Knee Osteoarthritis

Osteoarthritis is the most common form of arthritis and one of the leading causes of pain and disability worldwide. It can affect people at any age, but it is most common in people over 50 years of age ⁽¹⁾. Almost any joint can be affected by osteoarthritis but most commonly it affects the knees, followed by the hips and the small joints of the hands ⁽⁸⁾. Patients often report pain accompanied by varying degrees of functional limitations and reduced quality of life. It can be diagnosed using the patient’s age, symptoms and a physical examination, with or without an X-ray. Exercise, education and weight loss improve symptoms and function in most patients with knee osteoarthritis and should be trialled initially.

Knee osteoarthritis is often described as ‘wear and tear’, implying that the joint has ‘worn out’. Symptoms and physical function are frequently assumed to be directly related to these ‘wear and tear’ changes, which might make you think that symptoms would worsen with further use. This is a common misconception as appropriately loading (exercising) the knee stimulates healing and is essential for joint health. Furthermore, ‘wear and tear’ changes do not always correspond with symptoms as people can have changes identified with imaging (X-ray and magnetic resonance imaging) but be pain-free ⁽⁹⁾.

Abnormality in any of the knee tissues (e.g. cartilage, ligament, meniscus) can increase stress within the joint, which can contribute to tissue damage and subsequent repair. The repair process is slow but effective and can often make up for the initial damage. Several factors can influence joint stress and inhibit the repair process; the factors ultimately result in the breakdown of cartilage and bone within the joint.

Osteoarthritis is the most common joint disease worldwide, affecting an estimated 10% of men and 18% of women over 60 years of age ⁽⁷⁾. Approximately 18% of the UK population aged over 45 years have sought treatment for osteoarthritis of the knee ⁽⁸⁾.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like an MRI (magnetic resonance imaging) or X-rays are not always required to achieve a working diagnosis, but in unusual or persistent presentations they may be warranted.

Education, exercise and weight management are core treatments for knee osteoarthritis irrespective of severity, age, disability or co-existing medical conditions ⁽¹¹⁾. Self-management strategies should be developed with the individual, ensuring positive lifestyle changes are implemented alongside the core treatments and that they are maintained in the long term. You might also be advised to use over the counter medications such as pain relief/anti-inflammatories (prescribed by your GP).

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a multi-modal treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment.

Corticosteroid injections may be considered if appropriate conservative management has failed. They may produce an improvement in pain and physical function, but effects are likely to decrease over time. Even if conservative management does not achieve a marked improvement, careful consideration is heavily encouraged as in some cases they cause more harm than good.

Surgery, including high tibial osteotomy and total knee replacement, might be options if conservative management fails in those that have a significant level of decreased physical function, discomfort and advanced osteoarthritis.

https://www.versusarthritis.org/

https://www.csp.org.uk/conditions/arthritis

https://www.nhs.uk/conditions/osteoarthritis/

https://www.nice.org.uk/guidance/cg177/chapter/1-recommendations#diagnosis-2

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