The knee is the largest joint in the body and also one of the most complicated. It takes our weight and assists during stance and walking, whilst it withstands extreme stresses during twists and turns, such as when we run or play sports. It s consisted of the thigh bone (femur) the shin bone (tibia) and the knee cup (patella). All these bones are covered by a protective layer to minimize friction and enhance nutrition of the joint. The knee includes some other softer structures like ligaments and tendons and menisci with stabilizing role during movements.
There are many forms of arthritis but most frequent are osteoarthritis, rheumatoid and septic arthritis.
What Is Knee Osteoarthritis?
When the knee has osteoarthritis its articular surfaces become damaged and the cartilage becomes rough, thin and damaged. The bone at the edge of your joint grows outwards, forming bony spurs called osteophytes. The synovium may swell and produce extra fluid, causing the joint to swell.
Causes - Risk factors
Osteoarthritis usually starts from the late 40s because gradual wearing out of the joint with time. If you have a first degree relative with knee osteoarthritis then you’ll have a greater chance of developing it yourself. Other factors like obesity, injuries, physically demanding jobs and genetic may increase the risk for osteoarthritis development in the future.
Symptoms – Diagnosis
Pain, mainly during movements or at the end of the day, that can be combined with stiffness especially after rest. In addition crepitus, during movements, or sense of giving way may be present because muscles have become weak or the joint structure is less stable. What patient usually notices is swelling and that his knees becoming bent and bowed. The simplest and most commonly used method for the diagnosis is the medical history, physical examination and X-rays
There’s NO cure for osteoarthritis as yet, but there’s a lot that you can do to improve your symptoms.
- Weight loss: Research shows that being overweight or obese not only increases your risk of developing osteoarthritis but also makes it more likely that your arthritis will get worse over time.
- Aerobic exercise: Is good for your general health and can reduce pain by stimulating the release of pain-relieving hormones called endorphins. Additionally, strengthening exercises will improve the strength and tone of the weaken muscles that control the affected joint. A physiotherapist can advise you on the best exercises to do.
- Painkillers (analgesics) and non-steroidal anti-inflamatory drugs (NSAIDs): Consult your doctor before start.
- Injections (steroid, Hyaluronic acid): It is important to remember that steroid injections can’t be given frequently or indefinitely. If you need repeated steroid injections into an osteoarthritic knee then you may need to consider surgery.
- Biological therapies with prp or stem cells.
Surgical treatment – Total Knee Replacement
Surgery for osteoarthritis is only needed where other treatments haven’t been effective or where one of your joints is severely damaged. Available methods include partial knee replacement, correction osteotomy and total knee replacement according to damage extension, severity and age of the patient. After being officially trained (Fellowships) in UK in these surgical techniques we use the most update and certified surgical methods and postoperative rehabilitation protocols. In addition, by using Computer Assisted Total Knee replacement in combination with the most reliable implants, according to many literature studies, we aim to the optimal surgical result.
Knee pain after an injury
Fracture: The bones of the knee may sustain a fracture after an injury. The place, the type of the fracture and factors that are related with the patient may determine if the treatment will be conservative οr surgical.
Sprain and strain: Sprain and strain occurs when you somebody overstretches or twists a muscle. There might be pain, tenderness or weakness around the knee, the injured area is swollen or bruised and inability to put weight on the injured knee or use it normally. In addition there might be muscle spasms or cramping. After 2 weeks, most sprains and strains will feel better. You should avoid strenuous exercise such as running for up to 8 weeks, as there’s a risk of further damage. For the first couple of days Rest, Ice, Compression, Elevation, Painkillers, to bring down swelling and support the injury. Consult your doctor if the injury isn’t feeling any better. p
Tendinitis: Its often caused by repetitive running or jumping. Other less common causes are tight leg muscles, muscular imbalance and chronic illness which weakens the tendon. Pain is located between the kneecap and shin. Over time, the pain worsens with physical activity and eventually interferes with daily movements. Initially somebody can try self-care measures, such as icing the area and temporarily reducing or avoiding activities that trigger the symptoms. If the pain continues or worsens or interferes with the ability to perform routine daily activities or is associated with swelling or redness about the joint you need to consult your doctor.
