the individual. If you are overweight, your doctor may suggest weight loss, which can provide a surprising amount of relief. Certain strengthening exercises can also be helpful in mild cases.
You might be prescribed painkillers or anti-inflammatories, or your doctor may suggest corticosteroid or hyaluronic acid injections into the knee joint. Physiotherapy and knee supports can also be useful.
If your knee osteoarthritis is very advanced, best shown by ‘bone on bone’ appearances on X-ray, and these other options aren’t working, it may be time to consider surgery.
In these end stage cases patients are often woken from sleep with knee pain and are unable to do their activities of daily living independently, such as driving and shopping.
Types of surgery for knee osteoarthritis
There are several types of surgery that can be used to treat knee osteoarthritis, and the right one for you will depend on many factors. Here is a brief rundown of the surgeries available:
Total knee replacement
This is for more severe cases where there is widespread cartilage damage, accompanied with pain and functional loss. It involves the removal and replacement of the entire knee joint. Mr Punwar only uses modern implants with a proven track record. He ensures that every effort is taken to minimise tissue damage and promote rapid recovery. Emerging technologies such as custom made knee replacements are producing promising results. There is an added benefit of having implants tailored to individual anatomy. Please discuss with Mr Punwar if you are interested in finding out more about custom knee replacement surgery.
Partial knee replacement
This is increasing in popularity as the benefits of minimally invasive surgery are becoming clear. However, partial knee replacement needs to be performed in carefully selected patients for the best chance of success. Surgery involves replacing just one of the knee’s three compartments – the inner (medial), knee cap (patellofemoral) or outer (lateral) knee. By far the most common partial knee replacement involves the inner side of the knee only.
Benefits of the partial knee replacement approach include bone conservation, lower medical risks and faster recovery. Also, better function as all the natural knee ligaments are preserved. There are risks of other parts of the knee wearing out over time but generally partial knee replacement patients are very satisfied.
A form of keyhole surgery, this involves entering the knee through a tiny incision and using a telescope to view. The joint damage is assessed and minor procedures are performed to smooth the knee joint and remove inflamed tissue. This procedure is usually suitable for less severe cases and is no longer widely used in the treatment of knee osteoarthritis.
As with partial knee replacement, this is suitable for (usually younger) patients whose knees are poorly aligned. The procedure involves the removal of a small wedge of bone from either the femur or tibia. This is then replaced with bone graft or a synthetic replacement. The realignment of the leg changes the load distribution on the knee, reducing pain in the affected compartment.
The only way to be certain which of these surgeries is best for you is to have a thorough consultation with Mr Punwar. To book an appointment with Mr Punwar at either of his practice locations, please call his LIPS practice team on 0208 194 8541.