We subject our knees to impacts and place weight through them every day of our lives. This means that as we grow older, they will inevitably deteriorate. Indeed, the more stress we place on our knee joints, the faster that deterioration will occur. This article will detail the causes and tell-tale signs for osteoarthritis of the knees to ensure we can react accordingly.

 

What are the warning signs for osteoarthritis of the knees?

The first thing patients notice is a tight-feeling pain emanating from behind the knee, which generally occurs without any pain presenting inside the joint, but which then spreads to the side or front of the joint. The pain usually occurs when walking and ascending or descending steps, while some cases may notice a cracking sound coming from the joint alongside heightened sensitivity when weight is placed through it or when standing on one leg. Patients will often be unable to extend the knee completely or flex it fully, as they may do when sitting cross-legged, for instance. Finally, patients may experience a deformity developing, where the knees starting to move either in- or outward, indicating osteoarthritis. This can sometimes be obvious to the naked eye, or may require medical exam to diagnose.

 

Cause of osteoarthritis of the knee

Certain behaviors are the most common cause of this condition, with most patients unaware that their lifestyles or habits are significantly impacting their knee health. Examples are as follows:

• Being overweight: Our knees are responsible for carrying our body weight, so if we are overweight, it places a greater stress on the knees. This is why being overweight is a key factor behind the onset of osteoarthritis in the knees. We should therefore carefully manage our body weight, ensuring that we do not enter a BMI range of greater than 25.This is still the mainstay of prevention and treatment of osteoarthritis.
• Age-related deterioration and early onset deterioration: Naturally occurring osteoarthritis of the knees usually develops at around 50–60 years of age or older, coinciding with the time when our bone density also begins to wane. Unfortunately, once we reach 40 years of age, we will start to experience cartilage deterioration that results in bone endings rubbing against one another, potentially leading to pain that is disruptive to regular movement. Therefore, osteoarthritis occurrence is generally linked to aging.
• Prolonged exposure to impactful exercises: Overuse or strenuous use of the joint can lead to osteoarthritis, such as regularly playing sports that require rapid changes of direction, lifting weights, or performing squats, all of which can accelerate the onset of the condition.
• Accidents or injuries involving the knee joints: Accidents, such as falls or sport-related injuries, that directly impact the knees can result in the onset of this condition, as can certain other associated disorders, including rheumatoid arthritis and gout.
• Genetics: Genetics can play a key role in the onset of osteoarthritis, with a family history of obesity likely to cause the condition’s onset due to the knees being placed under a heavy stress.

 

Can osteoarthritis of the knees be cured using treatment?

It is not possible to cure the condition entirely and restore 100% health to the affected joint. However, treatments are focused on delaying the condition’s development and protecting the knees from further damage.
 
 

There are 3 main forms of treatment for osteoarthritis of the knee, as follows:

• Lifestyle modifications, medication, and physical therapy – suitable to patients in the initial stages of the condition.
• Non-surgical forms of treatment using knee joint injections alongside physical therapy – suited to patients in the initial to intermediate stages of the condition.
• Knee arthroplasty alongside physical therapy – suited to severe and chronic cases.

 

Non-surgical treatments involving knee joint injections

• Steroid injections can help to alleviate the pain and provide temporary relief from inflammation. However, the use of such injections must be overseen by a doctor as they are associated with a range of potential side effects.
• Hyaluronic acid injections refer to the introduction of artificial joint fluid into the knee to improve its movement capabilities. These injections can be used to replace the hyaluronic acid that has been lost to the condition, thus helping to reduce any pain and inflammation. This treatment is most suited to patients in the intermediate stages of the condition and involves patients usually receiving between 3–5 injections once a week over a period of up to 6 months. Nevertheless, the risk of infection posed by such injections means they must only be conducted under the supervision of medical professionals.
• Platelet-rich plasma injections are a form of treatment using a small sample of the patient’s own blood, from which the platelets and plasma are separated from the red blood cells in a centrifuge before being injected back into the patient’s knee to stimulate the production of new cells. This option is suited to patients who are in the initial to intermediate stages of the condition with no serious deterioration of their cartilage, and for whom medication and physical therapy have been unsuccessful.

 
Nonetheless, injecting medication into the knee joint is not suitable for everybody, with only the most experienced and expert specialists suited to administering these treatments due to the risk of infection and medication allergies inherent in their use. It should also be noted that treatment results differ significantly from patient to patient. Your doctor might suggest other forms of treatment depending on individual characteristics.

 

Surgical forms of treatment

Medical staff will carefully evaluate each patient’s situation to assess their suitability for surgery after non-surgical treatment options were exhausted. Crucially, the patient’s overall condition and quality of life must be considered. Especially the elderly, who might be worse off if they are incapable of performing the rehabilitation required to recover properly from the surgical procedure. It is therefore essential that patients and their doctors carefully consider any knee surgery to ensure it is as beneficial as possible and it presents the most effective solution for serious osteoarthritis of the knee.
There are various surgical techniques currently available, including surgery to reposition the joint in patients suffering with a deformity, partial knee replacement, or total knee replacement, all of which are more suited to patients in the late stages of the disorder and for whom all other treatment options have been exhausted.
 
 

Additional care advice for the knees

• Regulating body weight is one of the most effective preventive measures, especially in overweight elderly patients.
• Lifestyle modifications and ensuring that the knee joints are used properly can also help. This means avoiding any overuse or weight-bearing that can cause knee injuries.
• Exercising regularly without placing the knees under stress, such as through swimming, aqua aerobics, and other, more focused training that can help strengthen the muscles surrounding the knee joint, especially the quadriceps and hamstrings, can all help reduce strain on the joint.
• Courses of medication may be prescribed to alleviate pain. In less serious cases, topical creams and hot compresses may be effective in reducing inflammation.
• Another option is medicated dietary supplements, such as glucosamines and chondroitin sulphate, as these contain hyaluronic acid which is useful for joints. However, medical professionals must be consulted and thorough examination performed before patients begin any such courses of action.

Should symptoms not improve despite attempting these forms of treatment, a doctor should be consulted regarding potential next steps.  


The Sports Medicine and Joint Center at Bumrungrad International Hospital offers premium care and treatment for hip osteoarthritis and knee osteoarthritis. Our team of expert doctors, who have more than 15 years’ of experience in performing joint arthroplasty procedures, treated and replaced the joints of over 2,000 patients to date. The prosthetics used are of the highest quality and the technologies we have at our disposal represent the latest innovations in the field of medicine. Moreover, our team of doctors and medical staff ensure that each patient is carefully prepared for surgery and that they receive the appropriate rehabilitative care once the procedure is complete.
Surgeons at the Sports Medicine and Joint Center are highly regarded specialists in their field of medicine, recognized throughout Thailand and Southeast Asia.
 
The team is working in a comprehensive multidisciplinary team available to provide specialist care and advice. These team members cooperate effectively and efficiently to ensure our patients receive the best care possible, from the moment they enter the hospital for their procedure through to post-surgery care and rehabilitation.

This article was approved by  Assoc.Prof. Dr. Sitthiporn Orapin, orthopaedic surgeon specializing in arthroplasty at the Sports Medicine and Joint Center, Bumrungrad International Hospital.