Hip Preservation Clinic

Knee Arthritis

CONDITIONS

Defining Arthritis

Arthritis is defined as chronic joint inflammation and cartilage degeneration. The most common type of arthritis is osteoarthritis, which has a strong genetic component and involves painful and progressive loss of surface cartilage. Other less common forms of arthritis include:

  • Inflammatory or autoimmune (i.e. rheumatoid, lupus, psoriatic)
  • Gout and pseudo-gout
  • Septic or infectious

Common Arthritis symptoms include night pain, reduced range of motion, pain in external rotation and pain after prolonged sitting. The hallmarks of osteoarthritis include radiographic signs such as asymmetric cartilage loss, bone spur formation and cyst formation, with other indicators including progressive stiffness and deformity of the joint leading to loss of motion. Arthritis is diagnosed by combining clinical symptoms (pain, stiffness, swelling, deformity) with radiographic (x-ray) findings (joint space loss, bone spur formation, cysts).

Knee Arthritis Location

The knee is surgically divided into three compartments: the medial (inside of the knee/closer to center of the body), the lateral (outside of the knee), and the patellofemoral compartment (behind the knee cap and in front of the end of the femur). Arthritis most commonly occurs in all three compartments simultaneously with various degrees with the medial compartment being most commonly and greatly affected. When knee arthritis occurs preferentially in the medial compartment, this is referred to as a “varus” knee. When it occurs more significantly in the lateral compartment, this is referred to as a “valgus” knee. When it occurs behind the kneecap only, this is referred to as, “patellofemoral compartment” arthritis.

Knee Arthritis Diagnosis

Arthritis is diagnosed by combining clinical symptoms (pain, stiffness, swelling, deformity) with radiographic (x-ray) findings (joint space loss, bone spur formation, cysts). Occasionally, patients will present with radiographic evidence of arthritis and have minimal clinical symptoms. Even if the x-rays show “bone-on-bone” arthritis, the treatment is always guided by the clinical symptoms and not the radiographic findings.

Knee Arthritis Treatment

There are many different treatment options for knee arthritis, all of which aim to reduce pain and improve function. Conservative treatment options include:

  • Use of anti-inflammatory medication (i.e. ibuprofen, naproxen, acetaminophen)
  • Activity modifications (transition to low/no impact)
  • Bracing: sometimes varus/valgus unloader bracing and or shoe inserts can help to “offload” the side of the joint (medial or lateral) that is more painful and make the joint pain more tolerable for walking. They usually will not take the pain away, but may make your arthritis less problematic when walking.
  • Use of a cane, walker, or other ambulatory aid
  • Weight loss when appropriate
  • Low-impact physical therapy for muscle strengthening and conditioning
  • Various injections aiming to reduce joint inflammation and prevent further cartilage deterioration (see PRP section)
  • Patients with mild arthritis may have other less invasive treatment options available to them, including PRP injections and minimally invasive hip arthroscopy. These joint preserving options provide good short to medium term (2 – 5 year) relief and may enable patients to maintain a high level of activity before hip replacement surgery is the only option.