When it comes to arthritis, there are three basic kinds that can affect the knee joint: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Osteoarthritis (OA) which is a progressive degenerative disease that causes the joint cartilage to break down. This type of arthritis is the most common and it is usually found in older adults, and it may be inherited or a direct result of injury, infection or being overweight which causes wear on the lower-body joints. Rheumatoid arthritis (RA) is a long term disease that causes inflammation in the joints and the surrounding tissue and can destroy the cartilage in the joint. RA can occur at any age and normally affects most of the joints in the body. Women are much more likely to be affected than men. The cause of the condition is still unknown. Post-traumatic arthritis usually develops after an injury and is very similar to osteoarthritis in how it damages the body. Post-traumatic arthritis can present symptoms years after a fracture, ligament injury, or meniscus tear.
Knee Arthritis Symptoms
Because arthritis is slow to develop, symptoms can often go unnoticed for years before diagnosed by a doctor. The pain gradually gets worse over time and the joint may swell and become stiff. Patients often find that the pain and swelling are the worst in the morning or after sitting for a long time. Many people also report that changes in the weather can cause different levels of pain. Knee osteoarthritis causes the following symptoms:
- Pain which increases with physical activity.
- Warmth at the knee.
- Knee stiffness, especially in the morning or during periods of inactivity.
- Decreased knee mobility.
- Difficulty in getting in and out of chairs or cars, climbing stairs, walking or other physical activities.
- Creaking sounds from the knee during movement.
Knee rheumatoid arthritis causes these signs and symptoms:
- Widespread pain, swelling and inflammation
- Stiffness and warmth of the joints
- Fever and flu-like symptoms
Knee Arthritis Diagnosis
Depending on the type of arthritis you have, the physical examination and treatment you receive will differ. First, your doctor will take a medical history and note any symptoms you have experienced to help determine whether you have knee osteoarthritis or rheumatoid arthritis. Testing may be done to verify which form of arthritis you may have, and may include:
- Imaging studies: X-rays and MRI scans can show the bone and cartilage damage present in the knees. X-rays show dense structures, mainly bone, and MRIs show the soft tissues.
- Blood tests: Patients who have rheumatoid arthritis will often have positive tests for anemia, Rheumatoid factor, high erythrocyte sedimentation, cyclic citrullinated peptide antibodies, and high levels of C-reactive protein.
Treatment for Knee Arthritis
To help repair these types of knee injuries a doctor can try a variety of techniques from nonsurgical treatments like lifestyle changes and supportive devices, to drug treatments to help fight the arthritis. If these methods do not work surgery may be an option to consider. Nonsurgical treatment seeks to reduce pain and other unpleasant symptoms limiting knee function. Treatment methods utilized before pursuing surgery include:
- Lifestyle changes: your doctor may advise that you avoid activities that aggravate your knee, such as high-impact physical activities.
- Weight loss: Many OA patients are overweight and can benefit from losing weight, which will take pressure off the knees and other weight-bearing joints of the body. Weight loss often results in reduced pain and increased knee function.
- Physical Therapy: A physical therapist can help you increase the range of motion in your knee and work on flexibility. Exercise can also strengthen the leg muscles as you seek to reduce pain and improve knee function.
- Mobility aids: To take stress off the knees, you may use a cane or walker to better support your weight in the lower body. Energy-absorbing shoes or orthotic inserts may also be beneficial, particularly if one knee is worse than the other.
- Medication: medication may reduce joint swelling and pain, and your doctor may also prescribe a COX-2 inhibitor if knee pain is moderate to severe. Other oral supplements that may be recommended include glucosamine and chondroitin to reduce swelling and tenderness and to improve your mobility and function.
- Injections: Corticosteroids injected directly into the joint are powerful pain relievers and effective at reducing swelling. However, to achieve the same effect, injections must be given routinely, which can cause unpleasant side effects and exacerbate joint symptoms. Other injections that may be given include gold salt injections for rheumatoid arthritis, or vicosupplementation with hyaluronic acid to improve the quality of joint fluid.
- Alternative therapies: Some patients pursue acupuncture or magnetic pulse therapy to address knee pain. Although these alternative treatments have unproven results, they may be reasonable to try in addition to other methods if your doctor approves their use.
There are a number of surgical treatment options but the four most common are:
- Arthroscopic surgery – A doctor will use a small incision to insert a tiny camera and miniature surgical instruments to survey and either remove or repair the damage. This procedure is considered minimally invasive and helpful in removing damaged cartilage or loose particles while cleaning the bone surface and repairing tissue damage.
- Osteotomy – Surgeons will cut tibia also known as the shin bone or the femur, sometimes called the thighbone, to align the bone with the knee joint. Your orthopedist may recommend osteotomy if the damage is in one primary area or if you have a knee fracture that has not healed adequately.
- Total or Partial Knee Arthroplasty – This surgery, also known as a knee replacement, replaces the weight-bearing surfaces of the knee with medical grade plastics and metal. Usually patients who have this surgery are 50 or older and have severe osteoarthritis. Most patients have excellent results, but the surgery may need to be repeated if the prosthesis wears out, which usually takes about 20 years.
- Cartilage Grafting – Knees with limited or contained cartilage loss because of trauma or arthritis, cartilage grafting may be an option. This surgery is designed to replace cartilage on the surface of the joint.
- Synovectomy – Rheumatoid arthritis patients may benefit from removal of the inflamed joint lining, which may be performed laparoscopically. The pain relief from a synovectomy may last for up to five years.
Risks and Complications of Knee Replacement Surgery
Complications resulting from knee replacement are uncommon, but every surgery carries inherent risks. Certain complications which are very rare, such as heart attack or stroke, can affect full recovery. Some of the potential risks and complications include:
- Knee joint infection, which occurs in fewer than 2 percent of patients. Infection may set into the wound or deep around the prosthetic implant, and may happen during your hospital stay or after you go home. Some even experience infections year later. Severe infections may require additional surgery and implant removal to prevent the spread of the infection in the body.
- Blood clots are a more common complication, which can be life threatening if the clot travels to the lungs. Your orthopedic surgeon will take all precautions to prevent this possibility, such as elevating the legs and increasing circulation in the lower legs with support stockings. Blood thinners will also be administered after surgery to prevent blood clots.
- Implant problems may result from loose or worn down prostheses. Excessive scarring may also limit mobility.
- Continued pain is a rare complication.
- Nerve or blood vessel damage.
Knee arthritis can be treated a number of different ways. We want to make sure you're feeling your best, back on your feet, and no longer in pain. To discover more about knee arthritis treatment in Los Angeles and throughout Southern California, call our West Medical offices at (855) 690-0565.
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