Osteoarthritis of the knee

Most will be aware that osteoarthritis is a process where the articular cartilage (joint lining cartilage) may breakdown and wear thin. Although loss of articular cartilage is frequently present in osteoarthritis, many other features are relevant. The bones change shape, can develop osteophytes (bone spurs), the menisci can fray and tear and the lining of the knee can become inflamed (synovitis). The bone can become bruised (bone oedema). Chemical changes also occur in the knee that can trigger pain and swelling. The inflammation from osteoarthritis can be aggravated by obesity mainly due to the raised levels of inflammation seen in those who are carrying excess body fat. Treatments are usually directed at reducing pain and swelling.

Treatment of osteoarthritis will depend on the severity and duration of the problem. If the problem keeps flaring up and doesn't respond to simple measures then additional interventions may be required. In general, treatment options you might like to try may include:

• Rest, ice, compression and elevation (RICE) to help manage pain and swelling.
• Physiotherapy to help strengthen the muscles around the knee and improve flexibility.
• Changes to your activity level or technique to avoid further irritation or damage.
• Anti-inflammatory medication can help but don't take them for a prolonged period without advice from your doctor.
• Lose weight, this can reduce the inflammation associated with osteoarthritis.
• Try not to workout or play sports on consecutive days. Avoiding higher impact sports or even just cutting back on the volumes may, for many, be enough.

In general it is safe to keep going. If you can manage the flare ups and remain active then you may manage the symptoms yourself. There isn’t much evidence that you cause additional damage to the knee by soldiering on.

As a knee surgeon, I have extensive experience in diagnosing and treating osteoarthritis. I can help determine the best course of treatment based on the severity of your arthritis and your individual needs.

My aim is to manage your osteoarthritic knee without surgery. I want to help the active stay active. This is very relevant in those with early- and late-stage osteoarthritis. Much of what I can do in the early stages is simply help you understand what’s going on, how bad is it, whether it needs surgery (usually not) and what should you do to manage the condition. I will often see if we can help with a simply injection or course of injections such as hyaluronic acid or Platelet-rich plasma. We can often keep the knee going for some years with a non-operative approach. Braces sometimes help and we can discuss if they are suitable for you. I can also help you understand why and when you should consider surgery. We’ll discuss the potential outcomes and what sports you can do after surgery.

If you need surgery we’ll optimise your health beforehand, help you lose weight if required and explain the alternatives. If you choose surgery I’ll work with you to get you back to sports and if you ski I’ll even take you skiing on my Return to Ski day.

Other methods we can explore to help you stay active include:

• Anti-inflammatory medication or application of capsaicin cream to the joint.
• Corticosteroid injections to reduce inflammation and pain.
• Surgery, which may be necessary in severe cases when other treatments have not been effective.
• Ultimately knee replacement may be very helpful in curing the pain and can get those who have it back to light sports.