Osteoarthritis - rheumatology

Knee Osteoarthritis

Understanding the Knee

The knee is a complex joint formed by the thigh bone (femur), shin bone (tibia), and knee cap (patella). Cartilage covers the ends of the bones to help smooth, pain-free movement. Menisci (medial and lateral) act as shock absorbers and provide stability. Ligaments (ACL, PCL, MCL, LCL) hold the joint together.

Common Causes of Knee Pain

Knee Osteoarthritis – age-related cartilage wear and tear
Ligament Injuries – from twisting or trauma (e.g., ACL, MCL tears)
Meniscal Injuries – often caused by squatting or lifting
Inflammatory Arthritis – e.g., rheumatoid or psoriatic arthritis
Other – gout, infections, patellofemoral pain, bursitis

How Is Knee Pain Evaluated?

Doctors evaluate knee pain using history, physical exam, and investigations:

X-rays to check bone and joint space

(Left) In this X-ray of a normal knee, the space between the bones indicates healthy cartilage (arrows). (Right) This X-ray of an arthritic knee shows severe loss of joint space.

MRI if soft tissue injury is suspected
Blood tests if arthritis or gout is suspected

If the Diagnosis is Knee Osteoarthritis

Osteoarthritis (OA) is due to gradual cartilage loss. It leads to pain, swelling, and stiffness.
Main Causes: Aging, Obesity, Previous injury, Genetics, Joint overuse.

Main Goals of Treatment

Reduce pain
Improve mobility and function
Prevent further damage

Daily Care & Prevention Tips

Limit prolonged walking/standing
Avoid squatting and low chairs
Use ice packs during painful flares
Apply NSAID gels or creams as advised

Pain Relief Options

Tablets:

Paracetamol, short-course NSAIDs. Avoid long-term use without doctor advice.

Injections:

Steroids: short-term relief (3–6 months)
PRP: promising but still under study; works best in early OA
Gel (Hyaluronic acid): cushioning effect, temporary relief

Strengthening & Weight Control

Daily strengthening exercises (guided by physiotherapist or clinic video)
Low-impact cardio (cycling, swimming, cross-trainer)
Weight loss through diet is preferred. Avoid intense weight-bearing activity.

Role of Supplements

Glucosamine and fish oil are commonly used in Australia and Sri Lanka. Evidence is mixed. May offer mild benefit and are safe for most. Use only with medical advice.

When to Consider Surgery

Surgery is an option only when:

Pain is severe and affects daily life
Non-surgical treatments have failed

Options: Total or partial knee replacement. Arthroscopy (keyhole surgery) is not recommended for OA alone.

Summary

Knee OA is common, especially with age. Most people can avoid surgery with lifestyle change, exercise, and appropriate pain control. Work with your doctor and physiotherapist to manage your symptoms and preserve joint function.

Rheumatology