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Knee pain

Knee pain can be debilitating, but there are effective treatment options available to resolve your pain

Doctor examining patients knee joint weeks following surgery
Knee pain is estimated to affect as many as 25% of the UK adult population and is the second most common cause of chronic pain.

There are many different reasons why someone might experience knee pain, but fortunately, establishing the underlying cause of the discomfort is usually a fairly straightforward process.

Once the cause of knee pain has been established, orthopaedic specialists, such as Mr Sherif El-Tawil, Consultant Orthopaedic Surgeon at The Clementine Churchill Hospital in Harrow.

“Knee pain is one of the most common reasons why patients are referred to me,” explains Mr El-Tawil. “Whether it’s a sporting injury or degenerative disease causing their pain, patients can quickly find that their quality of life is adversely affected”.

The knee is a complex structure and so to be able to understand the causes of knee pain, it helps to have some knowledge of the anatomy of the joint and how it works.

The primary function of the knee is to work in conjunction with the hips and ankles to support the weight of your body. It is also an essential part of the function of the legs, enabling them to bend and straighten so that you can sit, stand and perform other day-to-day movements.

The knee contains three bones:

  • The tibia: this is also known as the shin or shin bone and is at the front of the lower leg
  • The femur: this is also known as the thigh bone and is in the upper leg
  • The patella; better known as the kneecap, it is a floating bone located where the tibia and femur meet. It protects the knee and connects the muscles in the front of the thigh to the tibia

At the end of each bone is a thin layer of cartilage that acts as a shock absorber and protects the knee from damage. Other integral structures to the function of the knee include:

  • Tendons: tough cords of fibrous tissue that connect muscles to bones in each of the joints
  • Ligaments: highly elastic cords of tissue that connect bone to bone

For optimal knee function, all of the different components of the knee must be in excellent condition and working harmoniously together.

The complexity of the knee joint means that there are many potential causes of knee pain.

However, there are some that are much more common than others, and it will be these that are first considered during your consultation with your Circle Health Group orthopaedic consultant.

Osteoarthritis

By far the most common cause of knee pain, osteoarthritis is a degenerative condition that occurs when the cartilage that usually covers the end of each bone starts to break down.

When this happens, the bones no longer glide softly off of each other when you move. Instead, they rub together, creating friction that triggers pain, inflammation and even damage to the bones themselves.

Osteoarthritis most often affects the older generation, but it can be seen in patients of all ages. It is also more common in people who are overweight or obese, or who perform repetitive movements at work or during leisure activities, such as painting or rowing, that accelerate wear and tear on the joint.

Many people don’t realise that they have osteoarthritis at all. “I see many patients for another type of knee injury, and only uncover the arthritis as a result of our investigations into this injury,” says Mr El-Tawil.

Osteoarthritis symptoms

Osteoarthritis can be painful and debilitating for those who suffer from the condition. The pain of osteoarthritis often starts off mild but gets progressively worse and can morph from sporadic to consistent. Many patients find that their arthritic pain gets worse in colder weather, and after they have spent a long period of time sitting still.

Patients with osteoarthritis also experience another key symptom — stiffness. Stiffness is a natural part of the degeneration of the joint, because as the cartilage starts to break down, the joint becomes unable to move as smoothly as before. As time goes on, they may find that their knee gets progressively stiffer until it becomes hard to move around.

“The longer a patient goes without treatment, the stiffer their knee is likely to become,” explains Mr El-Tawil.

Fortunately, there are a variety of treatments for osteoarthritis, ranging from anti-inflammatory medications to surgery to replace the entire knee joint. Your orthopaedic consultant will be able to advise you on the best course of action to treat your osteoarthritis.

Strains and sprains

Slips and trips are very common accidents and when they happen, we can find our knees put under excessive or sudden strain.

When this happens, it can cause the connective tissues of the knee to overextend. This creates countless micro-injuries in the ligament that result in symptoms including pain, stiffness, swelling and inflammation, limited range of motion and more.

Most sprains and strains will heal themselves, but patients will need to take extra care of the joint during their recovery. This may mean using a support bandage on the joint, getting plenty of rest and controlling inflammation using heat/cold and anti-inflammatory medications.

Ligament tears

In some cases, an accident can actually result in a ligament tear. If this happens, it won’t be possible for it to heal without surgical intervention. Your orthopaedic consultant will do this arthroscopically.

