Treatment options for knee arthritis
How is knee arthritis treated?
The most common problem with arthritis in the knee is the pain that it causes. While many people can cope with some discomfort, constant (chronic) pain can be frustrating to live with and can have a real effect on mood and psychological wellbeing, as well as physical activity. Stopping the pain, or significantly reducing it, is an important step in helping you to manage life with arthritis.
There are a number of ways that arthritis in the knee can be effectively treated, ranging from ‘do-it-yourself pain relief’ all the way through to knee replacement surgery. We will look at the available treatments under two headings, ‘non-surgical’ and ‘surgical’.
Non-surgical treatments for knee arthritis
Unless your arthritis is at an advanced stage, your doctor will usually start with non-surgical treatments first. These treatments are helpful at different stages of arthritis.
- Analgesia: This is the medical term for pain relief. There are many medicines available that help to relieve pain, but before taking any medicine, you should ensure it is safe for you to do so. If you are unsure, you should consult a doctor or pharmacist.
In the early stages of knee arthritis, an over-the-counter painkiller such as can often help to manage pain. As arthritis develops, the pain relief you get from pain killers may decrease and your doctor may suggest using a non-steroidal anti-inflammatory drug (NSAID). As well as reducing pain, NSAIDs also help to reduce inflammation. Some NSAIDS can be purchased over the counter from your local pharmacy, while others will need a prescription. Your doctor will be able to advise you on this.
- Physiotherapy: Expert guidance from a physiotherapist can help to strengthen the muscles in your knee joint, back and arm to compensate for the effects of arthritis. Physiotherapy may help to restore and maintain function and mobility in the knee for longer than would otherwise be achieved. This can help to delay the need for knee surgery to treat severe arthritis.
Often, people struggling with pain in their knee will stop or reduce their activity in order to reduce the pain. As a result, the knee becomes stiffer and the muscles around the joint can become tighter, meaning the joint is less supported.
The Circle physiotherapy team will work closely with your consultant and other healthcare professionals to structure a custom exercise plan for you to help keep you as mobile and active as possible, for as long as possible. They will talk with you about the importance of staying active for as long as possible and will show you exercises you can do to help maintain function in your knee.
Many people with arthritis can benefit from mobility aids and knee braces, as well as specialist exercise equipment like our AlterG anti-gravity treadmill.
- Weight loss: Your knee is a weight-bearing joint. Reducing your weight can help to reduce the pain you experience as a result of arthritis.
- Steroid injections: As arthritis progresses in the knee joint, pain and stiffness usually also become worse. Painkillers can start to have less of an effect in managing the pain. Steroid injections (also known as ‘corticosteroid injections’) can be of help in this instance. These anti-inflammatory medicines help to reduce swelling in the joint and the surrounding area, reducing pain and stiffness.
These injections will be given by your knee doctor at Circle. It usually takes a few days before you start to feel the full effects of the treatment. The effects are fairly short-term, lasting for a month or two before wearing off, although some people may find the effects last for longer. Steroid injections can be repeated, although they may become less effective over time.
Surgical treatments for knee arthritis
When knee arthritis progresses to the extent it is no longer being successfully managed by non-surgical means, your doctor may talk with you about the possibility of surgery on your knee. There are a number of different surgical options available, and a discussion with your doctor is the best way to determine if surgery is appropriate for you, and which surgical procedure would provide you with the greatest benefit.
- Arthroscopic surgery: This is a form of keyhole surgery, so-called because it only uses small cuts to access the joint, unlike traditional “open” surgery when larger cuts are made to open up the joint completely. Arthroscopic surgery of the knee is normally done under general anaesthetic, meaning you are asleep during it. This has the double benefit of keeping you pain-free while also relaxing the muscles around the knee during the operation.
During the surgery, a thin metal tube about the size of a drinking straw is placed into your knee joint through a small cut. This tube is known as an arthroscope and has a light and camera on one end, allowing the surgeon to clearly see inside the joint itself. Additional small surgical tools can be introduced into the joint if needed to help the surgeon clear out any floating loose bone fragments and to smooth out or ‘trim’ the menisci or cartilage on the ends of the bones to relieve friction when the bones move against one another.
Knee arthroscopy can usually be performed as a day case procedure.
- Osteotomy: Also referred to as knee realignment surgery, this form of surgery is carried out to realign the angle of the knee when arthritic changes have significantly altered it. The surgery is carried out under general anaesthetic. Carefully planned in advance using special X-rays or a CT scan, special cutting instruments are used to make a wedge cut near to the top of the affected bone (often the tibia). The surgeon then realigns the knee. The fractured ends are secured with a strong plate and screws and, if necessary, the surgeon will add a bone graft to secure the fractured bone further.
- Total knee replacement surgery: Should arthritis in your knee joint develop to the point you are in constant discomfort and have extremely limited movement, a total knee replacement may be advised as the best treatment for you.
During total knee replacement surgery, the damaged and worn surfaces of the knee joint are carefully removed and resurfaced with a cobalt/chrome metal joint. High-density polyethene (a type of plastic) sits between the metal surfaces and acts as a bearing surface. The back of the kneecap is also usually resurfaced with the same material.
This new artificial knee joint removes the problems caused by the worn articular cartilage of osteoarthritis and is designed to provide friction-free movement. This improves the mobility of the joint, while also helping to reduce the level of pain and stiffness you’ve been suffering from due to arthritis.
Once the joint has been replaced, the surgeon will use stitches to carefully close any cuts and then place a sterile dressing over the wound to promote healing and reduce the risk of infection. Your knee will be tightly bandaged to help minimise swelling and small drainage tubes may also be left in for up to 48 hours.
Total knee replacement surgery takes up to 90 minutes.
- Partial knee replacement surgery: Also known as uni-compartmental knee replacement, this surgery may be suitable for patients suffering from arthritis where only one of the three main parts of the knee has been affected. The inner half of the joint, between the thigh bone and shin bone, is called the medial compartment. Approximately one third of people with knee osteoarthritis will have it only in the medial compartment.
When considering a partial knee replacement, your doctor must be confident that any deformity in the joint will be corrected by the surgery and that the range of knee movement will be preserved. If this is the case, a partial knee replacement provides a quicker, less painful recovery and a better functional outcome than total knee replacement surgery. Should either of these not be the case, total knee replacement surgery will be the surgical option of choice.