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Anatomy of Osteochondritis Dissecans MRI scan of Osteochondritis Dissecans

Knee Osteoarthritis

Osteoarthritis is the most common form of arthritis and can be found in many joints, but the knee is commonly affected. Osteoarthritis involves the wear and tear of the whole joint, including the articular cartilage, subchondral bone and joint capsule. The cartilage at the ends of the bones becomes worn and then abnormal mechanics of inflammation and healing occur. This involves the body attempting to repair the joint; as a consequence, it produces extra fragments of bone called osteophytes. There may also be an increase in the thick fluid inside the joint, which is called synovial fluid. The joint capsule (a membranous sac that surrounds the joint) and the ligaments that provide stability to the joint, both become stretched and deformed.

It must be noted that degenerative changes to joints are a natural part of ageing and the level of degeneration shown in an x-ray does not correlate to the pain and disability experienced. Osteoarthritis symptoms will improve for some, especially if they maintain a healthy weight and regular exercise regime, while for others symptoms plateau or get progressively worse.

Symptoms:

Chronic (more than 12 weeks ) of deep aching joint pain, stiffness during rest or stiffness when being seated and then trying to stand. Stiffness in the morning that does not last for more than 30 mins. Decreased Range of motion , crepitus (creaking) and chronic swelling.

Aggravating factors:

Extensive use , which usually involves weight bearing activities such as walking, sitting to standing and going up or down the stairs. There is also pain at rest, especially if you are unable to move your knee.

Easing factors:

Regular unloaded movement/ gentle exercise ice/ heat

Onset:

In the case of primary osteoarthritis the onset is usually gradual and insidious. In secondary osteoarthritis the onset may be quicker and due to an additional factor such as a previous injury, substantial weight gain or an inactive lifestyle.

Management:

Weight control through healthy diet and exercise (please consult a healthcare professional for specific advice). Exercise that increases aerobic fitness and increases quadriceps muscle strength. The exercise sessions need to be 2-3 x a week and need to last a minimum of 12 weeks to see significant benefits. Realistically however, regular strengthening and aerobic exercise needs to be part of the life long management of this condition. Aids in the form of knee braces and or orthotics can be used if necessary. These aids need to be used together with exercise, weight management and medication as required. There is some low quality evidence in support of the use of knee braces to reduce pain, increase function and improve quality of life in people with knee osteoarthritis. They should be used only if you are also employing the primary management strategies of weight loss and exercise.

The severity of knee osteoarthritis can vary considerably. Those with mild to moderate arthritis can often manage their condition with exercise, weight management aid and corticosteroid injections. Some people with osteoarthritis will need to have either a partial or total knee replacement. Before and after surgery they will need to exercise in order to get the best possible results.

References:

Bruyère O, Cooper C, Pelletier JP, Branco J, Luisa Brandi M, Guillemin F, et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: a report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2014;44(3):253-63

Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev. 2015(3):CD004020.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554-7

Skou ST, Roos EM, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S, Simonsen O. Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials. Osteoarthritis and cartilage. 2018 May 1

The National Institute of Clinical Excellence (Nice) Guideline for Osteoarthritis care and management [cg177] (2014). Available online from: https://www.nice.org.uk/Guidance/CG177



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