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What is Osteoarthritis of the knee
In a young normal knee, there is a flexible, slippery material that protects bones from joint friction and impact.
In knee osteoarthritis, the cartilage wears away and in severe cases of osteoarthritis knee, the bones may rub directly against each other with minimal lubrication, leading to pain and disability.
Diagnosis of Osteoarthritis of knee
Typical medical history and confirmed by an X-ray of the knee.
Some of the classical features you see on Xray includes
- reduced joint space
- irregularity of the bone, which we commonly call spikes or osteophytes
- and knee joint deformities.
Risk factors of getting osteoarthritis of knee
- Previous knee injury like meniscal tear or ligamental tears or even fractures.
- Excessive wear and tear of knee joints from high-impact activities
- Age : Osteoarthritis occurs more commonly in patients 50 years and older but it can also occur sometimes in younger patients.
- Overweight : patients who are overweight are almost twice as likely to develop osteoarthritis of the knee
- Gradual onset knee pain that develops over months to years
- Worse on walking and squatting or climbing of stairs
- Early morning stiffness
- Reduced range of motion
- Crackling sounds when you bend and extend the knees
- Acute flares , patients can even have severe pain and redness and swelling of the knee joint.
- Reduce high impact activities like jumping and jogging to low impact activities like swimming and cycling.
- minimise activities that may aggravate the condition like climbing of stairs or prolonged standing
- Lose weight - 70% of weight loss comes from diet
- Wear shoes with good sole support - Wearing of shoes that have poor support may add further stress to the knee joint.
Exercise and Physiotherapies
The knee joint is a very large joint that is stabilised by ligaments and muscles around it. Exercises that strengthen the muscles around the knee joint helps in managing the pain and helps in stabilising the joint.
Simple exercises such as Seated Leg Extension (for both legs), standing calf raise, sit to stand, standing Knee Bend (both knees).
Glucosamine and Chondroitin may help in some patients in reducing knee pain. However it may not work for everyone.
There is an array of pain medications that can help to reduce their discomfort such as Panadol, NSAIDS, Cox-2 inhibitors, opioids.
These are medications that you take when required, and not be dependant on it.
Knee joint injections
Steroid injections: these injections helps to reduce inflammation and helps in acute severe pain where patients may not be able to walk. However, there are side effects to steroid injections and if done too frequently may worsen the osteoarthritis in the long run. Please consult your doctor in detail about it.
Hyaluronic acid visco supplementation. These are injections of hyaluronic acid into the knee joint to replace the cartilage that has worn out. These gel like materials will act as suspension and provide lubrication at the same time.
When all else fails or when there are severe deformities of the knee due to the osteoarthritis, surgeons may recommend surgical knee joint replacements to replace the worn out knee or to correct the deformities.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)