Osteoarthritis of the knee:- stage, diagnosis, and treatment
And welcome to the One Care Medical Center one of Coimbatore’s premier international orthopedic hospital, My name is Dr. Abdul Salam and I am a full-time orthopedic surgeon at OCMC. In today’s short blog post we are going to discuss about
Osteoarthritis (OA) is a very common condition that affects the knee joint. It affects a large portion of men and women after 50 years of age.
In OA knee, degeneration of joint cartilage takes place, along with inflammatory changes in the synovium (soft lining of the joint tissue)
As the protective function of both the cartilage and synovial lining break down, they can no longer protect the joint. Thus, damage occurs.
OA of the knee presents itself with well-known symptoms. These are pain and stiffness. Moreover, these symptoms worsen over a period of time.
OA of the knee proceeds in stages and symptoms usually worsen with disease progression. Moreover, in some patients symptoms may not manifest until a very late stage disease.
Let us look at the various stages of OA knee
Patients in stage 1 OA knee are unlikely to feel any specific symptoms as such. There will be no joint space narrowing too. The X-ray appearance will also be normal.
In this stage of the disease, small lumps of bone called osteophytes may grow in the knee joint area.
This stage is the symptomatic stage of the disease, where the patient may feel his knee is stiff and uncomfortable after sitting for a prolonged period of time. X-Rays usually show much more osteophyte growth as well. Cartilage thinning also begins.
In this stage, the bones are still not in direct contact with one another. Synovial fluid is still present and supports a movement.
Narrowing of the bone gap occurs and X-rays shows loss of cartilage. Daily activities also elicit significant pain. There may be signs of joint inflammation and also daily activities like running, walking, bending all cause significant discomfort.
The cartilage thins out, and the bone responds by growing outwards forming lumps. Swelling of the synovial lining also occurs, producing excess fluid.
Stage 4 is the most advanced stage of OA knee, symptoms are clearly visible. Joint space narrows severely. There is more inflammation and stiffness in the joint.
An X-ray may show bone on bone with complete loss of protective cartilage. Pain is also usually severe. Moreover, the bones may also be deformed/angulated. Surgical treatment is probably the only option left.
Diagnosis of OA:-
An individual may not initially notice any symptoms of OA knee at all.
Your treating orthopedic doctor will usually take a full-fledged medical history and also do a physical exam of your knee.
Common questions your ortho doctor would ask you includes:-
1. Where is the pain located?
2. How does it affect your day to day life?
3. Are you on any medications?
Frequently, your doctor will also prescribe you test like MRI and an X-ray as well. In some instances, your doctor would perform a fluid aspiration to remove some fluid and assess for the presence of gout and rheumatoid arthritis.
Treatment options for OA depend on disease staging.
Stage 1: –
Here the symptoms are mild, so over the counter medications can be used to relieve pain. Physiotherapy can be done to build joint strength and mobility.
Medications like Chondroitin sulfate may help
Stage 2 patients can
A. Take painkillers
B. Chondroitin sulfate
C. Wear a knee brace
A combination of the above strategies with some lifestyle changes may work best.
Stage 3 treatment strategies can include the use of 3 to 5 hyaluronic acid injections over a 3-5 week period.
Relief from these treatment strategies can last for about 6 months.
Stage 4 patients, cartilage has disappeared. The person may require joint replacement.
A number of factors can help individuals avoid the development of OA knee.
1. Maintaining optimal body weight
2. Strict blood sugar control
3. Regular exercise
4. Proper posture
5. Avoiding overuse from excessive sports activities
I hope you enjoyed reading this article on OA knee. If you have a friend or loved one suffering from OA knee, do share this article with them!
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1986 Aug;29(8):1039-49.