Osteoarthritis is a painful degenerative condition that can affect the knee joints. In its early stages, the symptoms may be mild and can normally be managed without surgery. However, as the condition develops, symptoms worsen and more invasive treatment options may become necessary, including surgery.
To mark Arthritis Awareness Week we are looking at the different stages of knee osteoarthritis and the different treatment options you might be offered.
It is important to get a proper diagnosis as soon as possible to ensure the widest range of treatment options is available to you.
What is osteoarthritis?
Osteoarthritis is a common form of arthritis. Around 8.75 million people in the UK have sought treatment for the condition which affects the cartilage, the strong, slippery tissue that acts as a cushion between the bones and helps the joint to move smoothly. It also affects the synovium, which is a soft tissue that lines the joints, supplying nutrients to the cartilage and producing synovial fluid to lubricate the joint. As the cartilage and synovium degrade, bones in the joint may start to rub against each other and become damaged.
The stages of osteoarthritis
Osteoarthritis is a degenerative disease which means it worsens over time. Progression of the condition can take several years and if you have a diagnosis of osteoarthritis you need to remain vigilant for changes in your symptoms, which could mean the disease is developing.
Doctors refer to the four stages of osteoarthritis:
- Stage one – this is the most minor form of the disease. If you have stage one osteoarthritis you may not experience any pain or discomfort and the joint will appear normal on an X-ray with no obvious narrowing of the space between the bones (a sign of cartilage wearing away). During this stage, small bony spurs called osteophytes may begin to develop and there may be minimal damage to the cartilage.
- Stage two – this is normally when the first symptoms start to appear. This is because the cartilage is starting to thin in the joint and tissues are starting to harden, causing the bones to become denser. A thin layer of bone (subchondral plate) may become more obvious beneath the cartilage in the joints and osteophytes may continue to grow. During this phase you may experience some joint pain or stiffness and your knee may feel particularly uncomfortable after you have been sitting for a long time.
- Stage three – During this stage X-rays will show narrowing in the gap between the bones and some cartilage loss. As the cartilage wears away the bones respond by growing outwards and thickening. Tissue becomes inflamed and it may produce extra synovial fluid, resulting in swelling of the joint. You may experience pain during everyday activities, including walking and bending.
- Stage four – this is the most severe form of osteoarthritis. It is characterised by stiffness in the joint, constant inflammation and a reduction in fluid around the joint. X-rays are likely to show that bone is rubbing against bone as a result of cartilage having worn away. Pain is likely to be intense and the bones may become deformed.
Treatment of osteoarthritis
There are different treatments for osteoarthritis of the knee depending on what stage the condition is at and how much pain you are experiencing. Treatments might include:
- Painkilling medication, anti-inflammatories, cartilage supplementation (cod liver oil, glucosamine and chondroitin sulphate) and exercises to build strength and maintain flexibility in the joint. If you have stage one osteoarthritis, this is the sort of treatment that may help.
- Physiotherapy sessions, adapting your day-to-day activities to reduce pressure on your joints and wearing a knee brace or shoe inserts to relieve stress on the knee. As the condition develops, your doctor may recommend measures like these, alongside painkilling medication.
- Prescription pain relief, such as codeine, injections of hyaluronic acid to improve joint lubrication and injections of corticosteroids into the joint to relieve pain. As cartilage and synovium degenerates, these treatments may help to improve joint function and relieve pain.
- Surgery may be necessary for the most severe cases of osteoarthritis.
Surgical options include:
- Arthroscopy – this is a minimally-invasive form of surgery. Torn meniscus (knee shock absorbers) or loose cartilage may be removed and cartilage repaired.
- Osteotomy – this involves cutting the bone and realigning the knee to reduce pressure on the worn part of the joint.
- Partial knee replacement – this involves replacing only those compartments of the knee that have been damaged by the disease.
- Total knee replacement – this involves replacing the entire knee joint with a prosthetic implant.
- Mako robotic arm assisted partial or total knee replacement – by using Mako robotic arm technology, it is possible to gain even more accuracy when performing joint replacement surgery of the knee to help treat arthritis.
If you have osteoarthritis of the knee, talk to an orthopaedic consultant who will be able to advise you about your treatment options and help you make the right choices.
