The ends of the bones in the knee joint are normally covered with a layer of smooth cartilage. If the cartilage wears out, bone will rub on bone, resulting in a stiff and painful arthritic knee.
Common Causes
Most degenerative knee arthritis is genetic, with a family predisposition. It is probably not activity related, and in fact activity may be helpful in reducing the risk of arthritis. ‘Post-traumatic;’ arthritis develops a long time after a significant knee injury, or as a consequence of a chronic knee injury or instability.
Symptoms
Pain when walking, worsened with increased activity and relieved with rest. Difficulty tying your shoes, or putting on socks. Difficulty with stairs. Swelling in the knee joint.
Physical Findings
Tenderness, and swelling in the knee. Loss of motion or deformity may be present.
Workup
History, examination, and x-rays are generally diagnostic.
Non-operative Treatment
Activity modification, weight loss, physical therapy, and anti-inflammatory medication may be helpful. Corticosteroid injections may bring temporary relief, but should be performed sparingly. Injections of hyaluronic acid may reduce symptoms for a period of time in some patients. Some patients report relief with chondroitin sulfate or glucosamine pills, but scientific studies are inconclusive.
Surgical Treatment
An arthroscopy, with debridement, will remove debris and cartilage fragments from the knee, and can provide relief. Ultimately, a total knee replacement may be necessary.
Injury Comment
Total knee replacement surgery has a high success rate, and great patient satisfaction. Biggest problem is durability of the prosthesis, which wears out or loosens with time. The success rate for a redo, or revision knee replacement is not nearly so high. Therefore, this surgery should be delayed as much as possible, especially in the younger patient.