Knee Osteoarthritis
Knee osteoarthritis causes pain, stiffness, swelling and reduced mobility. It is often described as wear and tear, which is a poor description of what is actually happening. Osteoarthritis is an active process involving the whole joint, and it is not a simple matter of a knee wearing out with use.
Why does an arthritic knee hurt?
The amount of arthritis visible on an X-ray does not reliably predict how much pain someone has. Some people have marked changes on imaging and relatively little pain. Others have far more trouble than their scan would suggest.
Pain is usually influenced by a combination of things:
- changes within the cartilage, bone and joint
- inflammation or swelling within the knee
- muscle strength and general conditioning
- previous injury or surgery
- how the knee is loaded during everyday activities
- body weight
- sleep, general health and other medical conditions
Diabetes, cardiovascular disease and other long-term conditions affect mobility, general health and the capacity to exercise. Treating an X-ray rather than a person is how knee osteoarthritis care tends to go wrong.
How is knee osteoarthritis assessed
Assessment starts with your history and an examination of how the knee moves and how it is loaded.
Diagnostic ultrasound has a specific role here. It does not grade osteoarthritis, which is what an X-ray does, but it shows swelling within the joint, inflammation of the joint lining, and other problems that can sit alongside arthritis or be mistaken for it. It also guides any injection accurately into the joint.
That distinction matters because not all knee pain in an arthritic knee is coming from the arthritis. A meniscal problem, a bursa or a tendon can be the actual source of the symptoms, and the treatment for those is different.
Exercise and physiotherapy
For most people, exercise is the foundation of treatment. It is also the part most often abandoned, usually because activity hurt at some point and avoiding it seemed sensible.
The aim is not to protect the knee by doing less. It is to find a level of loading the knee tolerates and build from there, improving strength, mobility and confidence together.
Treatment may involve strengthening the muscles around the knee and hip, improving general fitness, temporarily modifying activities, and building a programme you can sustain. Specialist physiotherapy is how that is judged and progressed.
Where someone is carrying extra weight, reducing it lowers the load through the knee and can improve both pain and function. That is worth considering alongside exercise and the management of any other relevant health conditions rather than in isolation.
Knee braces and supports
Some people benefit from a support or brace.
A simple knee support can add comfort and confidence during activity. Where osteoarthritis mainly affects one side of the joint, a specialised unloading brace may help by redistributing load away from the painful compartment.
Bracing is not for everyone, and it works best when chosen according to your symptoms, your knee alignment and the pattern of arthritis rather than fitted as a default.
Where do injections fit?
An injection may be worth considering when pain is preventing progress with rehabilitation, when symptoms remain troublesome despite appropriate treatment, or when surgery is not yet needed or wanted.
Injections do not reverse knee osteoarthritis. What they can do is reduce symptoms enough to create an opportunity, and the opportunity is the point. An injection that relieves pain and is not used to rebuild strength and movement has been largely wasted.
All injections at Meyer Physio are performed under ultrasound guidance, following assessment.
Steroid injections
An ultrasound-guided steroid injection, sometimes called a cortisone injection, can give relatively rapid short-term relief, particularly where the knee is painful, inflamed or swollen.
They are most useful during a flare-up, or when pain is making rehabilitation difficult. They are not a cure, and repeated injections are not appropriate for everyone. The benefits, limits and risks are discussed before treatment.
Hyaluronic acid injections
Hyaluronic acid occurs naturally in joint fluid. Hyaluronic acid injections aim to reduce pain and improve function in an osteoarthritic knee.
Results vary. Some people get worthwhile and reasonably prolonged improvement, others notice little. The research evidence is mixed and clinical guidelines disagree with one another, so the evidence, the likely benefit and the alternatives are all discussed before deciding.
Cingal
Cingal combines hyaluronic acid with a steroid in a single ultrasound-guided injection. The intention is to address both the inflammation and the lubrication of the joint at once, giving earlier relief than hyaluronic acid alone alongside longer-lasting benefit than a steroid injection on its own.
Arthrosamid®
Arthrosamid is an injectable hydrogel for knee osteoarthritis. Unlike steroid or hyaluronic acid, the hydrogel is non-biodegradable and becomes incorporated into the soft tissue lining of the joint.
It is intended to provide longer-lasting relief, and may suit people with persistent knee osteoarthritis where other treatments have not given enough benefit, or who want to delay or avoid surgery. Suitability is assessed individually, and the benefits, risks and alternatives are discussed before treatment.
When is knee replacement surgery considered?
Most people do not move straight from diagnosis to surgery.
Knee replacement is generally considered when pain, stiffness and loss of function are substantially affecting quality of life, and appropriate non-surgical treatment is no longer giving enough benefit.
That decision rests on the individual rather than the X-ray. General health, other medical conditions, weight, the severity of symptoms and your own goals all form part of it. If surgery is the right answer, we will say so.
Finding the right treatment
No single pathway suits everyone with knee osteoarthritis, and what is right changes over time. Management can include education, exercise and physiotherapy, weight and general health management, medication, supports or bracing, injections, and surgery when appropriate.
The aim is to work out what is actually driving your symptoms, and to help you choose what makes sense for where you are now.
What it costs
Every appointment lasts a full hour. Where a diagnostic scan is needed, that appointment is charged at the scan rate, which replaces the standard consultation fee rather than being added to it.
Current prices for assessment, scanning and ultrasound-guided injections are listed on the prices page. No GP referral is needed to book.
Knee osteoarthritis assessment in Weybridge
Meyer Physio is an advanced practice physiotherapy and MSK diagnostic clinic on Baker Street in Weybridge. Assessment, diagnostic ultrasound and ultrasound-guided injection all take place in the same room and the same appointment, with no waiting list.
Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].