Osteoarthritis (OA), also known as degenerative joint disease, is the most common form of arthritis in the knee and is typically the result of the progressive loss of articular cartilage. It is most common in the elderly, affecting 1 in 5 Australians over age 45, as well as 1 in 3 over age 75. OA is also more common in women than in men. Other risk factors include obesity, previous knee injuries, repeated stress on the knee, genetics and some metabolic diseases such as diabetes and haemochromatosis.
There are two types of knee osteoarthritis, including:
- Primary osteoarthritis, which involves articular degeneration without any apparent underlying reason and;
- Secondary osteoarthritis, which is the consequence of either an abnormal concentration of force across the joint (for example, following an injury), or abnormal articular cartilage (for example, in rheumatoid arthritis).
What are the symptoms of osteoarthritis?
Osteoarthritis often develops slowly, with symptoms gradually increasing over time. Common symptoms of knee OA include:
- A stiff and swollen knee, making basic movements difficult e.g. bending and straightening
the knee; - Pain and swelling that is worse in the morning, or after prolonged sitting or resting;
- Pain with vigorous activity;
- Noisy knees (e.g. creaking, clicking, grinding) or a knee that locks/sticks during
movements; - A feeling of weakness or buckling in the knee and;
- Increased knee pain associated with changes in the weather.
How is osteoarthritis diagnosed?
The diagnosis of knee OA is established by clinical examination. Although imaging is a common tool used when knee OA is suspected, recent studies have shown that there is no significant correlation between pain and function score and the radiological severity of OA of the knee. That is, patients with stage 1 OA on x-ray may have severe and debilitating pain whereas patients with stage 3 or 4 OA may have no pain or dysfunction. For this reason, diagnosis is based on a comprehensive clinical examination with consideration of the patient’s symptoms.
Knee Osteoarthritis has 5 stages:
- Stage 0: “Normal” knee health, no radiographic findings of OA knee joint.
- Stage 1: Very minor bone spur growth.
- Stage 2: “Mild” knee OA, which involves greater bone spur growth. From this stage, the change in knee joints cartilage is irreversible.
- Stage 3: “Moderate” OA, which involves obvious damaged cartilage and narrowing of the knee joint space.
- Stage 4: “Severe” OA, which involves a dramatic reduction of the knee joint space.
How can I manage osteoarthritis?
The most recently published guidelines for Australian GPs regarding the management of knee OA outline that the primary treatment for knee OA should be conservative management, with surgery considered only as a last resort. Although OA itself is not reversible in terms of imaging findings, symptoms such as pain and loss of function can be dramatically improved with conservative management. Physiotherapists are among such health professionals who can help to diagnose knee OA and provide c onservativemanagement. Physiotherapy intervention and treatment includes:
Patient education
This may include information about OA, strategies for lifestyle modification, the role of weightloss and pain management strategies.
Exercise therapy
Exercise therapy forms a large part of the conservative management of knee OA, particularly land-based strengthening exercises based on the individual’s ability and goals. Physiotherapists understand that people with knee OA may have a lot of pain and difficulty with various movements. As such, all exercises are designed to be achievable and tolerable. Other forms of exercise may also include stretching, posture correction, balance exercises and gait training, all of which are recommended in many research studies. When treating all stages of knee OA, the goals of exercise are to improve joint flexibility and the strength of the muscles that support the joint, to improve daily function and reduce pain.
Exercise therapy also plays a big role in regards to total knee replacement (TKR). Studies
have shown that pre-habilitation before TKR for osteoarthritis improves short-term functional
independence and reduces mid-term activity limitations after surgery, which improves the
recovery post surgery. After TKR, physiotherapy rehabilitation is vital to help regain range of
motion, strength of the knee and function, to help people return to their normal daily
activities.
Knee bracing
It is common for people with knee OA to experience pain with walking and weight-bearing.
Knee bracing aims to help reduce pain by supporting the knee and can help people feel
more confident when walking. Wearing a brace can improve your ability to get around and
help you walk farther comfortably, however the evidence of effect on pain in patients with
knee OA is lacking. It should be noted that knee bracing is recommended only as an addition
to exercise therapy and should not be used as a stand-alone treatment.
If you have knee OA and are struggling with pain or difficulty with your daily activities, our
physiotherapists are eager to help. Contact our reception team on 02 6255 2033 to book a
consultation!
Citations and Resources:
- Knee Osteoarthritis. Physiopedia. Retrieved May 1, 2023, from
https://www.physio-pedia.com/Knee_Osteoarthritis - Arthritis of the Knee. Orthoinfo. Retrieved May 1, 2023, from
https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-knee/#:~:text=Osteoarthritis
%20is%20the%20most%20common,knee%20joint%20gradually%20wears%20away - Osteoarthritis of the Knee. Arthritis Foundation. Retrieved May 1, 2023, from
https://www.arthritis.org/diseases/more-about/osteoarthritis-of-the-knee. - Hsu H, Siwiec RM. Knee Osteoarthritis. [Updated 2022 Sep 4]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK507884/ - Osteoarthritis. Healthdirect. Retrieved May 1, 2023, from https://www.healthdirect
.gov.au/osteoarthritis - Samuel AJ, Kanimozhi D. Outcome measures used in patient with knee osteoarthritis:
With special importance on functional outcome measures. Int J Health Sci (Qassim). 2019
Jan-Feb;13(1):52-60. PMID: 30842718; PMCID: PMC6392485. - Osteoarthritis. Spectrumphysio. Retrieved May 1, 2023, from
- Nguyen C, Boutron I, Roren A, et al. Effect of Prehabilitation Before Total Knee
Replacement for Knee Osteoarthritis on Functional Outcomes: A Randomized Clinical Trial.
JAMA Netw Open. 2022;5(3):e221462. doi:10.1001/jamanetworkopen.2022.1462 - Knee braces for osteoarthritis. Mayo Clinic. Retrieved May 1, 2023, from
https://www.mayoclinic.org/tests-procedures/knee-braces/about/pac-20384791 - Glad Australia Participant information. Glad Australia. Retrieved May 1, 2023, from
https://gladaustralia.com.au/ - Steenkamp, W., Rachuene, P. A., Dey, R., Mzayiya, N. L., & Ramasuvha, B. E. (2022).
The correlation between clinical and radiological severity of osteoarthritis of the knee.
SICOT-J, 8, 14. https://doi.org/10.1051/sicotj/2022014
