Overview of Osteoarthritis of the Knee
Osteoarthritis, also known as degenerative joint disease, is the most common type of arthritis. This appears when joint cartilage erodes away over time. It is generally progressive, but can be stemmed by taking management steps. With the cushioning cartilage diminished, bones rub against each other causing pain swelling, restriction of motion, stiffness and bone spur formation.
More than 27 million Americans suffer from osteoarthritis and the knee is the most typical area affected, with men less at risk than women
Risk factors include:
- Infection of the knee
- Age (over 45)
- Hereditary (family history)
- Occupational (using repetitive squatting, kneeling and weight lifting)
- Suffering from other conditions (osteoarthritis can occur in those with rheumatoid arthritis, overabundance of iron, growth hormone excess)
- Pain upon exertion
- Crackling or creaking sounds with knee movement
- Knee stiffness
- Decrease in mobility
Doctors Who Treat Osteoarthritis of the Knee
The following specialists comprise a team that addresses pain and swelling of the knee:
Orthopedists: doctors who focus on the health of the musculoskeletal system including joint issues and replacements.
Physiatrists: doctors who deal with rehabilitation therapy and physical medicine to restore functioning of the joints. They evaluate and treat individuals suffering from pain, lack of function and disabilities.
Physical Therapists: health professionals who devise personalized exercise protocols to strengthen muscles around joints to enhance range of motion and lessen pain.
Rheumatologists: doctors focusing on the health of bones, joints, tendons and muscles. They identify and treat arthritis, gout, osteoporosis, bursitis and tendonitis.
Occupational Therapists: health professionals that devise techniques to enable the performance of daily activities with less joint stress.
Acupuncturists: natural healers who relieve pain and boost healing through the use of special needles inserted into body energy zones in accordance with ancient traditional Chinese medicine.
How to Prepare for Your Doctor Visit for Osteoarthritis of the Knee
Having made your appointment with a healthcare provider, there are certain actions you can take to maximize the benefit of your doctor visit such as those listed in this osteoarthritis of the knee patient education guide.
Make a symptom list which includes:
- Any knee injury in the past
- How long have you had symptoms
- What aggravates the symptoms
- What alleviates the symptoms
- Is there a pattern to them
- Has it limited your range of motion or restricted activity
Bring this list with you for your doctor’s visit along with:
- List of medications
- List of allergies
- Past medical history
- Family history
- List of surgeries
If you will be undergoing an MRI, You will be asked to remove all jewelry, dentures, clips, artificial limbs, braces, hairpins, hearing aids.
Questions to Ask Your Doctor About Osteoarthritis of the Knee
From your initial diagnosis throughout your treatment and care, you will have questions about your osteoarthritis of the knee. This patient education guide lists questions to discuss with your doctor so you can make informed decisions about your condition.
Questions About My Diagnosis
- Can osteoarthritis be cured?
- Will my knee problem get worse over time
- How severe is my condition?
- Will it become debilitating?
- Is this part of the aging process or something else?
- Can this be part of a different medical condition and not osteoarthritis?
Questions About My Treatment
- Can this be cured with stem cell injections
- Can I use OTC medications or do I need something stronger?
- What treatments do you suggest and why?
- Will I need a knee replacement?
- Are there natural supplements that could alleviate my joint problem?
- With what symptoms should I seek emergent care?
Questions About My Lifestyle and Family
- Would weight loss help my knees?
- Does osteoarthritis run in families?
- Can my family do something to prevent getting this problem?
- What types of activities should I avoid?
- What exercises should I do for improvement of my knee?
- Will the type of work that I do be a problem for me?
Common Tests to Diagnose Osteoarthritis of the Knee
The physician, considering medical history and symptoms, performs a physical evaluation. Further laboratory or imaging tests are performed to pinpoint osteoarthritis and rule out conditions that cause similar symptoms.
|Test||Why Test?||What Happens?||Normal Result|
Anti-CCP (level of antibodies binding to citruline- modified proteins)
ESR (erythrocyte sedimentation rate) indicates inflammation
ANA for Lupus
CRP (C-reactive protein) indicates amount of inflammation
|After a tourniquet is applied to the upper arm, the puncture site of skin is swabbed with alcohol pads and a needle punctures the skin. Blood is then drawn into a syringe for analysis.
