If Surgery Is Required
The meniscus may be involved in some cases of knee OA. In the past, surgery to repair or remove parts or all of this cartilage was common. Current research, however, has shown that â in a group of patients who were deemed surgical candidates for knee OA with involvement of the meniscus â 60% to 70% of those who first participated in a physical therapy program did not go on to have surgery. One year later, those results were unchanged. This study suggests that physical therapy may be an effective alternative for people with knee OA, who would prefer to avoid surgery.
Sometimes, however, surgical intervention, such as arthroscopy or a total knee replacement, may be recommended. There are many factors to consider when determining the appropriate surgical treatment, including the nature of your condition, your age, activity level, and overall health. Your physical therapist will refer you to an orthopedic surgeon to discuss your surgical options.
Should you choose to have surgery, your physical therapist can assist you prior to and following your surgery. The treatment you require following surgery will depend on a variety of factors such as the type of surgery performed, your level of function, and fitness prior to surgery. Contrary to popular belief, surgery is not the easy choice you will still require treatment following your surgery to maximize your level of function.
Gradual Increase In Pain
Arthritis pain usually starts slowly, although it can appear suddenly in some cases.
At first, you may notice pain in the morning or after youve been inactive for a while. Your knees may hurt when you climb stairs, stand up from a sitting position, or kneel. It may hurt just to go for a walk.
You may also feel pain when youre simply sitting down. Knee pain that wakes you up from sleep can be a symptom of OA.
For people with RA, the symptoms often start in the smaller joints. They are also more likely to be symmetrical, affecting both sides of the body. The joint may be warm and red.
With OA, symptoms may progress rapidly or they may develop over several years, depending on the individual. They can worsen and then remain stable for a long time, and they can vary by days. Factors that may cause them to worsen include cold weather, stress, and excessive activity.
With RA, symptoms usually appear over several weeks, but they can develop or worsen in a few days. A flare can happen when disease activity increases. Triggers vary, but they include changes in medication.
With OA, this can be:
- hard swelling, due to the formation of bone spurs
- soft swelling, as inflammation causes extra fluid to collect around the joint
Swelling may be more noticeable after a long period of inactivity, like when you first wake up in the morning.
This is because RA is a systemic disease, which means it affects the whole body. OA, meanwhile, only has a direct impact on the affected joint.
Add The Power Of Pufas
Polyunsaturated fatty acids which include omega-3 fatty acids are usually associated with heart health. But their anti-inflammatory health benefits go beyond the heart, extending to people with arthritis, Dr. Burg explains.
Studies have shown that supplementation with n-3 PUFAs, which is the same thing as omega-3s, clearly does have an effect on pain and disease activity in people with rheumatoid arthritis, he says.
Good PUFA sources to add to your diet include wild salmon and other freshwater fish, flaxseed and olive oil.
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Complementary And Alternative Medicine
Many complementary and alternative medicine treatments have been used to treat knee osteoarthritis, with variable success. Glucosamine and chondroitin supplements have been marketed since the 1990s as disease-modifying options. A double-blind RCT showed little benefit from the use of glucosamine combined with chondroitin in participants with mild knee osteoarthritis.15 However, a greater benefit was noted in persons with moderate to severe pain. Glucosamine is safe, but the benefit is variable. Chondroitin does not decrease pain from osteoarthritis of the knee or hip.15
The benefit of acupuncture is not clear. A meta-analysis did not demonstrate any clinically relevant improvement in pain or function scores with acupuncture compared with sham acupuncture.16 However, in the short term and in the long term , patients who received either acupuncture or sham acupuncture felt better than those who received usual care. Another study showed that six months of treatment with traditional Chinese acupuncture decreased pain scores and increased functionality an average of 40 percent compared with sham acupuncture or no treatment.17
How Is Knee Arthritis Diagnosed
Your doctor may use some of the following diagnostic tests and procedures to determine if you have knee arthritis:
- Medical history and physical examination
- Blood tests for genetic markers or RA antibodies
- X-rays to determine cartilage loss in the knee
- Joint aspiration: drawing out and testing the synovial fluid inside the knee joint
Cartilage cannot be seen on X-ray, but narrowing of the joint space between the bones indicates lost cartilage. X-rays show bone spurs and cysts, which can be caused by osteoarthritis. Other tests such as MRI or CT scans are rarely needed for diagnosis.
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How Much Can I Walk With Knee Arthritis
Consistency and moderation are important when it comes to walking with arthritis in the knee. To begin with, patients are encouraged to do about 1015 minutes of light walking per day and eventually work their way up to 30 minutes per day. You can do one 30-minute walk or several shorter walks throughout the day. Follow these tips to ensure safety and comfort when walking with arthritis:
- Warm up: Lightly stretching and warming up the muscles is always a good idea before exercising. This helps prevent injury and is particularly beneficial for patients whose knees are stiff due to arthritis.
