Written by: Dr. Frederick Buechel, Jr.
What Is Osteoarthritis?
Osteoarthritis is the most common form of arthritis. “Osteoarthritis” is joint inflammation from a degenerative condition of the 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 can form as the pressure on the bones increase. Synovial fluid can fill the knee compartment causing swelling, pain, and reduced range of motion.
What Are The Causes Of Osteoarthritis?
The causes of knee osteoarthritis are most commonly due to genetic predisposition, from a prior joint injury that damaged the cartilage surface, or damage to the cartilage surface protecting “meniscus” that leads to higher pressure on the knee joint surface cartilage.
What Are The Signs And Symptoms Of Osteoarthritis?
These symptoms occur from the breakdown and loss of cartilage that causes increased friction and irritation, the release of chemicals that stimulate pain and the further breakdown of cartilage, and fluid production from the lining of the knee joint that makes motion more difficult, increases pressure in the knee, and directs fluid to places it normally is not present. The degenerated cartilage surfaces can also lead to the tearing of the cartilage bumper between the bones called the meniscus. Symptoms can 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, bone spurs, cartilage loss and pain
- 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.
How Is Osteoarthritis Diagnosed?
There are several steps to help diagnose osteoarthritis of the knee. These include:
History & Physical Exam
Patient health history of previous injuries or pain and a brief physical and mobility examination of the problem area may help narrow the cause of discomfort or lack of mobility.
X-rays are the first line of imaging to identify and characterize knee osteoarthritis. These should be taken first before or in conjunction with any other imaging studies done. 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. 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, increased white appearance)
- Bone spurs
- Bone cysts
- Angular deformity
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 all the healthy structures of the knee joint. 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
When To Order MRI’s:
- When pain is not limited to the compartment where the x-ray disease is located
- When X-rays are suspicious for other compartment disease or, when there is pain without x-ray explanation for the pain.
What Does Dr. Buechel Looks For?
- Meniscus Tears – When the joint line is tender or painful
- Large Popliteal Cysts – Can cause posterior knee pain and limited motion
- Osteonecrosis – Medial Femoral Condyle or Tibial Plateau
- Articular Cartilage Disease – Knowing the quality of the cartilage in each compartment can help make the proper decision between partial and total knee in some cases
- Bone bruising or stress fractures
- Tendon and ligament injury or inflammation
What Are The Possible Treatments For Osteoarthritis?
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.
There are more proven non-surgical options, and some that have not really shown much benefit in the medical literature that can be considered. Ultimately, it is the patients desire to try any of the options that determines the course of treatment. Below is a list of several of the non-surgical options for osteoarthritis of the knee:
- Physical therapy
- Nutritional supplements
- Glucosamine Turmeric
- Unloader Braces
- Electrical stimulation
- Cortisone injections
- Topical pain medications and anti-inflammatories
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
- Cartilage Repair Procedures
- Arthroscopic “washout”
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. There are non-surgical and surgical ways to treat knee osteoarthritis.
Select Relevant Publications
Buechel F., Buechel F., Conditt M. (2016) Robotic-Arm Assisted Unicompartmental Knee Arthroplasty (MAKO). In: Scuderi G., Tria A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. Link to Article
Buechel FF Sr, Buechel FF Jr, Pappas MJ, Dalessio J. Twenty-year evaluation of the New Jersey LCS Rotating Platform Knee Replacement. The journal of knee surgery. 2002 Spring;15(2):84-9. Link to Article
Buechel, Frederick F. Sr. MD; Buechel, Frederick F. Jr. MD; Pappas, Michael J. PhD; D'Alessio, Jerry MS. Twenty-Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements. Clinical Orthopaedics and Related Research. July 2001 - Volume 388 - Issue - pp 41-50. Link to Article