OA Knee Questions
There are many myths about OA Knee. Here are some questions and facts:
Does my OA knee need a clean out?
When people ask about a 'clean out', they often mean an 'arthroscopy'. There is no evidence an arthroscopy helps osteoarthritis alone. It may be useful if there is a structural problem within the knee, such as a large cartilage tear that is causing problems.
Do I need a knee replacement for my OA Knee?
Research suggests that only one third of people with osteoarthritis will experience disease progression. Two thirds don't worsen! Where possible, it is best waiting until the age of 70 for initial joint replacement to reduce the need for future revision.
Joint replacement is indicated for if you have failed a physical rehabilitation management program and still have significant disability and pain. For example, if your pain is like a constant tooth ache and you need pain medication for relief or to sleep.
What's the best thing I can do for my OA knee?
A good exercise program is as effective as anti-inflammatory medication without the risk. An appropriate exercise program is safe and effective to manage the symptoms of osteoarthritis. The link below takes you to some useful exercise information in My Pain Hub.
Staying active is one of the best things that you can do to manage your osteoarthritis. Exercise helps reduce pain, increases your ability to perform activities, and increases your quality of life. Ideally you should include both aerobic and strengthening exercises.
You are most likely to stick with an exercise program if you find something that you enjoy doing. Swimming or water aerobics, tai chi or yoga, walking 6000 steps per day, and/or using weights or bands to do strengthening exercises for the muscles around your knee are all useful. Find something that works for you to keep you motivated!
Will exercise make my osteoarthritic knee worse?
If prescribed appropriately, exercise shouldn’t make your knee worse over time. It could actually lead to an increase in your capacity, physical activity and quality of life - including your ability to walk and negotiate stairs.
What about a knee brace?
According to the research, knee braces are not considered to be the best first line of treatment. However, for some people, a knee brace may be helpful! Your health care professional will help guide you about this decision.
I have heard a bit about PRP, corticosteroids and stem cells - will they help?
There is not enough evidence to support the use of most injectables. Short term benefits gained corticosteroid injection could provide a window of opportunity to exercise. This assists in overall functional improvements.
A diagnosis of knee OA is almost 100% likely if you have all of the following signs and symptoms:
- Persistent activity-related knee pain
- Morning stiffness
- Reduced function - sitting to stand, walking, dressing etc
- Crepitus/noise on movement
- Restricted knee movement, inability to squat, go up and down stairs
- Bony enlargement seen visually and felt on palpation.
How is Knee OA diagnosed without X-ray or MRI?
Although age of onset, symptoms and progression of OA will vary between patients, there are several ‘typical features’ of OA.
- Age > 40 years
- Activity-related joint pain ie it hurts when you move and may ache afterwards
- Short duration of (or no) morning stiffness (< a half hour)
- Symptoms affect only one or a few joints
MRI should be considered only if there is suspicion of serious pathology not detected by X-ray as radiological features of OA typically have a low correlation to OA symptoms. Some X-RAYS reveal severe damage in people who don't have knee pain. Other knees can look normal on MRI despite marked difficulty with function.
Only severe night pain, gross resticion of meovment and major reduction in function are indicators of the possible need for a total knee replacment consultation with an orthopaedic surgeon.
How should knee OA be managed?
- Analgesics should be recommended to help enable physical function rather than to abolish pain
- Although management will differ for each individual – evidence proves that weight management and exercise are effective
- Intervention should be assessed regularly against individual goals to determine whether you are improving