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A sportsman with knee pain touching the painful knee area.

Osteoarthritis

What Is Osteoarthritis?

Osteoarthritis is the most common form of arthritis. “Osteoarthritis” means joint inflammation from a degenerative condition or wear and tear of the knee joint cartilage. This condition can occur as the result of a traumatic injury to the knee or, from a genetic predisposition to cartilage degeneration.

This process can begin with cartilage softening which can lead to fraying and fissuring of the surface cartilage, ultimately progressing until it is completely worn from the bone. Bone spurs (osteophytes) can form as the pressure on the bones increase and the bone tries to spread the force over a larger surface area, creating more bone.

Synovial fluid production often increases to lubricate the worn surfaces and begins to fill the knee compartment causing swelling, pain, and reduced range of motion.

Images of normal, moderate and severe arthritis inside the knee.

x-rays of knee osteoarthritis

What Are The Causes Of Osteoarthritis?

The causes of knee osteoarthritis are due to genetic predisposition, from a prior joint injury or impact that damaged the cartilage surfaces, or damage to the meniscus cartilage that protects the bone articular cartilage.

Dr. Buechel performing physical exam

What Are The Signs And Symptoms Of Osteoarthritis?

The following list of symptoms can occur from the breakdown and loss of cartilage on the joint surfaces. When the cartilage surface wears down increased friction and irritation occurs. This then causes the release of chemicals that stimulate pain and the further breakdown of cartilage, and in many people can cause an increase in fluid production. This fluid tightens the joint compartment making motion more difficult and stimulating pressure sensors that cause pain. The degenerated cartilage on the bone surfaces can also lead to the tearing of the cartilage bumper between the bones called the meniscus. The symptoms people can experience include:

  • Pain when walking
  • Pain getting up from seated position
  • Pain walking stairs
  • Dull aching pain
  • Stiffness in knee
  • Swelling of the knee joint
  • Swelling behind the knee joint called a popliteal cyst, or Baker’s Cyst
  • Loss of motion in the knee from fluid accumulation and bone spurs
  • Decreased walking distance due to pain
  • Limping due to pain and angular deformity
  • Knee angular deformities due to loss of cartilage surface and bone surface with advanced wear.
Dr. Buechel reviewing post-operative x-rays of his knee replacement patient.

How Is Osteoarthritis Diagnosed?

There are several steps to help diagnose osteoarthritis of the knee. These include:

History & Physical Exam

A patient’s health history is taken to learn about recent or old knee injuries, any family history of arthritis, and your activity level. A physical examination is performed to examine the structures of the knee, painful areas, look for swelling, check motion, evaluate ligaments and muscle function, skin health, vascular supply, neurologic function and gait. Other joints are examined as well including the ankles, hips and back to look for sources of pain.

X-Rays

X-rays are the first line of imaging to identify and characterize knee osteoarthritis. Proper X-ray views performed at the correct angles, and with weight bearing on specific views, are needed to be able to correctly diagnose the knee joint arthritic condition and properly show the joint space loss from osteoarthritis and look for other reasons for pain. X-rays show us the bones of the knee but not the cartilage surface. Knee osteoarthritis findings that are seen on x-ray include:

  • Joint space loss
  • Sub-chondral sclerosis (hardening of the bone below cartilage)
  • Bone spurs
  • Bone cysts
  • Angular deformity

The proper x-rays for evaluating for knee arthritis are shown below.

Osteoarthritis Knee X-rays : AP Standing View, PA Flexion View, Lateral Views and Sunrise Patella View

MRI

MRI images of Meniscus Tear, Popliteal Cyst and Osteonecrosis

After the diagnosis of osteoarthritis is made with proper x-rays, MRI images can further detail the damage and exact locations of cartilage disease and show the healthy structures of the knee joint as well.

MRI provides detailed images without the use of radiation, instead it uses magnets to create images of the bone and soft tissues of the knee. The MRI, unlike the x-rays, shows the cartilage, ligaments, tendons, muscles, nerves, and vessels, as well as the bone. The MRI can show:

  • Cartilage thickness
  • Areas of damage
  • Fraying and flaps and the areas of healthy cartilage
  • Bone reaction and inflammation in detail
  • Meniscus tears
  • Popliteal cysts
  • Osteonecrosis
  • Bone bruising or stress fractures
  • Tendon and ligament injury or inflammation
Healed knees of a patient after robotic knee surgery

What Are The Possible Treatments For Osteoarthritis?

Non-Surgically

There are many ways that patients can try to reduce the symptoms of their knee osteoarthritis. Any of the non-surgical options can be tried and used until the symptoms are no longer tolerable by the individual. Some treatments have very little risk, some have greater risk and more side effects. Patients must weigh the risk benefit ratio of each of these options when deciding if they are right for them.

Below is a list of some non-surgical options for knee osteoarthritis.

  • NSAIDs
  • Ice
  • Physical therapy
  • Nutritional supplements
  • Glucosamine
  • Turmeric
  • Unloader Braces
  • Electrical muscle stimulation
  • Cortisone injections
  • Hyaluronic Acid injections
  • A2M injections
  • Growth Factor injections
  • Ozone injections
  • Acupuncture
  • Topical pain medications and anti-inflammatories
Surgically

There are several surgical options for knee osteoarthritis that is painful and no longer responsive to non-surgical care. These options should be discussed with your surgeon based on your particular condition.

  • Partial Knee Replacement
  • Total Knee Replacement
  • Osteotomy
Dr. Buechel performing physical exam

Can You Leave Osteoarthritis Untreated?

Yes, you can leave knee osteoarthritis untreated. Unlike cancer or heart disease, osteoarthritis left untreated will not shorten your life. However, it will reduce your quality of life. Managing your quality of life, reducing pain and increasing function, is what treating knee osteoarthritis is all about.

Contact our office today to schedule a consultation and get the relief you deserve at 212-308-3089 or email us at info@RoboticJointCenter.com.

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