Knee Arthritis
Osteoarthritis of the knee is a very common orthopaedic condition and can have significant impact on the quality of life of individual patients and the community as a whole.
A thick layer of protective cartilage covers the bones of the normal knee joint. This cartilage has many functions including providing the knee with a very low friction surface to allow for ease of motion. When this cartilage wears away, exposed bony surfaces develop which is essentially the process of osteoarthritis.
The causes for the development of osteoarthritis are not fully understood, however there are many factors thought to be involved. Sometimes there is a hereditary predisposition, i.e. it runs in families. Females tend to be affected more than males and there is a strong link with obesity. Injuries to the knee may have a significant role to play, especially where there has been previous cruciate ligament, meniscus and cartilage injuries.
When end-stage arthritis occurs, there may be significant pain during weight-bearing activity such as walking, kneeling or squatting. In some instances certain regions of the knee are painful after holding the knee in a prolonged position (e.g. after sitting through a movie, car ride or flight). This pain is accentuated as the knee is loaded down with body weight, heavy force or strenuous muscle activity. Eventually the pain may go on to become present at night time, and this may be due to the release of inflammatory chemicals into the knee joint due to the breakdown of tissue. Other symptoms may include stiffness, swelling, limping or a sensation of grating or crunching from within the knee.
Treatment of osteoarthritis may be surgical or non surgical. Generally, non-surgical treatment should be exhausted prior to surgical management.
Treatment Options:
Non surgical:
- Physiotherapy/hydrotherapy
- Yoga/pilates
- Weight loss
- Non impact exercises
- Activity modification
- Anti-inflammatories + Panadol
- Braces
- Gait aids eg walking stick
- Intra-articular injections:
- Steroid eg Cortisone
- Viscosupplementation
- Platelet Rich Plasma (PRP)
Surgical:
- Realignment Osteotomy
- Joint Replacement
Procedural:
- Cooled Radiofrequency Ablation (CRFA)
-
Knee and Hip Osteoarthritis Information Brochure
Viscosupplementation
When the knee joint starts to develop arthritis, cartilage starts to degrade and wear away and the natural lubricating fluid within the joint may not be produced adequately. This leads to the common symptoms of arthritis – pain, stiffness and the reduction in function. The natural lubricating fluid within these joints is made out of a chemical called Hyaluronic Acid (HA). HA is continuously being made and broken down naturally in these joints, however in arthritic joints HA is often not adequately replaced. Viscosupplementation is a term which describes the process of replacement of the natural HA within the joint via an injection directly into the knee or hip. This can be performed in the office, alternatively in the radiology department or when combined with Cooled Radiofrequency Ablation, in the operating theatre if desired. HA comes in many different formulations. Jonathan uses a product which is a single injection of highly concentrated HA which according to clinical studies can relieve pain and improve function for up to six months. It is recommended that no vigorous physical activity be performed for 48 hours following injection.
Viscosupplementation can be considered for treatment of arthritis as part of a personalised approach, especially early in the process when surgery may not be desired. There are no real contraindications to HA injection.
-
Viscosupplementation Durolane
-
Viscosupplementation Artibest
-
Viscosupplementation Post Injection Guidelines
Cooled Radiofrequency Ablation
The final pathway of pain transmission from arthritis is from the sensory nerves that surround the joint. When they are activated by a painful stimulus they send a message to the brain which is felt as pain. Cooled Radiofrequency Ablation (CRFA) is a non surgical method of blocking the pain that is generated by these nerves. It targets these nerves by using a cooled radiofrequency probe near the nerve to heat the tissue surrounding the nerve. The controlled heating of the nerve then blocks pain transmission of these sensory nerves. The motor nerves that supply muscle control around the knee are protected and not affected. Although not technically considered an operation as no incisions are made, the procedure is carried out in the operating theatre under a general anaesthetic. CRFA typically will take approximately 20-30 minutes to complete and is performed as a day procedure, not requiring admission to hospital. There are no formal restrictions in activity following the procedure which is minimally invasive and has a low complication profile. The effect from CRFA can last 6-9 months, sometimes longer and the procedure may be repeated if necessary. In a large case series in the USA the reported outcomes demonstrate that approximately 75% of patients report an improvement by at least a 50% reduction in pain. CRFA may be indicated for painful joints where surgery such as joint replacement or osteotomy may not be desired or possible. If desired this may be combined with other non surgical interventions including viscosupplementation injection.
-
Cooled Radiofrequency Ablation (CRFA)
Your individual plan and method of treatment is best discussed in person with Jonathan.