There are two forms of knee arthritis: osteoarthritis which results from damage to the articular cartilage (joint surface) of the knee, and less common inflammatory arthritis of which Rheumatoid arthritis is the best known. Osteoarthritis gradually gets worse with age.
Treatment of knee arthritis depends on the severity of your symptoms. The first stages of treatment try to control day-to-day symptoms with simple measures. For some people, glucosamine with chondroitin may help and for others symptoms can be controlled with a combination of simple painkillers -such as paracetamol often with codeine - and possibly anti-inflammatories such as naproxen. In general terms symptoms from osteoarthritis gradually get worse with time. Regular low-impact exercise is extremely helpful to prolong the deterioration and exercises such as cycling, a cross trainer or exercise bike as well as front and back crawl swimming can be very helpful. Once your symptoms increase further treatment options include specific physiotherapy to teach exercises to strengthen the muscles around the knee and to try to maintain function. Often injection treatment - for example with local anaesthetic and steroid - can help if you experience a significant exacerbation of your symptoms. Unfortunately there is some evidence that steroid injection when used regularly may cause damage to the bone surface of the joint and can in fact cause some progression of arthritis.
Once conservative measures have failed and your symptoms are severe enough, operative treatment needs to be considered. In the past many patients were offered an 'arthroscopic washout' of the knee which was a day case procedure with the object of removing debris from the joint. Although some patients described benefit from this procedure it is now well recognised that this gives no lasting benefit in the case of arthritis alone. Arthroscopy is now reserved for patients with significant mechanical symptoms - for example locking from a loose body.
Operations for knee arthritis fall into two separate types. The choice of surgery will depend on the extent of arthritis in the joint. For some patients the arthritis is localised to a small area of the knee joint and for those patients sometimes an osteotomy operation to break and reset a bone to take pressure off the area of arthritis can be helpful. For other patients joint replacement can be the best option. It is possible to replace just part of the joint for some patients and for other patients a total knee replacement is the choice.
When you see Simon to discuss management of your knee arthritis he will take a careful history from you and ask you about the effects of your symptoms on day-to-day life, the treatment you have received so far as well as reviewing x-rays as these are the most appropriate images to help to make a decision. Many patients may have already had x-rays carried out and it is important for any images to be available for Simon to review when he sees you in clinic. His practice manager can help to obtain x-rays and scans from other hospitals provided sufficient notice is given. At the end of your consultation a plan for ongoing treatment will be made in discussion with you.