- Choose appropriate terrain: Make sure you choose an even walking surface, such as a track or mall, to avoid possible accidents or undue strain on the joints. While some doctors believe a very moderate incline is helpful for the knees, flat surfaces are just fine.
- Dont overdo it: Begin by walking short intervals at a moderate, comfortable pace. In the coming weeks, your body and joints will likely feel better and stronger, allowing you to increase the distance of your walks.
- Walk when your knees feel the best: While walking may help arthritis pain in the long term, it is important to try and walk when your joints are feeling their best. For example, if you wake up with stiff, painful knees, it may be best to wait until later in the day to begin your walk. Additionally, walking right after taking anti-inflammatory medications can help minimize any possible discomfort.
Starting An Exercise Program
Problem is, if you have hip arthritis, pain may prevent you from exercising. This lack of exercise can contribute to your osteoarthritis and cause muscles to atrophy. That only feeds the cycle of pain.
If you can push past the pain a little and start getting just a little regular physical activity you will get stronger. As your muscles get stronger, your ability to be active will improve. Youll be able to do more at home in your everyday activities.
This strength is good for your bones, your joints, and for your overall quality of life.
Your overall health and your age will determine which exercises are best for you. Talk to your doctor before starting a new exercise routine, as you will need to work with a physical therapist. A therapist can help ensure you start with the correct exercises for your situation.
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Different Types Of Arthritis
The knee is the joint where the bones of the lower and upper legs connect. It moves like a hinge, allowing you to sit, squat, walk or jump. The basic anatomy of the knee consists of three bones: the femur, tibia, and patella. The ends of the bones are covered with a layer of cartilage – a slick, elastic material that absorbs shock and allows the bones to glide easily against one another as they move. Different types of arthritis affect this joint differently.
What Are The Symptoms Of Knee Arthritis
While knee pain can certainly affect patients without arthritis, there are some classic knee arthritis symptoms to keep an eye out for. These can include:
- Chronic or recurrent pain
- Stiffness, often upon waking or after sitting for a long period of time
- Limited mobility
If you are experiencing any of these symptoms, it is important to be evaluated by a qualified provider to obtain a definitive diagnosis and find out what treatment options are available to help relieve your discomfort. During your initial consultation for knee arthritis in Atlanta, GA, Dr. Williams will thoroughly evaluate your joints and perform any necessary imaging studies to determine whether arthritis may be affecting you.
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Do: Wear Comfortable Knee Joint
There are a fair number of studies that suggest shoe choice matters if you have knee osteoarthritis, Pisetsky says. In fact, flat, flexible shoes that mimic the foots natural mobility can decrease the force placed upon the knee during daily activities, according to a study published in the May 2013 issue of Arthritis and Rheumatology.
Why Does My Knee Hurt When I Walk
For countless men and women across the country, knee pain is a daily struggle. In fact, knee pain can be so severe that some patients are unable to continue working. There are several possible causes and risk factors for chronic knee pain, including:
- Obesity
- Overuse
- Arthritis
Without a doubt, one of the most common causes of knee pain is arthritis. Patients suffering from arthritis in the knee may have either rheumatoid arthritis a condition developing in the joints lining or osteoarthritis, which is characterized by the breakdown of cartilage. While RA may occur at any point in a persons life, osteoarthritis is much more common and affects the vast majority of patients suffering from knee arthritis.
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What Are The Types Of Arthritis Of The Knee
There are around 100 types of arthritis. The most common types that might affect your knees include:
- Osteoarthritis is the most common of the types on this list. Osteoarthritis wears away your cartilage the cushioning between the three bones of your knee joint. Without that protection, your bones rub against each other. This can cause pain, stiffness and limited movement. It can also lead to the development of bone spurs. Osteoarthritis gets worse as time passes.
- Post-traumatic arthritis is a type of osteoarthritis. The cartilage starts thinning after trauma to your knee . Your bones rub together, and that causes the same symptoms as osteoarthritis: pain, stiffness and limited movement. Your knee arthritis symptoms might not start until years after the trauma.
- Rheumatoid arthritis is an autoimmune disease. A healthy immune system causes inflammation when it’s trying to protect you from an infection, injury, toxin or another foreign invader. The inflammatory response is one way your body protects itself. If you have rheumatoid arthritis, you have an unhealthy immune system that triggers inflammation in your joints even though theres no foreign invader. The inflammation causes pain, stiffness and swelling of the synovial membrane, which can also wear away your cartilage.
Adding Or Removing Some Bone Around A Joint
If you have osteoarthritis in your knees but you’re not suitable for knee replacement surgery, you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.
