Chronic Knee Pain & Arthritis
Complete loss of the cartilage layers in the knee commonly becomes painful and is termed as arthritis – this can be either focal (in one defined area of the knee) or generalised (widespread throughout two or all three of the knee compartments).
Signs of arthritis: The pain commonly develops over months or years and is not usually associated with an obvious injury or incident. Other signs of painful knee arthritis include activity-related pain and swelling, knee joint stiffness (particularly in the morning or after periods of rest) and night pain which often disturbs sleep. Normal daily tasks may become difficult and walking any distance is a challenge.
Diagnosis: Diagnosis is made largely from the history and examination with Xrays confirming these findings. An MRI scan may be used, particularly when a focal area of cartilage is suspected.
Treatment – The treatment options will depend on your individual goals and needs. In broad terms these are split in to:-
- Non-operative Management
- Maximal Conservative Treatment
- Operative Treatment
Non-Operative Management: For some of us just understanding that our pain is from arthritis is the necessary assurance. I would always suggest that some simple conservative measures are undertaken to minimise symptoms, however. These are listed below.
Maximal Conservative Treatment: The following are well-proven to improve the symptoms of knee arthritis and should be considered as standard in the initial treatment of most cases of arthritis:-
Weight loss – due to the way our knees carry load when we move the knees take substantial loads in our daily routine. Every pound (or kilogram) that we lose will offload 9 times that weight from the knee joint during some day to day activities. This commonly results in significant improvements in pain.
Physiotherapy & Strengthening Programmes – Improvements in strength and flexibility restore normal movement to the knee. This reduces pain. Your physiotherapist or local gym may be able to help with finding arthritis-specific classes and water-based classes, both of which can be very helpful. We are constantly visiting local physiotherapists and have been very impressed with the quality offered – click here for an updated list.
Analgesia (Pain-killers) – Your GP may have already started you on simple painkillers. They can play an important role in containing arthritic pain, particularly at night. Injections into the knee joint (steroid or viscosupplementation) are not something that we recommend in in majority of cases. The scientific evidence is that these give only short-term relief and, in the case of steroid injections, can actually damage the normal cartilage layers that remain. In addition these injections are not without their own complications.
Operative Management: If symptoms are significant and affect your life on a regular basis then you may decide on a surgical solution. The type of surgery will depend on the area(s) of your knee that are affected as well as other important factors that will be discussed in detail. Options may include bony-realignment procedures, known as knee osteotomy, or a form of knee resurfacing which replaces the worn surface either fully (Total Knee Resurfacing) or partially (Unicompartmental Knee Resurfacing). For further information on these procedures click the link below:-