The test tube that received the blood is assessed in one hour. The more red blood cells that settle into the bottom of the tube, the higher the sedimentation rate and the higher the inflammation.
These tests are normal in osteoarthritis but abnormal in other conditions.
|Needle Aspirate of Knee||Joint fluid analysis
Rules out gout or infection
|The affected area is cleansed with antiseptic swab and covered with a sterile drape. An injection with local anesthetic is then given.
A thin needle attached to a syringe is introduced through the skin into the abnormal area and body fluid or tissue is aspirated (suctioned) into the syringe. This sample is then analyzed microscopically.
The site is swabbed and a pressure dressing is applied.
|Normal fails to show bacterial growth, fluid is clear with no white blood cells or inflammatory cells.|
Magnetic resonance imaging
Visualizes detailed images of bone, cartilage and soft tissues around joints. It can image:
*clots or active bleeding in the joints
|You will be asked to remove jewelry, dentures, clips, artificial limbs, braces, hairpins, hearing aids.
You will then lie on the table (possibly having received sedation) which slides into a tunnel-like space.
Earplugs or headphones with music may be given to mask the tapping noises during the scan.
If needed, contrast material may be given in the IV line inserted into a vein.
|No visualization of growths, tumors, bleeding.
No signs of inflammation.
|CT Scan||Looks for abnormalities of the knee including tumors, demineralization of bone, swelling of joints||You will be asked to remove jewelry, hearing aids and glasses.
You will lie on a table and straps will be applied to your head to keep it steady. Sedation may be given.
The table slides into a round opening of the scanner which then moves around your body, taking pictures. Buzzing can be heard during this process.
If contrast material is needed, it will be inserted into an IV in a vein (of the arm or hand)
The test takes 30 min.
|Images show no bleeding,
No foreign objects, no tumors or growths, no fractures.
|X-Rays||Assesses joint spaces, and narrowing which indicates cartilage breakdown. Bone spurs may be seen.||You will lie down on a table in the radiology department with a film plate underneath.
An X-ray machine emits a beam of ionizing radiation from the tube through the knee area ,which is then absorbed onto the film or digital camera for imaging.
The full test lasts 10-15 minutes and no pain is felt.
|No bone or cartilage damage. Absence of bone spurs noted.|
Common Treatments and Medications for Osteoarthritis of the Knee
While there is no cure for osteoarthritis of the knee, there are treatment regimens that relieve pain and improve joint motion so daily activities can resume with less pain.
Modification of lifestyle choices and rehabilitation therapies are often attempted first.
These would include:
- Exercise – to strengthen muscles surrounding the knee making the joint more flexible, and stable
- Weight loss -the more excess poundage lost, the less knee pain will occur.
- Physical and Occupational therapy – exercises can strengthen muscles and flexibility to the knee joint. Instruction on how to perform daily actions with less pain is quite helpful.
The following chart details medications used for relief of osteoarthritis.
|Drug Treatment||Mode of Action/Benefits||Risks /Side Effects|
(Over the counter pain medicine)
Tinnitus (ringing in ears)
Liver and Kidney damage
Ulcers, bleeding from GI tract
|Naproxen (over the counter pain medicine)||*Decreases inflammation
|Side effects are the same as Ibuprofen|
|Acetaminophen||Decreases pain||Can cause liver damage in high amounts|
|Tramadol||Central acting analgesic- effective pain relief||Nausea
Used only for short time for flare-ups
|Narcotics||Relieves strong pain||Addiction is possible
|Corticosteroid injections||Relieves joint pain||Number of treatments is limited – can cause joint damage (osteoporosis)|
|Hyaluronic acid injections||Cushions the knee joint to relieve pain||Only approved for knee joints
Number of times used is limited
Joint Replacement: damaged joint surfaces are replaced with prostheses (plastic and metal replacement devices) This provides a return to an active, painless life. Duration of benefit depends on types of activity and stress placed on them.
- Braces – Support type reinforces and stabilizes the knee. Unloader type diverts weight from affected knee
- Topical creams – containing capsaicin
- Supplements – such as glucosamine and chondroitin