Knee arthritis

Arthritis is a condition that causes pain and inflammation in the joints of the body. It affects millions of people in the UK. While arthritis becomes more likely as we age, it can occur in people of all ages, including children.

Living with long-term arthritis can be difficult. You may be in considerable pain and you may be concerned about the gradual loss of mobility. As the disease develops, these levels of pain and discomfort will only increase, which in the long term may affect your mental and physical wellbeing.

If you are living with painful arthritis in your knee or knees and it's impacting your quality of life, it's time to speak to a specialist. At Circle Health Group, our orthopaedic consultants help thousands of people each year to manage, reduce or even eliminate their knee pain altogether. Call us or book online today and you could be meeting with a specialist in as little as 48 hours.

The knee is one of the most complex joints in the body. It is commonly referred to as a hinge joint due to the way it bends. It is made up of three main components:

• The lower end of the thigh bone (femur)
• The upper end of the shinbone (tibia)
• The kneecap (patella)

The ends of the bones in the knee joint are covered with a smooth tissue called articular cartilage, which helps to cushion the bones during movement.

Within the joint, two crescent-shaped pieces of cartilage, called the lateral meniscus and medial meniscus, sit between the thigh bone and shinbone. This rubbery material acts as a shock absorber as well as keeping the joint stable.

Finally, a thin lining, called the synovial membrane, surrounds the joint. This helps to lubricate the cartilage and reduce friction.

Knee arthritis occurs when the cartilage that cushions the knee wears down. This can be due to overuse of the joint, trauma, autoimmune conditions or wear and tear over time. When the cartilage wears down, the damage is irreversible. However, there are a range of treatments, both surgical and nonsurgical, available to improve your flexibility and quality of life.

What causes knee osteoarthritis?

Osteoarthritis is the most common type of arthritis. It is also known as wear and tear arthritis.

In a healthy knee joint, the articular cartilage that covers the ends of the bones in the kneecap is smooth. Osteoarthritis causes this articular cartilage to weaken and become thin. Over time, it may become so thin that it cannot prevent friction between the bones from occurring.

Normally the body is very good at repairing the damage. However, osteoarthritis causes the articular cartilage to break down much more quickly than the body can repair it. In addition, the healing process itself can sometimes create new bony growths called osteophytes. These osteophytes can cause additional pain and stiffness in the knee.

In more severe cases of osteoarthritis, the protective layer of articular cartilage in the knee will have worn away completely. This means that the bones start to rub directly on one another as the knee joint moves. The friction causes can cause severe, chronic pain as well as extreme stiffness in the knee.

What causes rheumatoid arthritis of the knee?

The other common type of arthritis to affect the knee is rheumatoid arthritis (RA). This is an autoimmune condition, which means that the immune system attacks healthy tissue. It is still not known what triggers this.

The immune system makes antibodies to attack bacteria and viruses. This helps the body to fight infections. If you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.

When the immune system attacks the knee, it causes the thin layer of cells (synovium) that cover the knee joint to become inflamed. This causes chemicals to be released that damage nearby bones, cartilage, tendons and ligaments.

If rheumatoid arthritis is left untreated, it can cause the joint to become deformed and harder to bend. Eventually, it may destroy the knee joint completely.

Knee pain and stiffness

In the early stages of arthritis, the two most common symptoms are pain and stiffness in the knee. As the disease develops, these symptoms gradually worsen, affecting everyday activities and exercise. The joint pain is usually felt over the whole of the knee rather than confined to one specific area.

As arthritis develops, more of the articular cartilage breaks down. Ultimately, this will allow the bones to rub against one another. At this point, the pain in the knee will become very severe. The pain may be so intense at times that it will prevent you from sleeping at night.

Eventually, as the disease progresses, the bones in the knee can be forced out of their normal position. This can lead to a deformity of the knee. However, these changes will happen very slowly so you may not notice the change in the knee until at an advanced stage.

Other symptoms of knee arthritis include:

Reduced movement

As the disease progresses, you may find certain movements become more difficult, such as standing up or sitting down, without aid.

Weakness in the knee

You may notice that your leg feels weaker or that the muscles have lost some of their strength and tone. On some occasions, the knee may give way without warning.

Swelling

Over time the joint may become swollen. Joint inflammation can be caused by rheumatoid or psoriatic arthritis in the knee.

Noisy knee

You may hear or feel creaking or cracking noises when bending or straightening the knee. This is called crepitus.

For knee arthritis diagnosis, your doctor will look for stiffness and structural changes in the joint. Other indicators of knee arthritis will be swelling and reduced movement in the affected leg.

Diagnosis will often be made from a physical examination and an x-ray of the knee. Occasionally an MRI scan may be helpful, especially if the arthritis is not at an advanced stage.

You can usually see a consultant orthopaedic surgeon for your first appointment within 48 hours of booking your appointment with us.

What will your consultant ask you?

Your initial consultation is a chance for your specialist to find out as much as they can about you and your knee. They will ask you lots of questions about your health, and they'll examine your medical history in detail. they want to know about both previous and existing medical conditions, whether you are taking any medications or currently undergoing any treatments for your knee pain, and whether anything has helped to ease your knee problems in the past.

