Arthritis of the knee

Introduction

Osteoarthritis or arthritis of the knee is classed as one of the most widespread pathogenic conditions, and also a leading cause of musculoskeletal inability in the elderly patients. However, it may also occur in the young and middle aged people. The most commonly reported consequences of knee arthritis are, pain and loss of function. The patients, who experiences knee arthritis, are impacted hugely on performing personal, occupational, and social activities. In addition, they lose the independence, and cannot enjoy the quality of life. It is one of the common causes of work-related absence in many individuals. Women are more likely to develop knee arthritis.

According to a research, published in the Journal of Arthritis and Rheumatology, knee arthritis (OA) is a pathology of joint failure. The pathology of the joint failure happens as a result of inadequate, excessive, or high impact loading in the joint, which leads to the degeneration of the articular cartilage. It means, the cartilage of the joint gradually wears, exposing the underlying bones. As the knee arthritis progresses, the bone spurs also develop in and around the knee joint, in response to the changes of the biomechanical load.

What are the causes of knee arthritis?

The most common factors of knee osteoarthritis is age. Almost everybody experiences some degree of osteoarthritis of knee at some point in their life. Some factors, which can cause arthritis of the knee in both young and older people, are:

Aging:

As you get older, your joint surfaces undergoes natural wearing, particularly in the large, weight-bearing joints of the lower extremities. Apart from that, the cartilage healing capacity also decreases with advanced age.

Weight:

Extra body weight or lifting heavy object can also effect on the knee joints. When your joints are strained by the weight, which is beyond the normal limit, it directly impacts on wearing of the cartilage.

Gender:

Women, above the age of 55, are more prone to have knee osteoarthritis.

Heredity:

A genetic mutation may also make a person susceptible for osteoarthritis. It also causes the abnormality in the shape of the joint bones.

Previous knee injury:

A previous knee injury can alter the biomechanical capacity of the knee joint. This leads to an abnormal distribution of load across the knee in everyday tasks.

Jobs or sports that repeatedly load your knee joint

The repetition of activities that excessively load the knee joint, such as squatting, lifting and running, has been linked to an earlier onset of knee arthritis.

What are the symptoms of knee arthritis?

Knee pain often occurs with a gradual onset and progression often worse first thing in the morning or after periods of inactivity

Often becomes worse in the morning or after the periods of inactivity

Knee pain often aggravated by weight-bearing activities such as walking, climbing stairs, kneeling and squatting

Stiffness of the knee

Swelling of the knee

The heat around the knee area

Clicking or grating

Decreased muscle strength of the lower extremities

What is the treatment for knee arthritis?

Knee Osteoarthritis is a (long-term) chronic diseases. There is no cure for the condition, but one can control the symptoms by getting a proper treatment. Some of the popular treatment options are:

The long term treatment of the disease includes several factors:

Management of symptoms:

Improving the joint mobility and flexibility

Maintaining a healthy weight

Physical exercise/activity

Medications:

There are several medications available for knee osteoarthritis, which help reduce the symptoms like,

Topical painkillers

Anti-inflammatory drugs

Narcotic pain reliever

Knee injection

Cortisone injections:

Corticosteroid injections can relieve joint pain. During this procedure your doctor numbs the area around the joint, and then places a needle into the space inside the joint and injects the medication.

Surgical management

In surgery, the joint replacement is performed, called arthroplasty. The surgeon removes your damaged joint surfaces and replaces them with plastic and metalgraft. Some complications may occur in the post-operative period, like infection and blood clots. However, the complications are seen only in 1-2% of cases. The surgery should be performed by an experienced and skilled surgeon to reduce the chances of chances of negative results like loosening of the graft, or graft wearing.

Cartilage graft:

Normal, healthy cartilagenous tissue can be taken from another part of the knee or a tissue bank to re-attach the articular cartilage of the knee. This procedure is only considered for younger patients with small areas of cartilage damage.

Uni-compartmental knee replacement:

Uni-compartmental knee replacement is considered as for a small amount of patients with knee osteoarthritis. It is also called partial knee replacement. Your surgeon usually advises partial knee replacement if the arthritis involves only a small or one part of the knee.

Physiotherapy

Physiotherapy treatment is proven to be very effective to reduce the symptoms like knee pain, swelling, or stiffness. You will notice a tremendous improvement within a few sessions of physiotherapy.

The main objectives of physiotherapy for knee arthritis are:

Reduce knee pain and inflammation.

Normalize knee range of joint motion.

Strengthen the knee quadriceps esp (esp VMO) and the hamstrings.

Strengthen your lower extremity: calf muscles, hip and pelvis.

Improve your patellofemoral (kneecap) alignment and function.

Normalize muscle lengths.

Improve your proprioception, agility and balance.

Improve your technique and function such as walking, squatting.

The knee braces

Your physical therapist may recommend you to use a knee brace to support, and help to de-load certain knee structures. The knee braces are available in different styles. Your doctor or physiotherapist can help you to choose the right one for you.

Assistive Devices

Assistive devices can help withthe functions like mobility. Some of the assistive devices are, canes, walkers, splints, orthopedic shoes, etc. But, you should always use some devices only under the concern of your doctor or physiotherapist, such as, knee braces and wedges shoes.

Exercises

Quadriceps Setting

This exercise helps strengthen the quadriceps (the large muscle in the front of the thigh). It is an important stabilizer of the knee.

Lie on your back with your leg straight. Place a small rolled towel under the knee. Slowly squeeze the muscle at the top of the thighs (quadriceps) and push the back of the knee down on the rolled towel. Hold the contraction for 5 seconds and then release slowly; giving a break of 5 seconds between each contraction.Perform 4 sets of 10 repetitions, once daily.

Straight leg raise

This exercise also helps to strengthen the quadriceps muscle.

Lie on your back with your leg straightthat you wish to exercise. The other knee must bow to support your lower back. Tighten the muscle at the top of your thigh and lift up to the level of the other knee. Bring it back to the original position slowly. Perform 5 sets of 10 repetitions, once daily.

Hamstring Stretch

When you have osteoarthritis of the knee, hamstrings (muscles that run along the back of the thigh to the knee) tend to be tight. This exercise helps to stretch the hamstring muscles, improves range of motion of the knee and helps you feel more flexible.

Lie on your back with the leg straight stretches with a strap around the bottom of your foot. Using of the belt support,raise the leg until you feel a gentle stretch in the back of the knee and thigh. Hold it up for 30 seconds, then lower it slowly. 5reps, 1time per day.

Gluteal strengthening

This exercise will help strengthen the muscles of the buttocks (the large muscles in the back of the hip), helps in trunk control, and enhance the stability and balance, while leg stands up and walk.

Lie face down with your hips over a pillow to support your back. Keep the leg to be exercised directly, squeeze the gluts and lift your leg slightly off the bed. Lower slowly. Perform 4 sets of 10 repetitions, 1 time a day.

Calf Stretch

This exercise will help your leg and ankle remain flexible, helping to improve balance and gait.

Stand facing a wall with the leg extended behind you and the other leg in the front. Place your hands or forearms on the wall for support. Slowly bend the knee, keeping the heel of the leg on the ground. Once you feel a stretch in the calf muscles of the back of the ankle, hold it in this position for 30 seconds. Slowly relax. 5 reps, 1 time per day.