Conditions and treatments
Osteoarthritis (OA)
What is OA?
The lower end of the thigh bone (femur), top of the shin bone (tibia) and the knee cap (patella) articulate with each other, being covered by a thin layer called articular cartilage. It facilitates movement by minimising friction, and, along with the meniscus, it absorve loads between bones.Osteoarthritis is a complex process were these structures lose their properties, leading to inflammation, pain, swelling, and stiffness of the joint. It has multifactorial causes and may involve one side of the knee (tibiofemoral compartment), only the knee cap (patellofemoral compartment) or all of it. It is usually a progressive process resulting in wear of the joint that may or may not impair your life. Some people have advanced radiological signs of osteoarthritis but with very little trouble in their daily life activities. What matters is how you feel, how it limits your life, not just the grade of the arthritis.
What are the symptoms and how to diagnose?
Most commonly, people start having pain with weight-bearing and physically demanding activities. With time, the pain increases its frequency, intensity and starts even at rest, alongside with swelling and stiffness. As the condition progresses, it may impair even the most basic daily life activities such as going shopping, household activities or even interrupt your sleep. Diagnosis is made through careful medical exam where the symptoms are interpreted, and a throughly assessment of your quality of life is made. The grade of your OA does not determine the need for an invasive treatment, the symptoms alongside with imaging does. If the degree of symptoms is not matching the grade of changes in X-rays, further imaging such as MRI maybe needed to make a clear diagnosis.
How is it treated?
Treatment will depend on several factors, including your symptoms, level of activity, expectations and mental health. Only a complete and exhaustive assessment by your physician will give you the appropriate pathway in your treatment strategy.
In the vast majority of cases, non surgical treatment is indicated. This includes pain management with analgesic and anti-inflammatory medication, exercises to improve neuromuscular control, strength and fitness, nutritional plans to control weight, and adapting your daily life activities and exercise to your condition. In some cases, injections in the joint may help controlling symptoms in short term, allowing you to start the strengthening programmes with less pain and effusion.
Where conservative treatment fails, surgical treatment maybe the next step. Depending on your limb alignment, number of compartments involved, age, and level of activity, different surgical solutions are available: osteotomy (OTM), unicompartimental knee arthroplasty (UKA), patelofemoral joint arthroplasty (PFJA), total knee arthroplasty (TKA).
OTM: realigning the lower limb in order to unload the affected compartment, where an extra-articular deformity is present; usually, only used if one compartment is affected
UKA: replacing one tibiofemoral joint surfaces with implants, preserving the rest; usually, only used if that compartment is affected
PFJA: replacing the patelofemoral joint surfaces with implants, preserving the rest; usually, only used if that compartment is affected
TKA: replacing all the joint with implants when end stage osteoarthritis envolves more than one compartment of the knee
Therefore, treatment in highly individualised, and a throughout assessment is needed to keep you moving.