They will ask you personal questions too, perhaps about your hobbies and interests and how your pain has affected your ability to enjoy these. This is because they want to understand what's important to you and why you are seeking treatment for knee pain. They want to know how long you've been in pain, how and when the pain began, and how it impacts your daily life.

In order to assess your symptoms properly and make an accurate diagnosis of your knee pain, your consultant will gently carry out a physical examination of your knee joint(s). They want to evaluate how you move your knee joint and in which positions it causes you the most pain. Sometimes your consultant will request an X-ray to help confirm their diagnosis. If so, this will be performed by one of our radiographers. Other diagnostic testing that could be used includes CT scanning and blood tests.

What should you ask your consultant?

After your consultant has confirmed the cause of your knee pain, they will share more information about knee arthritis and potential treatments for your knee pain to ensure you have a comprehensive understanding of your options.

Your consultant is there to answer any questions you might have about knee arthritis and to alleviate any concerns you might have about having surgery, or any other treatment. Please don't hesitate to ask any and every question that comes into your head. No question is silly, no question is too small. We want you to feel as informed and involved as possible.

There are several different types of arthritis, however, the most common types of arthritis in the knee are:

Osteoarthritis (OA)

Osteoarthritis is the most common form of arthritis. In the UK it affects nearly 9 million people. Osteoarthritis is more common in women and those who in are their mid-40s or older, but it can occur at any age as the result of injury.

Knee osteoarthritis affects the smooth cartilage that lines the knee joints. The process of osteoarthritis involves wearing or thinning of the smooth cartilage joint surfaces as well as stiffening to the soft tissue surrounding the joint.

Arthritis in knee makes the movement of the affected joint more difficult, which leads to pain and stiffness. It can also lead to the formation of bone spurs in the knee.

Rheumatoid arthritis (RA)

This is where the immune system itself attacks the joints in the body. This causes swelling, damage and sometimes a noticeable change in the shape of the joint itself. In the knee, rheumatoid arthritis affected joints may appear deformed and become harder to bend.

While osteoarthritis is the most common cause of knee pain, treatments and medical support are available for other types of arthritis as well. There is currently no known cure for arthritis, but a range of treatments can help reduce symptoms and manage pain.

Rheumatoid arthritis of the knee brings its own challenges. As it is an autoimmune disease, other areas of the body can be affected. For example, rheumatoid arthritis may cause other autoimmune problems like inflammation of the heart, lungs or eyes.

At present there is no cure for arthritis in the knee. However, there are some effective arthritis knee treatments available that will help you to reduce pain and improve your range of motion in the joint. In the early stages of disease, your doctor will recommend non-surgical therapies. Conservative knee arthritis treatments available include:

Pain relief

Over-the-counter pain medication can help give some arthritis knee pain relief. Your consultant will discuss with you what medications maybe suitable, the amount to take and the frequency of this. Medication can help you manage the condition of knee arthritis successfully to help improve your quality of life.

Weight loss

Losing weight can help reduce the weight-bearing load on the knee. Losing weight may therefore help reduce pain in the knee. You and your consultant can discuss this option together as well as how to encourage weight-loss and exercises suitable.

Physiotherapy

Physiotherapy for joint pain comprises a specialist exercise programme designed to strengthen the muscles around your joints, improving mobility and - in taking the pressure of your joints - reducing your pain. It can be a highly effective treatment and many people see amazing results.

If you have private physiotherapy with Circle Health Group, we will build a custom programme of exercises to help you to strengthen your hip and the surrounding muscles. Our hospitals are all equipped with advanced specialist equipment to help you get the best from your sessions.

If you are interested in knee physiotherapy and would like to try this before considering surgery, you can refer yourself to any of our physiotherapy departments, without needing a reference from your GP. If the physiotherapist you see thinks that you would better benefit from another treatment, whether instead of or alongside their sessions, they can directly refer you to one of our experienced orthopaedic consultants.

Steroid injections

Also known as steroid injection therapy, this treatment involves injections of steroid medication (corticosteroid) into your painful knee joint. This can effectively reduce pain and inflammation in your knee, and the effects can last anywhere from a few weeks to a few months. This form of pain relief may be recommended if you can't take oral anti-inflammatories for any reason.

Knee braces

In some circumstances, you may find a knee support for arthritis, such as a compression sleeve, or a knee brace for arthritis, such as a knee unloaded brace, as a method of providing support for the joint and managing pain.

If the forms of pain relief listed above do not effectively alleviate your joint pain symptoms, it might be time to speak with an orthopaedic surgeon to discuss the possibility of having knee replacement surgery.

Surgery

For more advanced arthritis, your doctor may recommend knee surgery. This might be keyhole surgery (called an arthroscopy) or it might be partial or total knee replacement.

This page tells you everything you need to know about knee surgery.

Whatever options are available to you, your consultant will discuss everything with you in detail and together you can decide on the best course of action to take.