Knee pain

Living with joint pain or stiffness can affect everyday activities, from climbing stairs to playing sports.

Seeing a knee specialist quickly could help you get back on your feet faster.

People with knee pain in Swindon, Wiltshire and further afield won’t have to wait long to see a knee consultant at The Ridgeway Hospital.

At Circle Health Group, our skilled consultant orthopaedic knee surgeons can help you discover why you are suffering knee problems.

They offer assessment, diagnoses, and treatments to tackle and get rid of knee pain quickly.

Our consultant orthopaedic surgeons at The Ridgeway Hospital can usually see you about a knee problem within one to two weeks. Around 60-70% of the patients we see at the hospital have non-operative first treatments, such as physiotherapy.

But suppose you need surgery? In that case, our orthopaedic group includes specialist knee consultants with specific interests, vast experience, and expertise in knee problems, from anterior cruciate ligament (ACL) repairs to total knee replacements.

Our knee specialists work in multidisciplinary teams, including nurses, physiotherapists, rheumatologists, pain specialists and sports pain specialists, whose ability and standards of care are exemplary.   

Knee pain conditions and injuries affect people of any age. Symptoms include pain, swelling, discomfort, stiffness, and limited movement.

At The Ridgeway Hospital, we help knee patients from a large area in and around Swindon and Wiltshire.

Patients come to us with knee pain from soreness due to a sprain or muscle tear to chronic and acute pain from arthritis and inflammatory conditions.

Anatomy of the knee

Your knee is a complex joint consisting of three bones – the lower thigh-bone (femur), upper shin-bone (tibia) and kneecap (patella). Your knee specialist at The Ridgeway may talk about three parts or compartments:

• Patellofemoral – where the shin-bone and thigh-bone meet
• Medial – inside the knee
• Lateral femorotibial – outside the knee

When osteoarthritis (OA) affects all three compartments, it’s called tricompartmental OA.

Four ligaments hold the knee bones together – the collateral ligaments inside and outside the knee, and the cruciate ligaments, shaped like an X inside your knee joint.

The knee also includes:

• Articular cartilage – covering the ends of the thigh-bone, shin-bone and back of the kneecap
• Meniscal cartilage (meniscus) – on the knee’s inner and outer side

The smooth articular cartilage cushions the knee as it bends and straightens, while the rubbery meniscus cartilage acts as a shock absorber, keeping the joint stable.

A lubricating lining around the joint, called a synovial membrane, prevents friction.

Typical knee pain comes from an injury, such as a sprain or torn ligament. Constitutional or mid-to-late-stage osteoarthritis, caused by old age or wear and tear, or an inflammatory condition like rheumatoid arthritis (RA) can also cause knee pain.

As many different symptoms can present themselves in one person, a knee consultant is often best placed to unravel their actual cause or causes.

Sunny Deo, a Consultant Orthopaedic Surgeon and knee specialist at The Ridgeway, said: “Diagnosing the specific causes of knee pain can be tricky. Historically, we’ve thought of the knee as a purely mechanical structure, focusing on structural abnormalities such as the cartilage and joint surfaces as the prime causes of knee pain. However, there are lots of potential other causes, and they often coexist.”

Causes of knee pain from injuries

• Simple sprains and strains
• Cartilage damage
• Tendon and ligament tears
• Tendonitis
• Fractures
• Dislocations

Causes of knee pain without injury

• Osteoarthritis
• Rheumatoid arthritis
• Septic arthritis
• Gout
• Bursitis – inflammation of the fluid-filled sac (bursa) near your knee

There are multiple symptoms of joint pain, also known as musculoskeletal pain, not all of which are listed here. Many knee pain symptoms co-exist, so you should speak to a suitable clinician, such as a knee consultant at The Ridgeway, who can find the actual cause.

Knee pain when running

Pain felt behind the kneecap or around it when running, cycling, doing squats or flexing the knee might mean a torn ligament or damage to the cartilage.

Pain under the kneecap

It could be tendonitis if you feel pain between your kneecap and shin, particularly after running or jumping. It might be Osgood-Schlatter's disease if you’re between 14 and 18.

Swollen knee and pain

A cruciate ligament tear could be the culprit if you experience pain and rapid swelling when injured and hear a popping sound. It may worsen when you bend the knee and put pressure on it. Osteoarthritis also causes pain and swelling.

Sharp knee pain

A dislocation of the kneecap (patella), usually following a blow or twist to the knee, can cause severe knee pain, a popping feeling, swelling and difficulty straightening the knee.

Knee clicking and pain

Crunching, grating and crackling sounds, joint pain, and stiffness are classic symptoms of knee osteoarthritis. The symptoms can range from mild to chronic.

Pain when kneeling

A tender, warm, painful, and swollen knee that hurts when you kneel on it or bend it could signify bursitis. Mr Deo said: “If a knee is inflamed, it will be warm or hot, which can fluctuate.”

