Osteoarthritis

Osteoarthritis is a chronic degenerative joint disease that results in damage to the articular cartilage of your joints. Articular cartilage is essential for smooth and pain free movements of your joints. With osteoarthritis there are three main disease processes that results in joint damage and symptoms:

• Inflammation of the joint and joint surfaces
• Thinning and dehydration of the articular cartilage
• Damage to underlying bone and bone spur formation

There are several risk factors that lead to knee joint osteoarthritis and often these occur in combination. They include:

• Aging
• Genetics
• Obesity
• Previous joint injury
• Repetitive use
• Muscle weakness

The typical symptoms of osteoarthritis are:

• Joint pain which is worse with activity
• Joint stiffness which is worse in the morning or after periods of rest
• Joint swelling or tenderness to touch
• Joint deformity (bone bumps or change in shape)
• Crepitus which is griding or cracking in the joint

It is important to be educated about osteoarthritis as it is a chronic condition and will need to be managed for life. Fortunately there are good treatment options available and having a good understanding of how to successfully manage osteoarthritis is essential. An active approach to managing knee joint osteoarthritis is the key to successful symptom control.

We know that with knee joint osteoarthritis there is thinning of the articular cartilage of the knee which reduces the knee's ability to withstand load. Weight loss of 5 to 10% can significantly reduce symptoms of knee joint osteoarthritis and help reduce disease progression. Weight loss should be achieved through exercise and a well balanced diet. Often talking to a dietition is recommended.

The most common medications used for the treatment of osteoarthritis are paracetamol and antiinflammatories. Paracetamol offers effective pain relief from pain related to osteoarthritis and slow release paracetamol is generally recommended for a sustained relief of symptoms. Anti-inflammatories such is ibuprofen, celecoxib or meloxicam can also be used when there is associated swelling. However antiinflammatories do have side ffects and should not be used long term. Topical anti-inflammatories can be used in some cases. You must discuss the use of medications with your doctor before starting.

There are several supplements that have been used to manage the symptoms of knee joint osteoarthritis. These include glucosamine, chondroitin, tumeric, fish oil and vitamin D. However the evidence for their benefit in treating osteoarthritis is lacking and therefore are not routinely recommended. These supplements also cost a lot of money so without clear evidence for their effectiveness they are not typically advised. However some people do report benefits from these supplements and the side effects are low.

Exercise has some of the strongest evidence for the management of knee joint osteoarthritis. Land based activities that have low impact and build muscle strength and balance are the most effective. These include walking, muscle strengthening exercises, stationary cycling, pilates, Tai Chi and yoga. Hydrotherapy is also an effective options for those who like exercising in the water.

Physiotherapists are well trained in the management of knee joint osteoarthritis and can provide guidance on the correct exercises to perform to optimise your knee health. They can also help reduce pain and inflammation.

Joint injections can be very effective in the management of knee joint osteoarthritis. There are many different types of injections that can be used and they all have different benefits. Corticosteroids can be very effective in managing joint inflammation and pain but must be used sparingly. Hyluronic acid injections can be very effective in providing lubrication to the joint and thereby reducing symptoms. Platelet rich plasma injections can be very effective is reducing inflammation and slowing down the osteoarthritis disease process. It is advised to discuss these options with your doctor.

There aren't any surgical procedures recommended for mild to moderate knee joint osteoarthritis. In severe cases of knee joint osteoarthritis a total knee replacement may be required when the pain is not well controlled by other treatment options.