What is the best treatment of knee arthritis?

Arthritis in the knee is a common condition that causes pain with weight bearing activities and can cause significant disability.

Osteoarthritis or “arthritis” as it is commonly known in simple terms is often referred to as “wear and tear” of the joint. It is not completely accurate as the condition also involves changes in the capsule and fluid within the joint. It is a condition that can affect any joint in the body but is more common in the large weight bearing joints like knees.

You are usually more likely to get knee arthritis with age however it can develop sooner if you have had previous trauma to a joint like a fracture or damaged cartilage in the joint from a sprain.

Knee -OA

 

The most common risk factors are:

 

  • Age: It most likely affects those from their late forties and above. Most individuals over the age of 75 have been shown to have knee arthritis (Blagojevic et al, 2010).
  • Males: Osteoarthritis of the knee is more common in men.
  • Obesity: If you carry more weight, it will put more pressure on the knee. If you are overweight you are more likely to be less active too which is another risk factor to developing knee arthritis (Katz et al, 2021).
  • Sedentary lifestyles: The more sedentary your lifestyle the more likely you are to develop knee arthritis (Katz et al, 2021, Lee et al, 2015). Runners have been shown to be less likely to develop knee arthritis! That does not mean everyone should go out running, but it does highlight how important exercise is for general joint health.

What does knee arthritis feel like?

 

Usually people will complain of pain on either side of the knee or around the knee especially with activities that involve loading eg walking up stairs.

Usually symptoms are worse in the morning before you get moving but the knee can usually ease up with a little gentle activity but get worse the longer you are on your feet loading the knee. Often it can feel stiff and sore getting up from prolonged sitting too. Occasionally there can be tenderness around the joint and usually pain is associated with joint swelling.

    Stages of Knee OA

    So what is the best treatment for knee arthritis?

     

    It’s all about reducing inflammation in the joint. That could be by way of load management ie. not doing too much on the joint and letting it recover after activity before loading it again. If you go on a long walk for example, it may cause swelling and pain in the knee. In this case it is best to rest it for a few days to let it recover before you go on a long walk again.

    Some people are able to take over the counter Non Steroidal Anti-inflammatory drugs (NSAIDs) like Ibuprofen. This will help reduce inflammation in the joint and decrease pain. Occasionally you may require a prescription for a stronger anti-inflammatory drug to reduce severe symptoms like naproxen or Etoricoxib. There are topical creams which some people find useful like Flexiseq to aid in the treatment of knee arthritis too.

    Weight management is another way to reduce the load in the joint. If you are overweight, by far the best treatment approach is to lose weight. Going upstairs can increase the load through the knee by 4 x your body weight so the heavier you are, the higher the loads passing through a painful damaged joint.

    Exercise is the key with any arthritic joint. You need to maintain flexibility of the stiff joint and improve the strength around it. The stronger the muscles surrounding the knee, the more load they will absorb improving the force absorbing capacity of the joint. The good news about exercise is that it increases endorphins which are the body’s natural painkillers and it may also help with weight management.

    Tried all of that but pain persists or stops you from being able to exercise and lose weight?

    Steroid injections are often used to reduce inflammation in painful joints primarily to allow you to get back to activity. They are a potent anti-inflammatory and for the right individual can really help with arthritic knee pain. If your pain is not easing and you need relief of the symptoms of knee arthritis then you could consider having a steroid injection to help reduce the pain. These procedures are quick and easy to perform and you can read more about having a steroid injection here.

    Hyaluronic acid injections are also a treatment option for persistent knee pain from arthritis. They are not a steroid so don’t have as powerful anti-inflammatory effect but as it is not a drug, some people prefer to try this route. Hyaluronic acid injections can last a little longer than steroid injections and are most appropriate for those individuals with mild to moderate knee joint arthritis. Occasionally we can combine a steroid injection and Hyaluronic acid injection at the same time to achieve the benefits of both. You can read more about this treatment here.

    Platelet Rich Plasma (PRP) injections  are another alternative to Steroid and Hyaluronic acid injections for knee pain from arthritis. This involves using your bodies own blood to create a product that we then inject back into an arthritic joint to help give symptomatic relief. This treatment may require more than one injection and you can read more about that here.

    In Summary

     

    A knee replacement is not the only option when treating knee osteoarthritis.

    The best treatment for knee arthritis depends on the individual. If you are overweight, then weightloss is the best treatment. If you are lean and exercise a lot, then more rest days is your best treatment approach. Either way exercise is important, but always in the right quantity so that you are not overdoing it, and still building strength to help reduce the forces going through the knee.

    Adjuncts to help with the pain include NSAIDs and topical creams, injections of Hyaluronic acid or PRP. For more severe symptoms then you can consider having a steroid injection to reduce pain to allow you to return to your normal activities of daily living sooner and not letting the pain limit your ability to move and exercise. 

      If you are experiencing knee pain and want to find out what is causing your symptoms, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact Steroidinjectionslondon.co.uk on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk

      References

      Blagojevic, M., Jinks, C., Jeffery, A. and Jordan. K.P. (2009) Risk factor for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 18(1) pp.24-33.

      Costigan, P.A., Deluzio, K.J. and Wys, U.P. (2002) Knee and hip kinetics during normal stair climbing. Gait Posture. 16(1) pp. 31-37.

      Hunter, D.J. and Bierma-Zeinstra,S. (2019) Osteoarthritis. The Lancet. 39 (10182). pp.1745-1759.

      Katz, J.N., Arant, K.R. and Loeser, R.F. (2021. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A review. Journal of the American Medical Association. 325 (6). pp.568-578.

      Lee, J., Rowland, W.C., Ehrlich-Jones, L., Kwoh, C.K., Nevitt, M., Semanik, P.A., Sharma, L., Sohn, M-W. Song, J. and Dunlop, D.D. (2015) Sedentary behaviour and physical function: objective evidence from Osteoarthritis Initiative. Arthritis care and research. 67(3) . pp. 366-373.

      Zhang, Y. and Jordan, J.M.(2010) Epidemiology of osteoarthritis. Clinics in Geriatric Medicine. 26(3) pp. 355-369.