This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.
If you have osteoarthritis in your knees and your doctor has recommended an osteotomy, you can watch a video about how an osteotomy works, including the risks and benefits of having this type of surgery, on The Health and Care Video Library.
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What Questions Should I Ask My Healthcare Provider About Arthritis Of The Knee
It might be helpful to arrive at your healthcare providers office with a list of questions you want or need to be answered. Consider:
- Do I have arthritis in one knee or both?
- What type of arthritis do I have?
- Whats a possible cause of my arthritis?
- What treatments do you recommend?
- What medications should I take?
- Do I need physical therapy?
A note from Cleveland Clinic
Knee arthritis can affect people of all ages. Its painful, impairs movement and causes swelling of the joint. Some people are so disabled by it that they cant work anymore. Others can only work after surgery. Meanwhile, for others, the pain isnt necessarily as bad, but it still prevents them from regular activities like cleaning, gardening and running after their kids.
Arthritis of the knee can decrease your quality of life. The good news is that treatments can lessen the severity of your symptoms. The pain and swelling might not be as bad. See your healthcare provider for evaluation and treatment if you have symptoms.
Last reviewed by a Cleveland Clinic medical professional on 10/18/2021.
References
How Is Osteoarthritis Of The Knee Diagnosed
The diagnosis of knee osteoarthritis will begin with a physical exam by your doctor. Your doctor will also take your medical history and note any symptoms. Make sure to note what makes the pain worse or better to help your doctor determine if osteoarthritis, or something else, may be causing your pain. Also find out if anyone else in your family has arthritis. Your doctor may order additional testing, including:
- X-rays, which can show bone and cartilage damage as well as the presence of bone spurs
- magnetic resonance imaging scans
MRI scans may be ordered when X-rays do not give a clear reason for joint pain or when the X-rays suggest that other types of joint tissue could be damaged. Doctors may use blood tests to rule out other conditions that could be causing the pain, such as rheumatoid arthritis, a different type of arthritis caused by a disorder in the immune system.
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Change The Way You Walk To Ease Knee Pain With Osteoarthritis
Overloaded or unevenly loaded knee joints can cause osteoarthritis , or cause your OA to get worse. Learning how to walk differently may be able to correct the loading problem and reduce your knee pain. This approach is being studied in people with medial, or inner, compartment OA which is 10 times more common than other forms of knee OA.
The medial knee compartment bears a much higher load than the lateral compartment, says Pete Shull, PhD, assistant professor in the School of Mechanical Engineering at Shanghai Jiao Tong University in Shanghai, China. Thats just the way our bodies are structured. The inside knee compartment experiences loading thats two to three times higher than the outside.
Researchers are looking for ways to shift some of the medial compartments load to the lateral one. The lateral compartment almost always has healthy cartilage, says Shull. The compartments are like brake pads on a bike, unevenly worn. So by changing the way someone walks, we can get the cartilage in the compartments to wear more evenly.
Deformities Of The Knee
The appearance of the knee can change during a flare and as damage progresses.
In RA, swelling and redness are common during a flare. In the long term, persistent inflammation can result in permanent damage to the cartilage and the tendons. This can affect the shape and appearance of the knee.
With OA, the muscles around the knee can weaken, resulting in a sunken appearance. The knees can start to point toward each other or bend outward.
Knee deformities range from barely noticeable to severe and debilitating.
Treatment will depend on the type of arthritis a person has.
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What Questions Might A Healthcare Provider Ask To Diagnose Arthritis Of The Knee
Your healthcare provider will interview you when you report your symptoms. Some questions might include:
- Does anyone in your family have arthritis of the knee?
- Does your knee swell up?
- Is your skin often red?
- Is your skin often warm?
- Do you have symptoms in one knee or both?
- How long have you had these symptoms?
- What medications do you take?
- How severe is your pain?
- Do you struggle to walk?
- Do the symptoms interfere with your daily activities?
What Is Osteoarthritis Of Knee
Knee osteoarthritis is a progressive disease caused by inflammation and degeneration of the knee joint that worsens over time. It affects the entire joint, including bone, cartilage, ligaments, and muscles. Its progression is influenced by age, body mass index , bone structure, genetics, muscular strength, and activity level. Knee OA also may develop as a secondary condition following a traumatic knee injury. Depending on the stage of the disease and whether there are associated injuries or conditions, knee OA can be managed with physical therapy. More severe or advanced cases may require surgery.
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Transcutaneous Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation uses a machine that sends electrical impulses through sticky patches, called electrodes, attached to the skin. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain.
Treatment with TENS is usually arranged by a physiotherapist or doctor, who can advise you on the strength of the pulses and how long your treatment should last.