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Knee Arthritis

Knee arthritis is common: there are 3 common types that affect the knee joint

  1. Osteoarthritis - the commonest form of arthritis. This is a slowly progressive disorder where there is wear and tear of the bearing surfaces of the knee. It frequently affects middle aged and older people.
  2. Rheumatoid arthritis - this is an inflammatory arthritis that is associated with hand pain and stiffness commonly. It can occur at any age and generally affects both knees.
  3. Post- traumatic arthritis - this develops after an injury to the knee such as a fracture, ligament injury o meniscal tear. It is similar osteoarthritis.

Symptoms

The main symptoms of knee arthritis are pain. Other symptom include stiffness of the knee and swelling.

Pain is worsened after activity such as walking and climbing stairs, although some pains describe pain in the knee after a period of inactivity such as after sitting down watching television for an hour.

Cold weather frequently exacerbates symptoms of pain.

Diagnosis

Your doctor will ask you a few questions (take a history) and examine you knee and also take x-rays of your knee to confirm the diagnosis of arthritis.

Occasionally other investigations such as blood tests and magnetic resonance imaging (MRI) are required to diagnose other forms of arthritis.

Treatment

Treatment can be non-surgical or surgical. Non-surgical treatment should always be considered at first as it is effective.

Non surgical

  • Lifestyle change
    This includes weight loss, minimising activities that exacerbate the painful symptoms ( such as running and performing alternative exercises that are kinder to the knee like cycling.)
  • Exercise/ Physiotherapy
    Exercise can help patients with early arthritis by helping maintain a good range of knee movement and muscle strength. A physiotherapist can help assess and tailor specific exercises to help.
  • Painkillers
    There are a number of different types of painkiller that are helpful in the management of osteoarthritis.Your GP will be able to advise you best on the types of painkiller, but typically patients start with regular Paraacetamol and  Ibuprofen. If this is ineffective then stronger painkillers like Codeine and Tramadol can be prescribed by your family doctor. Anti-inflammatory gel (Ibuprofen) can also provide significant pain relief.
  • Steroid injections
    Steroids are potent anti-inflammatory substances that can be injected into the knee joint. There effects are not long lasting and no more than 3 injections a year should be performed as frequent injections may lead to increased joint damage. These injections are commonly reserved for patients ho are medically unfit for knee replacement surgery.
  • Viscosupplementation
    Injections of hyaluronic acid into the knee can be performed, however the results of this can be short lived and unpredictable.

Surgery

There are a number of surgical procedures that your surgeon can discuss with you after non operative management has been trialled.  The options depend on the age of he patient and the extent of arthritis.

  • Arthroscopy
    Arthroscopy of the knee is only recommended if you have 'mechanical symptoms' ( locking of the knee). It can provide short term relief of symptoms and does not address the main problem of osteoarthritis, i.e. the wear and tear.
  • Joint Replacement Surgery ( aka Arthroplasty)
    A total or partial knee replacement can be performed where the worn out parts to the knee are replaced with metal and plastic (see knee replacement).
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