Maybe you hear a popping or grinding sound in your knee, you find it catches sometimes, or you feel a twinge when you climb stairs. You wonder if it could be arthritis. Its possible stresses on the cartilage over time might have worn it out, causing degenerative knee osteoarthritis.
Andrew Adamczyk, MD, an orthopedic specialist at Banner Health in Arizona, explained more about this common condition.
What causes degenerative knee osteoarthritis?
There are a couple of causes:
- People who have suffered previous injuries to the ligaments or bones in their knee are more likely to develop degenerative knee arthritis. Dr. Adamczyk said, “That’s because injuries such as ligament tears, meniscus tears and breaks in the joint change how the knee sees stress going forward.”
- Many people who develop it are slightly knock-kneed or bowlegged, so their alignment is abnormal, which generates increased stress on the cartilage. “For these people, everyday walking is probably fine, but those who are long-distance runners, practice high-impact sports or work physically demanding jobs can stress their joints and wear them out more quickly,” Dr. Adamczyk said.
With degenerative knee arthritis, the first sign is most commonly knee pain, but it won’t always keep people from doing what they want. They may rest or take anti-inflammatories or even seek help and guidance from a physical therapist, which can help in the early stages of osteoarthritis. Once the cartilage wears down to the level of the bone and spurs (extra bone) begin to form, the pain worsens, and people seek medical attention.
How can you prevent knee arthritis?
In some cases, knee osteoarthritis is not preventable — you can’t help it if you injure your knee in an accident, for example.
But, to prevent knee arthritis from progressing, you want to keep your leg muscles strong and maintain flexibility and range of motion. “Physical activity to maintain strength in your quadriceps and your hamstrings helps stabilize the knee,” Dr. Adamczyk said. Strong leg muscles can also help prevent ligament injuries, since more strength means more stability and less stress on the ligaments.
You don’t want to overdo it, though. “If you’re going to be an ultra-marathoner, you’re going to increase stress on the joints, since you are using them much more than the typical person. That’s the extreme end of the spectrum.” Dr. Adamczyk said. “However, I would never stop someone from doing what they love or disprove physical activity, but simply educate them of the risk in certain situations.”
There’s debate about whether glucosamine chondroitin supplements can help; however, there is some evidence that it can support cartilage health and help with pain, so it’s an option you may want to consider, since there’s little to no risk.
Bracing your knee with soft braces won’t change the course of osteoarthritis. “It can give you a feeling of relief because it squeezes the knee, but it doesn’t change the disease that’s going on inside,” Dr. Adamczyk said. Custom rigid braces, however, in cases of correctable deformity, can help offload the inside or outside of the knee in the setting of localized osteoarthritis.
For those who have a rare deformity that’s causing or worsening knee arthritis, a surgical procedure called an osteotomy, which reshapes or realigns the bones, can correct the deformity and normalize stresses to the joint.
What are symptoms of knee arthritis?
Most people feel pain where the bones meet at the knee, called joint-line pain. “Pain going up stairs is often one of the first symptoms people describe, because there’s more stress on the knee,” Dr. Adamczyk said. The pain could be on the inside, the outside or the front of the knee behind the kneecap. It usually worsens throughout the day as you use your knee more. “You feel much better in the morning because you’ve been off your knees overnight,” he said.
You may also notice your knee catching, buckling, locking, popping or grinding. Some people have flares of inflammation or swelling.
How is knee arthritis diagnosed?
In most cases, your doctor will ask about your symptoms and evaluate your knee. They will want to see if you can fully extend your lower leg—arthritis can make it difficult. They’ll ask where you notice pain when they touch your knee. And they’ll see if your ligaments are loose, which could mean the joint space is narrow, so the ligaments have more room to move.
Your doctor will also examine your bone on X-ray to see if the joint space is narrowing and the bone is denser. “The bone will light up more if it’s seeing more stress,” Dr. Adamczyk said. The X-ray may show bone spurs or a complete loss of the joint space, where your bones are touching each other without a cushion of cartilage.
It’s possible to diagnose knee arthritis with an MRI, but it’s usually unnecessary, especially in people 55 to 60 and older.
How is knee arthritis treated?
It’s important to seek care if you think you have osteoarthritis. Since the condition decreases your mobility, you might not be walking and exercising as much, so you might not maintain your bone health. If osteoarthritis gets bad enough, it can increase your risk of falling — if your knee catches and hurts, that could lead to a tumble and result in other injuries. When you’re less active due to arthritis, you’re also more likely to gain weight, which can, in turn, lead to other health problems.
Physical therapy and anti-inflammatory medications are the first steps. If they don’t work, corticosteroid or hyaluronic acid injections are options. “These introduce fluid into the knee to decrease inflammation or help the joint glide,” Dr. Adamczyk said.
People often ask about biological agents such as platelet-rich plasma. However, Dr. Adamczyk said the evidence for its use in treating knee osteoarthritis isn’t clear, especially for end-stage or bone-on-bone arthritis.
“A lot of people can get better with non-invasive options,” Dr. Adamczyk said. “You should have an open mind toward conservative treatment options before you think you need surgery.”
If conservative treatment options don’t alleviate your pain enough, you may want to consider a partial or total knee replacement. If your osteoarthritis is only in one part of the knee — either the inside, the outside or behind the kneecap, you might be a candidate for a partial knee replacement. If you have arthritis in more than one area, a total joint replacement (knee arthroplasty) is a better choice.
The bottom line
Degenerative knee arthritis is a common problem as you get older. Symptoms can be present occasionally or all the time, sometimes even at rest. Physical therapy, anti-inflammatory medications and injections can help. If those options don’t bring relief, a partial or total knee replacement might be an option. To talk to an orthopedic specialist about treatment options for your knee pain, reach out to Banner Health.