Arthroscopic surgery is minimally invasive and uses just a couple of small incisions rather than performing open surgery. This means less scarring, less risk of complications, faster healing and less pain,” explains Mr El-Tawil.

The ligament is simply stitched back together and left to heal, which should reduce your knee pain and eventually restore your full range of motion.

Tendonitis

Unsurprisingly, tendonitis affects the tendons, which are the thick, fibrous cords that attach bone to muscle.

Tendonitis is characterised by irritation and inflammation of the tendons, which is usually caused by repetitive strain. For example, if you cycle, you will be repeatedly bending and straightening your legs as you pedal. This movement can put excessive strain on the tendons in the knee, causing pain, stiffness and limited mobility.

Some patients find that their knee looks red or feels hot to the touch. Others may hear an audible creaking sound when they try to move their knee.

Tendonitis management

Tendonitis can be managed at home using hot/cold techniques, anti-inflammatories and knee supports.

However, if you suffer from regular episodes of tendonitis, or you aren’t able to ease your symptoms sufficiently yourself, it’s a good idea to seek a referral to an orthopaedic consultant. They can offer more specialised treatments such as:

  • Steroid injections, which work by counteracting inflammation
  • Platelet-rich plasma, or PRP, which uses platelets from your own blood to accelerate the healing process
  • Surgery to repair a damaged/ruptured tendon

Again, where possible, any surgery will be performed arthroscopically.

Dislocated kneecap

The kneecap, or patella, is usually positioned within a groove in the femur. However, an accident or injury, such as a sudden pivot or a crush injury to the knee, can push it out of place. This is known as dislocation and can be extremely painful.

Other symptoms of knee dislocation include:

  • Swelling and inflammation
  • An audible ‘pop’ in the knee at the time of dislocation
  • Being unable to bear weight on the knee, even for a moment
  • Being unable to straighten the knee

While it’s not unheard of for a dislocated patella to naturally slip back into position, it is still advisable to speak to your orthopaedic consultant. They will be able to help carry out investigations to determine why the dislocation happened, identifying any weaknesses that could lead to further dislocations in the future.

If your knee doesn’t go back into position by itself, you’ll need medical support to resolve it. Fixing a dislocated knee is known as a reduction and requires a short forceful manipulation.

Don’t worry — you’ll be given pain medication before the manipulation is performed. Most patients who’ve had a dislocation will require physical therapy to support their recovery. Your orthopaedic specialist will be able to refer you to a suitable physical therapist.

In some cases of knee pain, professional medical intervention is needed to help treat the underlying cause of knee pain so that your discomfort is alleviated.

However, there are also many tricks and techniques that you can use at home to keep your knee pain under control.

The importance of reducing inflammation

Inflammation is the body’s normal response to an injury or illness, and its purpose is to protect itself from perceived harm such as infection or a virus. When you suffer an injury, your body will automatically swell to protect it, with the area becoming red, painful and even warm to the touch.

The same is true of an injured knee. In most cases, inflammation will only last during the initial stages of the healing process. However, some patients who suffer an injury go on to develop chronic inflammation — something which causes continued cycles of pain and relief.

Fortunately, there are things that you can do to help relieve knee pain yourself at home.

  • Get plenty of rest
  • Protect the knee from further trauma using a support, bandage or splint
  • Ice your knee several times each day, for up to 30 minutes at a time, using an ice pack or a bag of frozen vegetables wrapped in a clean cloth or towel
  • Use compression garments to counteract swelling
  • Elevate your knee, which will reduce swelling and disperse any fluids that have collected in the knee
  • Take anti-inflammatory over-the-counter medications such as ibuprofen

If at-home treatments aren’t giving you enough relief from your knee pain, your Circle Health Group orthopaedic consultant may recommend steroid injections.

Steroid injections are a short-term, but highly successful, treatment for many types of joint pain. They aren’t the same as anabolic steroids, which are the illegal drug used by some athletes to build muscle mass.

“Steroid injections are recommended for patients with sports and general knee injuries, but sadly aren’t effective at helping to reduce the pain of osteoarthritis,” says Mr El-Tawil.

How steroid injections for knee pain work

The active ingredient in steroid injections is hydrocortisone. Hydrocortisone works by calming down your body’s immune response to reduce pain, itching and pain. Although topical hydrocortisone treatments are available, for knee pain it’s necessary to administer the ingredient directly into the joints.

The process of steroid injections can cause some discomfort, and your knee may even feel stiffer and more painful for the first few days after your treatment. Nevertheless, within a week you should experience a significant drop in your discomfort without medications, and this could last for several months or even longer.

