The knee joint and cartilage
The knee is a hinge joint between the femur, tibia and patella. The ends of the bones are covered in smooth articular cartilage. In arthritis, this cartilage is gradually worn away — eventually exposing rough bone, which produces pain and stiffness. The body responds by forming bone spurs (osteophytes) around the joint margins.
Symptoms
- Pain localised to the knee, often worse with activity
- Sleep disturbance, particularly with severe arthritis
- Limp and a sensation of weakness
- Stiffness, especially after rest or first thing in the morning
- Crepitus — grinding or grating with movement
- Bowing of the leg as the arthritis advances
- Reduced walking distance and difficulty with stairs
Diagnosis
The history and examination, supported by weight-bearing X-rays, are usually sufficient. MRI may be required to identify other causes of pain in earlier stages.
Non-surgical treatment
- Quadriceps strengthening and a guided exercise programme
- Activity modification and low-impact exercise
- Weight loss where appropriate
- Anti-inflammatory medications (NSAIDs)
- Walking aids in more advanced disease
Alternative therapies
Glucosamine, hyaluronic acid injections and platelet-rich plasma (PRP) all have some patient advocates. The high-quality evidence supporting any of these in established knee arthritis remains limited. They may be considered alongside conventional treatment.
A note on stem cell therapy
Stem cell therapy is widely promoted but is not currently supported by rigorous clinical evidence for established knee arthritis. Most "stem cell" products available outside clinical trials contain few true stem cells. Mr Gormack is happy to discuss the current evidence with you.
Surgical treatment
- Total knee replacement — the gold standard for diffuse advanced arthritis.
- Partial knee replacement — for arthritis confined to one compartment.
- Patellofemoral replacement — when only the kneecap joint is affected.
- High tibial osteotomy — realignment of the tibia for younger patients with single-compartment arthritis (see knee surgery).