Cartilage damage: Is a relatively common type of injury. Cartilage is a tough, flexible tissue that covers the joint surface, acting as a shock absorber and allowing bones to slide over one another. It can become damaged as a result of a sudden injury. Symptoms include joint pain, swelling, stiffness, a clicking or grinding sensation, locking, catching, or giving way. Minor cartilage injuries may get better on their own within a few weeks but more severe cartilage damage may eventually require surgery. Consult your doctor if symptoms haven’t started to improve within a few days, you can’t put any weight on the injured limb or it gives way or has unusual lumps or bumps, you have numbness or discoloration.
Torn ligament: Ligament tear can be the result of sport, vehicle crush of contact injury. Sometimes it’s a combined injury. If you injure your anterior cruciate ligament, you might hear a “popping” noise and you may feel your knee give out from under you. Other symptoms include pain with swelling, loss of full range of motion and tenderness. Treatment will vary depending upon the patient’s individual needs, age, activity level and degree of injury.
Torn tendon: The quadriceps and patellar tendons can be stretched and torn. This injury is common among middle-aged people who play running or jumping sports. Tendon tears can be either partial or complete. Symptoms are an indentation in the kneecap, bruising, tenderness, the kneecap may move, inability of extension, sense of giving away. Several things must be under consideration when planning the treatment such as the type and size of the tear, the activity level and the age.
Dislocated kneecap: It’s caused when the bone that is located in front of the knee (knee cup or patella) comes out of place and usually laterally. When the kneecap dislocates, in many cases it will pop back into place soon afterwards. Symptoms can include a “popping” sensation, severe knee pain, being unable to straighten the knee, sudden swelling of the knee, being unable to walk. You need to seek consultation immediately, even if its back in place, in order to check for other injuries as well. Surgery is usually only necessary if there is a fracture or ligament tear. It may also be the choise if you have dislocated your kneecap at least once before.
Torn meniscus: Sudden meniscal tears often happen during sports. Tears in the meniscus can occur when twisting, or even when getting up from a chair may be enough to cause a tear, if the menisci have weakened by the age. You might feel a “pop” when you tear a meniscus. The most common symptoms of meniscus tear are pain, stiffness, swelling, catching or locking of your knee and inability to move your knee through its full range of movement. As long as the symptoms do not persist and the knee is stable, nonsurgical treatment may be adequate otherwise a keyhole operation is needed.
Knee arthroscopy is one of the most commonly performed surgical procedures. Βy this, a miniature camera is inserted through a small incision (portal) inside the knee providing a clear view. Surgeon inserts tiny surgical instruments through other portals to trim or repair the tear.
In this procedure, the damaged meniscus tissue is trimmed away.
Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy. Mr Oikonomidis is well trained in arthroscopic knee surgery and certified in meniscus repair.
Knee Pain with no injury
Knee Bursitis: It occurs when the fluid-filled sacs (bursa) that cushion your joints become inflamed. The knee might become painful, tender or warm and swollen. For the first couple of weeks Rest, Ice, Compression and Elevation may bring down swelling and improve symptoms. Consult your doctor if symptoms are getting worse, you have a very high temperature, or you feel hot and shivery, you can’t move the affected joint, you have very sharp or shooting pains in the knee. One possible intervention could be the fluid aspiration ± steroid injection. In case of infection, your doctor will prescribe a course of antibiotic treatment. If you have severe chronic or recurrent bursitis that doesn’t responds to other treatments, your doctor might recommend surgery to remove the bursa.
Iliotibial band syndrome: This occurs when the tough band of tissue that extends from the outside of your hip to the outside of your knee (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome. Symptoms might be pain on the outside of the knee. NSAID’s, exercises, physiotherapies ± local injections may be necessary for the treatment.
“The above provided information derives from evidence-based literature and treatments presented are indicative. Patients should not exclusively rely on the above since it doesn’t replace medical advice and each case requires a unique approach”