Osteoarthritis
Phone +971-2-4446600
Anatomy
Cartilage is the smooth surface of the joints that slide towards each other. Cartilage is a delicate tissue and we use the cartilage in the knees every time we move and therefore it gets a bit worn out during the end of our lifetime. When the cartilage gets thinner without any specific injury, just by loading the knee, we call it osteoarthritis.
Sometimes, an injury to the knee can result in increased wear and tear to the cartilage, speeding up the process of which the cartilage gets thinner and the smooth surfaces become more rough. This results in loading pain and swelling with activities.
Evaluation
Osteoarthritis is common in older age, but with knee injuries during youth or in early adulthood it can occur earlier in life effecting your ability to stay active and healthy.
To evaluate a painful knee, examination and information regarding previous injuries or symptoms is important. X-rays are very helpful for diagnostic purposes.
Sometimes the osteoarthritis affects the entire knee, but often after previous injuries just one area or part of the knee is affected and this can be treated completely differently and is therefore crucial to identify.
In older individuals with general osteoarthritis in the knee there is no major role for MRI. However, if the suspicion is that only a part of the knee has cartilage damage and the rest of the knee is doing well, an MRI can be helpful to determine what treatment options are available.
There are many treatment options to preserve as much of your own knee as possible including injections, cartilage transplant, meniscus transplant and osteotomies
Treatment
First line of treatment is to have strong muscles surrounding the knee, making physiotherapy and training the first step. With time, the problems tend to come back in one way or another, but with the correct training regime it can sometimes be pushed as far as decades into the future.
The ground rule is that if we can preserve your own knee, that is preferred, especially in young individuals. That is for multiple reasons, but mainly because the longer you can replace or change just small parts of the knee, the better it works and lasts.
Therefore, if we can help to decrease pain or swelling to the knee by treating cartilage or meniscus injuries with preservation procedures, that is preferred. If we can treat larger lesions with transplants of meniscus or cartilage to help the knee last for years or sometimes decades, that’s also preferred. Or if we can offload the most affected part of the knee with realignment procedures, like osteotomies, that can also buy your knee time when it feels better, works better and you can stay active and healthy longer into the future.
To sum up…preservation before replacement!
Finally, when none of those options are helping or when the osteoarthritis has progressed to larger areas or deeper into the bone making those kind of preservation procedures less effective, we move towards pain-relieving treatment such as anti-inflammatory and pain medicine and sometimes injections to relief the pain, increase the function and make the knee last as long as possible. In the end, if none of those treatments have good effect it is possible to do a knee arthroplasty, knee joint replacement surgery. This can also be done for a part of the joint if needed. This is to be seen as the final solution for osteoarthritis.
When no more preservation options are possible, the final treatment is a knee joint replacement surgery
Rehabilitation
As you have just read, there are multiple different treatments to preserve your own knee and to replace parts of the knee. All of these come with their own specific physiotherapy protocol and rehabilitation plan.
Transplantations and osteotomies need 6-8 weeks on crutches and about 6-12 months of rehabilitation. But they are also there to give the knee improved function for longer time into the future and therefore is considered time well invested.
An arthroplasty, or knee joint replacement surgery, needs about 3-6 months of rehabilitation, but you are actually able to put weight on the knee the day after surgery and can start moving around as soon as your muscles have good control, and pain is settling down just a few weeks after surgery.