• What are the causes of osteoarthritis of the knee?
• What are the behavioral risk factors associated with osteoarthritis of the knee?
• What are the warning signs that our knee joints are beginning to develop osteoarthritis?
• Preventing osteoarthritis of the knee
• At which stage does surgery become a viable option?

Our bodies are constantly deteriorating as we age, which, at some point, can affect our daily lives. This is especially true with regard to our knee joints as the degeneration affecting this area can make it difficult to walk and stand from a sitting position. In some severe cases, this pain can be so great that it makes going about daily tasks extremely difficult, thus impacting overall quality of life. In this article, Charlee Sumettavanich, M.D., Orthopedic Surgeon Specializing in Arthroplasty at the Sports Medicine and Joint Center, at Bumrungrad International Hospital will be outlining the causes, management and treatment of osteoarthritis of the knee.

 

What are the causes of osteoarthritis of the knee?

The most common cause of knee osteoarthritis is the prolonged use of our knees, over the lifespan substantial wear and tear affects the joint. Indeed, our bodies are subject to significant use when compared to a machine. When you think of it as a lifetime of use that reaches more than 70 years, it is actually extremely impressive. Nevertheless, joint wear and tear is an inevitable part of aging, and it is this which causes osteoarthritis in the knee to develop.

 

What are the behavioral risk factors associated with osteoarthritis of the knee?

There are a range of other potential factors behind the onset of osteoarthritis, including systemic arthritis, infectious arthritis, an accident involving a heavy impact to the knees, torn ligaments, torn tendons, and fractures affecting the bones making up the knee joint. All of these issues can accelerate the onset of osteoarthritis. The severity of their condition depends on the level of inflammation or the seriousness of an injury affecting the knee joint.
 

What are the warning signs that our knee joints are beginning to develop osteoarthritis?

The condition’s onset is generally preluded by pain that follows regular, everyday use of the joint. This pain is usually manageable at the outset but, after time, it may start to affect the knee during use, while performing everyday tasks, or during exercise. The pain intensifies as the degeneration progresses, and is dependent on a couple of key factors. The first of these is wear out of the cartilage inside the joint, resulting in the bone rubbing against one another. Given that cartilage does not have any nerve endings, it can wear away without the patient recognizing it.

In addition to cartilage deterioration, inflammation affecting the epithelial surface of the bones can also cause pain. The inflammation can affect either the joint surface, ligaments, tendons or the cartilage, resulting in constant pain for the patient. Treatment for either condition is focused on reducing inflammation and treating any degeneration of the knee joint, while the methods used can also be classified into two main types.

 

Osteoarthritis of the knee characteristics

• Intermittent knee pain that is at its worst when the knees are in use, especially when ascending or descending stairs.
• A sharp, stabbing pain in the knees is an indicator of inflammation affecting the tendons and muscle tissue around the joint.
• A cracking sound coming from the knees when moving is an indicator that cartilage has begun to wear away.
• Tender point at weight bearing area
• Swelling and heat in the knees, with some severe cases experiencing knee joint swelling caused by joint effusion.

 

Preventing osteoarthritis of the knee

• Avoid strenuous and improper use of the knee joints.
• Focus on exercises that can strengthen the knee and surrounding muscles to support the work required of the knee and to reduce the load placed through these joints.

Prevention is always the best course of action, so if patients experience what they believe may be the initial stages of this condition, they should consult a doctor who can advise them on how best to protect themselves going forward.

 

Techniques used in the treatment of osteoarthritis of the knee

• Modify activities that place a heavy burden on the knees to reduce wear out of cartilage. If these do not work, patients should consult a doctor regarding other potential ways to prevent additional damage.
• Medication can alleviate pain and inflammation.
• Non-surgical forms of treatment using knee joint injections alongside physical therapy is suited to patients in the initial to intermediate stages of the condition.
• Total knee replacement surgery alongside physical therapy may be considered in severe osteoarthritis.

Once medical staff have analyzed the condition to determine its stage, they will be able to recommend a suitable form of treatment for the patient, which will differ from case to case as each individual has their own set of needs and limitations.

 

At which stage does surgery become a viable option?

