Being the second in the weight bearing chain after the hip join the knee is under a great deal of load and stress. This day to day stress results in a wear and tear of the articular cartilage which is covering the surfaces of the Femoral condyles (lower end of thigh bone) and the upper end of Tibia (lower leg bone).
This is a normal finding with aging but this process of cartilage degeneration can take place faster with occupations, biomechanical alterations (i.e. leg length discrepancy), overweight, trauma to the joint and sports that exert lots of loads on the joints. Once the cartilage is worn out the joint becomes painful and the motion becomes limited.
Stages of osteoarthrosis ranges from Minor, Mild, Moderate to Severe changes and it is determined by the amount of cartilage loss and the reduction of the intra-articular space (joint space).
Minor Stage: this stage is usually asymptomatic and the patient doesn’t complain of pain. Some erosions of the cartilage are evident on x-rays but with no clinical finding and the joint space is not compromised.
Mild Stage: degenerative changes of the cartilage are more obvious on x-rays with more bone erosions and the cartilage. The space appears normal on x-rays. It’s at this stage the patient develops pain or discomfort in the joint. Pain is experienced after getting up from a seat after a prolonged sitting, after workout or early in the morning.
Moderate Stage: at this stage erosions grow further and narrowing of the joint space is evident on x-rays. There is associated inflammation of the joint and pain interferes with most of activities of daily living. Running, squatting and kneeling increase pain. Clicking and snapping of the joint also heard when the knee moves.
Severe Stage: this stage is characterized by great loss of articular cartilage, markedly reduced joint space and major stiffness of the joint. Bone erosions cause excruciating pain. Almost all of activities of daily living are painful.
Treatment of Knee Osteoarthrosis:
The treatment depends on the stage of the disease and associated signs and symptoms. Pain and inflammation can be reduced by pain killers and non-steroidal anti-inflammatory drugs. Physiotherapy plays important role in improving joint mobility, flexibility and strength of surrounding muscles.
In the mild and moderate stages physiotherapy includes:
- Application of ICE to reduce pain and inflammation in the acute phase and application of Heat in chronic phase.
- Patellofemoral and Tibiofemoral mobilization techniques to improve the range of mobility of the joint.
- Stretching both Quadriceps and Hamstring muscles.
- Strengthening exercises for the Quadriceps and Hamstring muscles.
- Balance training.
- Teaching the patient on how to use assistive devices if needed.
In advanced osteoarthrosis of the joint surgery is unavoidable. The damaged articular surfaces of the joint are replaced with metal components.
After the operation patients are referred for physiotherapy to:
- Control joint swelling and reduce pain.
- Increase range of motion, stretch tight muscles both Quadriceps and Hamstring muscles.
- Reeducating the Quadriceps muscle which is inhibited after the operation.
- Balance Training.
- Gait retraining using walker at the beginning which is weaned off after stability and balance improves.