Hot and painful knee

Gout signs include sudden hot and severe pain in the joint, with swollen, red skin over the knee. If you also have a high temperature, worsening pain and sickness, you should seek urgent medical help as it might mean an infection.

Hip pain radiating down the leg to the knee

10-15% of adults with severe end-stage hip arthritis will present with mainly knee pain, said Mr Deo, which doesn’t happen the other way around.

He added: “Pain can arise in the knee from conditions of the bone in and around the knee, particularly the lower end of the thigh-bone or distal femur, or you can get referred pain to the knee from the hip and the back.”

As soon as you have had a knee injury, the acronym PRICE can help you remember the first steps to take:

• P – Paracetamol
• R – Rest
• I – Ice
• C – Compression
• E – Elevation

Other self-help for knee pain

• Weight management
• Local massage with anti-inflammatory gels
• Painkillers – NSAID tablets such as ibuprofen

Mr Deo said: “In general, being overweight for your height will affect any underlying problem affecting a large load-bearing joint such as the knee.”

At your first appointment, your knee consultant will talk to you about your symptoms, do a physical examination and arrange for any necessary pictures of your knee at The Ridgeway Hospital’s extensive imaging suite.

In addition to X-rays or magnetic resonance imaging (MRI) scans to aid diagnosis, you could be sent for an ultrasound or computerised tomography (CT) scan, which can be arranged quickly.

GPs may prescribe opiates such as codeine for patients with severe uncontrolled pain where standard paracetamol and ibuprofen have not helped.

You may already be on a potent painkiller prescribed by the GP when you see a knee consultant at The Ridgeway Hospital. If not, and if needed, our consultants can prescribe strong pain relief and arrange for targeted treatments based on your symptoms. The assessment includes discussing patient-related factors such as your hobbies, lifestyle and family history.

Once a diagnosis is made, many treatments are non-operative. They include exercise and activity advice (e.g., cycling is generally better than walking for most knee conditions). Other treatments are painkillers and anti-inflammatories, adjuncts like walking aids and generic braces, and prescriptions for specialised braces for the knee.

Physiotherapy for knee pain

Your consultant may recommend a physiotherapist to help with physical therapy for knee pain due to osteoarthritis or injury. The physiotherapy department at The Ridgeway Hospital has a gym and hydrotherapy pool. Hydrotherapy or aquatic therapy helps physios reduce your knee pain and increase the joint’s range of motion.

Discover what happens during hydrotherapy.

Injection therapy for knee pain

A steroid injection could reduce painful joints and inflammation. Other injections that might be useful if you have painful osteoarthritis in the knee, for example, include synthetic joint surfacing injections and newer platelet-rich plasma injections, which use your platelets to accelerate healing.

Our specialist knee consultants at the Ridgeway Hospital may recommend surgery as a last resort if all other options have been tried and failed.

Markers of severe knee pain symptoms are an acute knee injury where you can’t walk, significant swelling and pain, and pain at night that interrupts sleep.

You should think about seeing a clinician such as a knee specialist at the Ridgeway Hospital if you have had a chronic condition lasting more than three weeks and have seen no improvement in symptoms.

For people with late-stage osteoarthritis, progressive or severe symptoms that affect your quality of life for over a year might mean you should consider joint replacement surgery.

When to see a knee specialist

If the pain does not go away or is so bad that it affects your quality of life, you should see a clinician such as a knee consultant for further guidance.

The orthopaedic group at The Ridgeway Hospital includes consultant orthopaedic surgeons with specific clinical interests in knee conditions, so it’s worth looking at our list of specialists to see who specialises in what.

You can also choose to see, or be referred to, a rheumatologist, a sports medicine consultant (who will see any sports-related condition) or a pain specialist at the hospital.

Shorter waiting times are available at The Ridgeway for all types of knee surgery. The following primary operations are performed by our knee specialists in one of three well-equipped theatres.

Keyhole surgeries – arthroscopy and debridement

To look inside your knee joint, your consultant may perform a knee arthroscopy (keyhole surgery) to examine and diagnose the cause of symptoms. Knee debridement or washout describes the removal of loose cartilage and debris.

Total knee replacement

This major operation, also known as arthroplasty, is performed thousands of times in UK hospitals every year. The surgeon will replace all three knee components (parts) with implants during surgery.

The Stryker Nav Suite at The Ridgeway includes an integrated computer-assisted machine to guide the consultant orthopaedic knee surgeon using digital on-screen monitoring.

Partial knee replacement

In a partial knee replacement procedure, also known as unicompartmental surgery, the surgeon replaces one part of the knee with an artificial joint.

Read more about partial knee replacement surgery.

ACL reconstruction

An anterior cruciate ligament (ACL) reconstructive surgery involves repairing or reconstructing the ligament with a graft to stop it from giving way when you twist or turn it. 

High tibial osteotomy

In this procedure, the leg is broken to realign the knee and take the load off the damaged joint.