Arthritis of the knee joint (usually osteoarthritis) is basically wear and tear of the joint. The knee can wear out because of age or because of a previous injury which accelerates wearing of the knee joint.
Pain may have been experienced in one or both knees for some time, with limited movement when squatting or walking up and down stairs. There may also be a “crunching” of the knee which can be heard and felt when bending the knee.
On examination of the knee, Dr Wood may request an X-ray to confirm the diagnosis by viewing the joint space, the gap between the thigh bone (femur) and shin bone (tibia). This gap is usually made up of meniscus and articular cartilage (similar to the shiny white gristle seen on the joint. Articular cartilage does not show up on X-ray and thus appears as a gap.
If this articular cartilage is worn out by a previous injury or by wear and tear, the gap or joint space narrows, sometimes to the degree where bone rubs on bone and becomes very painful, causing crunching of the knee.
The options for treating arthritis depend on a number of factors:
- Severity of arthritis
- General health
- Amount of pain – at rest and walking
These factors also help Dr Wood decide on the treatment of the arthritic knee – conservative treatment or surgery.
Conservative treatment is usually chosen for younger people (30 to 60 years) when the disease is mild to moderate and little pain is experienced. This may include anti inflammatories, physiotherapy and a change in lifestyle ie avoiding all twisting sports or change of job. Some people can go on for many years being treated conservatively and some deteriorate rapidly to severe pain which may require surgery.
Surgery may be recommended for older patients who have severe pain and arthritic changes on X-ray.
For those people who are still young (40 to 60 years) a high tibial osteotomy may be necessary to alleviate the pain and grinding of the joint. This operation is 80% successful and thorough discussion with Dr Wood is necessary before proceeding to surgery.
A successful high tibial osteotomy is especially good for those people who wish to return to an active lifestyle with little restriction on activities.
For the more senior patients (60+ years) a total knee replacement may be necessary when pain in their knee is constant and prevents them from enjoying a good quality of life eg walking to the shops or playing nine holes of golf. If a patient has pain at rest and at night preventing sleep it is probably time for a total knee replacement.
It is important to emphasise that a total knee replacement is only performed to relieve pain. It will not enable you to kneel, play netball, touch football, ballet or any twisting type activities or sports. It will help improve the quality of life so that you can walk to the shops or play golf.
Sometimes a knee replacement will be performed on a younger person (40+ years) if their arthritic knee pain is severe and their quality of life is poor.
This operation is 95% successful but with a recovery time of twelve months. Thorough discussion with Dr Wood involving the potential complications of this operation is necessary. Only when you are prepared to accept the risks of surgery should you consider having this performed.