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Knee Arthritis

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  • Knee arthritis is a condition that causes pain, swelling, and stiffness in the knee joint. It occurs when the articular (joint) cartilage (which cushions the bones in the knee) wears down over time or becomes inflamed. This can make everyday activities like walking, climbing stairs, or standing for long periods more difficult and painful.

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    Types of knee arthritis

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    • Osteoarthritis (OA): The most common type, usually related to ageing or wear and tear. Cartilage gradually wears away, causing exposed bones to rub together.

    • Inflammatory arthritis: An autoimmune disease where the body’s immune system attacks the joint lining, leading to inflammation and joint damage. The most common forms of this are rheumatoid and psoriatic arthritis. 

    • Post-traumatic arthritis: Can develop after a knee injury such as a fracture, ligament tear, or meniscus injury which alters the mechanics of how the knee joint works, exposing the cartilage excessive forces.

    Healthy knee, with no arthritis
    Knee with widespread arthritis

  • The knee joint in compromised of three separate articulations (compartments) - the medial (inner) compartment, the lateral (outer) compartment, and the patellofemoral (kneecap) joint on the front of the knee. Often arthritis will affect only one of these compartments, leaving two-thirds of the knee healthy and unaffected. The commonest type of unicompartmental arthritis is ‘anteromedial arthritis’, which affects the medial compartment only.

    Knee with unicompartmental arhtritis

    • Pain in or around the knee

    • Stiffness, especially in the morning or after resting

    • Swelling and warmth in the knee

    • Reduced range of motion (bend and straightening)

    • A grinding or popping sensation during movement

    • Difficulty with activities such as walking or climbing stairs

  • Knee arthritis is diagnosed based on your symptoms, a physical examination, and imaging tests such as X-rays or sometimes an MRI scan. Blood tests may be used to identify whether there is an autoimmune inflammatory cause to it.

  • There us no way to reverse the cartilage and bone damage associated with arthritis at present. Treatment follows a step-wise pathway.

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    • Lifestyle changes: Amending your activities can be very successful, especially for treating early arthritis. Changing to low impact exercise can delay more invasive treatments. Weight has a significant affect on knee pain from arthritis. Maintaining a healthy body mass index (BMI) can be extremely powerful in managing arthritis pain, and is also beneficial for overall health and well-being. To calculate your BMI, click here (link to NHS BMI calculator).

    • Medications: Over the counter medications (paracetamol and ibuprofen) can help manage pain. Stronger pain relief can be prescribed by your GP. Topical treatments (gels/creams) may provide more localised relief. Please speak to a qualified professional who can help you with you pain relief regimen.

    • Physiotherapy: This helps to keep the muscles around the joint strong, meaning that less weight is transmitted through the joint surfaces. It can also help with stiffness.

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    Injections: 

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    • Corticosteroids can be used to reduce swelling in the joint if it is particularly inflamed. This is a good management for early or inflammatory arthritis. There is evidence that multiple repeated injections can damage cartilage in the long term, and so this is used sparingly for the treatment of unicompartmental disease

    • Arthrosamid® is an injectable polyacrylamide hydrogel (iPAAG) implant that is showing encouraging results is early arthritis. Its exact mechanism of action is not fully understood, but it appears to alter the function of the synovium (lining of the knee), providing symptom improvement at short to medium term follow up. For further information click here.

    • Platelet-Rich Plasma (PRP) is a concentration of platelets derived from a patient’s own blood. It contains growth factors and proteins that are believed to aid in tissue healing and regeneration. Results from clinical studies are varied, but it may of benefit in early arthritis. 

    • Surgery: Surgical options broadly fall into surgery that aims to preserve the joint, or replace it. Osteotomy (realignment surgery with link) can help to offload an area of the knee where the cartilage is becoming worn, by placing the weight through an area with better cartilage. Knee replacement is used when there is no cartilage left, and can be partial (unicompartmental) or full (total knee replacement).

  • You should seek assistance if you experience persistent knee pain, swelling, or if your symptoms interfere with daily life. Early diagnosis and treatment can slow the progression of arthritis and improve your quality of life.

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