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Osteoarthritis of the Knee

I. Description

II. Causes

III. Symptoms

IV. Diagnosis

V. Treatment

Description

Few things can impact quality of life and daily activities as pervasively as Osteoarthritis (OA) pain, and it is a daily reality for over 27 million Americans. Osteoarthritis usually affects only specific joints in the body and is typically found in major weight-bearing joints such as the knees and hips, but also commonly in the hands, low back and neck.  There are two types of OA: Primary and Secondary.  The causes of the onset of the disease determine the type. Primary OA is brought on slowly by overuse and hereditary factors, while secondary OA is caused by injury or trauma to the joint.

OA is the “wear and tear” arthritis, to be distinguished from the systemic, autoimmune types of arthritis such as Rheumatoid Arthritis.  A healthy joint with proper alignment distributes weight evenly. Poor body posture, trauma, and excess weight can damage joint alignment and function over time, leading to wear and tear and eventually, osteoarthritis.  Thus it is not a natural result of the aging process, but rather a dysfunction of joint biomechanics (joint movement). There are some elderly people who have proper joint biomechanics and body posture that never develop OA. OA is a chronic condition that progresses slowly over time, characterized by the breakdown of joint cartilage- the substance that acts as a cushion on the knobby ends of bones and facilitates smooth, easy movements of the joints.  As the cartilage breaks down, the joints no longer have a cushioned buffer for movement and rub together resulting in stiffness, pain and loss of mobility in the joint (arthritis).

In Knee Osteoarthritis, the discomfort can be significant due to the weight bearing function of the knee. Knee OA, like other forms of OA, cannot be cured but can be managed and possibly slowed through a variety of ways. Depending on the severity, a combination approach that integrates exercise, weight management, medical and/or chiropractic care, and specific products designed to support and protect the joint can effectively slow the progression of the disease.  Medical care may offer ways to medicate pain and swelling symptoms. Chiropractic care may provide better functioning joints through improving body biomechanics. 

Causes

The exact cause of osteoarthritis is not yet known but it is thought that a genetic predisposition combined with other risk factors can bring on the disease. Knee OA risk factors include:

• Family history of OA
• Improper joint biomechanics causing wear and tear and improper weight bearing
• Overuse injury from sports or other repetitive activities
• Injuries/trauma to the joint
• Being overweight
• Muscle weakness due to inactivity
• Aging contributing to cartilage breakdown

Symptoms

The symptoms of Osteoarthritis in the knee usually develop over time, with a gradual worsening.  Most commonly, symptoms begin to appear after age 40.  The level of pain a person feels can vary and is related to the level of disease progression. Symptoms of Knee Osteoarthritis include:

• Pain or tenderness around the knee during activities or while at rest
• Swelling and inflammation around the knee joint(s)
• Creaky, popping joints (Crepitus)
• Bony growths on the ends of affected joints
• Loss of range of motion in a joint, stiffness

Diagnosis

A diagnosis of Osteoarthritis of the Knee can be made from an exam and an assessment of a patient’s medical history. The physical exam can involve:

• Discussionof medical history, and family medical history
• X-Rays or MRI (Magnetic Resonance Imaging) to assess the level of joint or cartilage damage and rule out other possible conditions
• Joint aspiration is a procedure whereby a sterile needle and syringe are used to drain fluid from an affected joint. This fluid (called “synovial fluid”) is then tested for the presence of specific components that can indicate a particular type of arthritis. Elevated levels of certain antibodies found in the synovial fluid can indicate Rheumatoid Arthritis, ruling out Osteoarthritis. The joint fluid may also be tested for white cell count, crystals, protein levels and infection.
• Blood tests do not test directly for osteoarthritis but rather are performed to rule out the presence of rheumatic and inflammatory types of arthritis. For example, elevated levels of an antibody in the blood called Rheumatoid Factor may be tested for, as well as a protein known as “C-Reactive Protein, which can point towards other types of arthritis.

Treatment

Treatment of Knee Osteoarthritis will vary by the severity of the symptoms and often involves a combination of at-home care and/or professional care.  A treatment plan may involve drugs, rest, exercise, physical therapy, joint support and protection, and thermal or cold therapies to reduce pain.  Exercise can improve circulation and strengthen tissues and muscles surrounding the damaged joint. This can improve stability and prevent further injury.

At-Home Care For Knee Osteoarthritis:

• Unloader Knee Braces (for moderate to severe Knee Osteoarthritis) This type of brace redistributes or "unloads" pressure and weight around the knee, and can lessen the pain of ambulation (movement) by providing support and protection for the damaged joint. Unloader braces also usually feature ligament support. In some cases of knee osteoarthritis, the individual has suffered prior damage or injury to the ligaments, leading to the development of degenerative joint disease (arthritis).
  
• Knee Supports & Wraps (for mild Knee OA) Provides mild support and compression to the knee as well as some mild protection, thereby assisting with pain and swelling. View all knee braces for osteoarthritis here.
  
• Hot Knee Wraps Provide soothing warmth to the knee and increases blood flow and circulation to the area. Helps reduce pain and loosen stiff and achy joints.
• Cold Knee Wraps  Soothes irritated and inflammed areas and can help reduce swelling. Ice is a part of the RICE system for treatment (Rest, Ice Compression and Elevation)
• Exercise Exercising assists in keeping the knee muscles strong, and helps improve knee range of motion.

Lifestyle changes that incorporate weight loss if necessary, physical activity, and a healthy, balanced diet can make a big impact on the success of treatments and the progression of the disease.  For every pound of excess weight lost, four pounds of pressure is taken off of the knees. While there is no consensus in the medical world about a specific diet for arthritis, consuming a variety of vegetables, fruits, proteins, and healthy fats such as fish oil and olive oil can ensure that balanced nutrient intake is achieved. 

Professional Care for Knee Osteoarthritis

• Medical care may involve certain prescription or over-the-counter drugs called NSAIDs (Non-Steroidal Anti-inflammatory Drugs) like ibuprofen, aspirin, and naproxen sodium.
• Cortisol injections can be administered into affected joints to temporarily reduce inflammation. Cortisol is a natural hormone produced by the adrenal glands that acts as a powerful anti-inflammatory.  Doctors use a synthetic cortisol for injections, and this treatment can often provide significant pain relief by reducing inflammation from within the joint fluid.
• Surgery is sometimes necessary to correct joint deformities, increase joint function, and reduce pain. Surgery for knee osteoarthritis can be minimally invasive or for more severe cases involve a total knee replacement.
• Chiropractic care may be beneficial in rehabilitating the improper joint biomechanics that caused the degenerative process.

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