There are several aspects to consider before deciding whether surgery is a suitable option, mainly how beneficial the procedure will be for the patient. Crucially, surgery must be able to restore the function of the joint, so that patients can make a full recovery and enjoy a high quality of life following the procedure.

 

Is age a factor in the decision to undergo surgery?

Age is not the most important aspect when making a decision, as medical staff will first analyze whether surgery will help patients make a satisfactory recovery, which depends on a range of factors. Some patients are very active, while others rarely engage in physical activity, so it is essential that medical staff and their patients have in-depth discussions about whether to undergo any surgical procedures.

 

What forms of surgery are available and what benefits can they provide?

There are two standard forms of surgery available. The first does not involve replacing the joint with an artificial joint but the second does involve such a replacement. The first surgical treatment is osteotomy used to correct the angular deformity of the knee joint and is suited to younger patients suffering with joint or bone deformities. The repositioning is focused on straightening the joint to ensure that there is less subsequent wear and tear on the cartilage inside it.

The second type is knee replacement which can be further separated into two categories. The first of these is a partial knee replacement surgery, which is used to replace only the affected part of the knee. This option is suitable for use in patients with only one part of the knee worn out, especially where that degeneration has reached such a severe stage that replacing the affected area is the only viable option. The second technique is a total knee replacement procedure, meaning that the existing knee joint is replaced in full using a new, artificial joint. Each of these procedures has its own set of benefits and drawbacks. Suitable options should be discussed with the surgeon.

 

Can an artificial joint be 100% as good as a healthy knee joint?

A replacement joint is more than 90% as good as a healthy knee joint. So, when the function of the knee is reduced from osteoarthritis to 40 – 50%, the replacement will provide the most benefit.

 

Can osteoarthritis of the knee affect both joints simultaneously?

Generally, in elderly patients who have not sustained an accident or injury to their knees previously, the condition tends to affect both knees as they have been subject to a similar amount of wear and tear, whereas those who have sustained an injury previously may only have one knee affected. Nevertheless, symptoms of simultaneous deterioration still tend to start in one knee before they eventually both begin to present symptoms as the deterioration worsens.

 

Should surgery be conducted on one or both knees at the same time?

Whether one or both knees are replaced have to be discussed with the surgeon. Key factors to be considered are severity of osteoarthritis, recovery time and general health.

 

Can dietary supplements be helpful with regard to managing osteoarthritis of the knee?

Osteoarthritis of the knee is a mechanical issue, meaning that it is caused by structural problems affecting the body, such as deformities, dislocation, and degeneration in the knee joints. Dietary supplements are therefore not helpful in this regard as they can only support the recovery of muscles that may help to lessen joint deterioration and reduce workload on the knee joint, although exercise is also vital in this regard.

As you can see, osteoarthritis can be effectively managed and there is no need for patients to suffer in pain if they can identify the root cause of their issue and seek out techniques that can prevent additional deterioration, which will also help restore the knee to full strength and regain movement to the joint.

The Sports Medicine and Joint Center at Bumrungrad International Hospital offers a full range of treatment services for patients suffering with osteoarthritis of the hips and osteoarthritis of the knees. With the latest tools and equipment at their disposal, our team of highly experienced doctors and surgeons specializing in arthroplasty have performed an extensive number of successful procedures and have decades of experience between them. Collaborating with the doctors and surgeons, our support team of medical personnel provide the highest standards of pre- and post-surgery care, including physical therapy as part of the rehabilitation process. With so many successful procedures behind them, our team of knee and hip surgery specialists are renowned in their field, both throughout Thailand and across the region as a whole.

Above all, our multidisciplinary team specializing in a range of fields related to osteopathy cooperate closely to provide the best possible service to our patients, who can be confident that they are receiving world class care from the moment they enter our hospital and all the way throughout their treatment to the post-surgery rehabilitation process. We work as one to achieve the ultimate objective of restoring a high quality of life for our patients so that they can make a full return to their former lifestyles.
 
Written by Charlee Sumettavanich, M.D., orthopedic surgeon specializing in arthroplasty at the Sports Medicine and Joint Center, Bumrungrad International Hospital.