Unfortunately, steroid injections are not a long-term treatment for knee pain. This is because, over time, they can reduce how well your immune system works. Low immunity puts you at risk of picking up any bacterial or viral diseases going around and makes it harder for you to fight them if you are affected.

Your orthopaedic consultant will be able to advise you if you are a suitable candidate for steroid injections and provide you with all of the information that you need to understand what’s involved with this treatment.

PRP stands for platelet-rich plasma. Platelet-rich plasma injections are a fairly new treatment for a variety of different conditions, ranging from sports injuries to issues such as hair loss.

PRP is a form of regenerative medicine. This is because it uses your own body cells to have a therapeutic effect. PRP treatment has been shown to help support wound healing in trauma and joint injury by stimulating growth factors. PRP uses your own blood, meaning that it is very safe and there is no risk of treatment rejection.

“PRP therapy is generally a good option for patients with knee pain caused by injury such as a torn ACL. It can also be beneficial for patients with early-stage osteoarthritis,” explains Mr El-Tawil.

Hyaluronic acid is most commonly known as a key ingredient in dermal fillers — a non-surgical cosmetic treatment.

However, hyaluronic acid injections have also been proven to be an effective treatment for osteoarthritis. Not only do they have anti-inflammatory effects, but hyaluronic acid also aids lubrication and shock absorption within the knee joint, reducing pain and preventing further loss of cartilage and bone.

Like steroid injections, your knee may initially feel worse after treatment. The reason for this is that it takes time for hyaluronic acid to have an effect. However, the pain usually starts to improve around four weeks after the first injection and continues to improve for up to six months. Research shows that additional injections may provide longer relief of up to three years.

“Hyaluronic acid injections are a very effective way of nourishing the knee cartilage and boosting natural collagen production for the soft tissues of the knee, making it a good treatment option for patients with early osteoarthritis,” states Mr El-Tawil.

Non-surgical treatment methods are always recommended initially, but the reality is that these won’t be effective for every patient. Depending on the underlying cause of your knee pain and the success of non-surgical treatments, your orthopaedic consultant may recommend you for knee surgery.

Some of the ways in which surgery can help include:

  • By removing or repairing damaged cartilage within the knee
  • By removing loose fragments of bone
  • By removing inflamed areas of connective tissue
  • By treating the infection that is affecting the knee

Your orthopaedic surgeon will be able to explain how surgery could help you, what will be involved in your surgery, how to prepare and what to expect from your recovery. This will include things like how long you will need to take off of work, when you’ll be able to drive again and what other rehabilitation steps you’ll need to take (such as having physical therapy). 

Knee pain may be frustrating and limit your day-to-day activities, but with the right support and care from the orthopaedic team at The Clementine Churchill Hospital, it’s possible to get to the cause of your discomfort and find the best knee pain treatment to restore your quality of life.

If you’re experiencing knee pain and would like more information about possible treatment options, you can book your private consultation online or give us a call on 020 8872 3872

Specialists offering Knee pain

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Mr Arjuna Imbuldeniya

Consultant Hip, Knee and Trauma surgeon

MBBS, B.Med.Sci(Hons), MSc, DIC, FRCS (Tr& Orth)

The Clementine Churchill Hospital 1 more Syon Clinic

View profile Book online

Mr John Murphy

Consultant Orthopaedic Surgeon

BSc (Hons), MB ChB, FRCS (Eng), FRCS (Orth)

The Clementine Churchill Hospital

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Mr Naveed Shaikh

Consultant Trauma and Orthopaedic Surgeon

MB BS, FRCS (Tr&Orth)

Bishops Wood Hospital 1 more The Clementine Churchill Hospital

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Mr Amgad Nakhla

Consultant Orthopaedic Surgeon

MB.BCh. MSc. MRCS, FRCS (Tr & Orth)

The Clementine Churchill Hospital

View profile Book online

Prof Hasan Tahir

Consultant Physician in Rheumatology & Acute medicine

BSc, MB BS, D Sports-Ex Med, MSc, MFSEM(UK), FRCP(UK)

The Cavell Hospital 2 more The Clementine Churchill Hospital The Kings Oak Hospital

View profile Book online

Mr Hinesh Bhatt

Consultant Orthopaedic Surgeon

FRCS(Tr&Ortho), M.S(Ortho)

Bishops Wood Hospital 1 more The Clementine Churchill Hospital

View profile Book online

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