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Braces and Supports for Knee Osteoarthritis

Braces and Supports for Knee Osteoarthritis

Introduction

Introduction

Osteoarthritis is the most common type of arthritis in the UK. According to data by Arthritis Research UK, 8.75 million people are being treated for this condition, including about 4.11 million people with knee osteoarthritis. This figure is expected to increase to about 6.5 million by 2020 due to the growth of obesity rates and an ageing population.

The condition occurs where the cartilage (the connective tissue between joints that acts like a cushion) wears away and causes the bones in the joints to rub against one another (leading to bone on bone contact which is the source of the pain). The joints that are most commonly affected by osteoarthritis are found in the knee, hips, neck, back, hands and toes.

Diagram showing the stages of osteoarthritis

Causes

Causes

Osteoarthritis is often referred to as a ‘wear and tear’ condition but is not just limited to the older generation, with the average age of sufferers slowly reducing.

Risks of developing knee osteoarthritis are higher in:

  • People over the age of 45
  • Women
  • Overweight people, as knees have to handle extra pressure
  • Those with relatives suffering from the condition
  • Workers of certain occupations where regular kneeling, squatting or heavy lifting is required, such as mining, farming or more
  • Those doing certain sports, especially athletics
  • Sufferers of other related illnesses, including rheumatoid arthritis or metabolic disorders
  • Those who suffered a knee injury or had knee surgery 
Symptoms

Symptoms

Symptoms of osteoarthritis vary from case to case but can include some or all of the following:

  • Pain
  • Stiffness
  • Swelling
  • A creaking sound
  • A grinding sensation when moving
  • Diminished ability to move, partly due to the muscles around the knee becoming weaker

These symptoms can vary in their severity from joint to joint. While they might be constant for some people, for others these might change every day. Some sufferers are also affected by the weather and experience worsening symptoms with dampness and low pressure.

There are two main complications of knee osteoarthritis, which can make symptoms more severe. These are:

  • Calcium crystal deposits in the cartilage
  • Baker’s cysts, where extra joint fluid is trapped and a lump can be felt at the back of the knee.
Diagnosis

Diagnosis

If you experience any of the symptoms associated with osteoarthritis then you should speak with your doctor as early diagnosis can help to slow down the onset of the condition.

A GP examination will ask you about the source of the pain, any instability in the joint and other symptoms you might be experiencing such as creaking, swelling, muscle wastage etc.

Following this you may be referred for an x-ray, a blood test (used to rule out other types of osteoarthritis rather than determine osteoarthritis itself) or an MRI in order to categorically determine the presence of osteoarthritis or not.

Doctor holding up an x-ray of a knee joint

Non-Surgical Treatment

Non-Surgical Treatment

Treatment options for osteoarthritis knee problems mostly focus on pain relief and improving mobility with an individualised treatment plan for each patient depending on the severity of the condition and your current / desired lifestyle. These can be sub-divided into non-invasive (non-surgical) and surgical options.

Non-surgical options include:

  • Weight management: A diet could improve quality of life as the stress affecting the knee would ease while losing weight.
  • Exercise: Improving one’s exercise regimen with a focus on strengthening muscles around the knee can help the condition significantly. Although it might be difficult to start exercising due to the pain, there are some sports that could improve the condition gently, such as swimming or cycling. Besides strengthening exercises, aerobic exercises can help reduce pain and improve overall well-being. Natural endorphins released when exercising also act as natural painkillers.
  • Medications: Medications prescribed for osteoarthritis usually include painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), steroid and hyaluronic acid injections, transcutaneous electrical nerve stimulation (TENS), topical creams, acupuncture, or supplements.
  • Braces: Often used to take the weight off the affected side of the knee (unloading knee brace) or to provide support for the entire knee.
  • Physiotherapy: An important part of most treatment plans, involving the assessment of movements and providing advice on how to protect joints, how to avoid injuries, and how to reduce pain. Each treatment plan will be customised to the individual’s symptoms and needs, and specialist physiotherapists might be involved in some cases.
  • Occupational Therapy: Supports people with difficulties in their everyday life, including work. Occupational therapists can help with advice on how to avoid straining joints and what equipment can support arthritis sufferers. They can also give advice on reducing tiredness or what equipment could be beneficial for the condition.
  • Hydrotherapy: A treatment option for osteoarthritis knee sufferers, focusing on gentle exercises in warm water

Unloader One being fitted to a patient by a clinician

Surgical Treatment

Surgical Treatment

Before an osteoarthritis knee replacement is offered, sufferers might be able to consider alternative surgical options including:

Arthroscopy: Keyhole surgery for removing debris from the knee joint.

Microfracture: Keyhole surgery method that entails drilling holes into bone surfaces to encourage the development of new cartilage from the bone marrow.

Osteotomy: Surgical method where the shin bone is cut in order to shift the load from the area affected by arthritis

Autologous Chondrocyte Therapy (ACT): Involves the growth of new cartilage in test tubes, which is later applied to the knee joint.

Knee replacement surgery is usually offered as a final option for those suffering from knee osteoarthritis. In a knee replacement surgery, the worn ends of bones and hard cartilage are replaced by artificial parts made from metal or plastic. This is then secured with cement. Patients may undergo a partial or full knee replacement.

There are four main types of this knee replacement, depending on whether the whole knee needs to be replaced or only parts of it. Doctors and the orthopaedic surgeon usually offer advice on the best solution for each patient.

Knee replacement surgery usually improves the quality of life, with four out of five people being happy following the treatment. There might be nuisances involved. For example, following the surgery, there might be limited bending function, stiffness or occasional clicking sounds might occur.

Knee replacements usually last for 20 years, which also means that younger patients may need additional surgery later in life (and one of the reasons why conservative treatment is promoted to reduce the risk of having follow up surgery).

Diagram of a total knee replacement

Following knee replacement surgery

Following knee replacement surgery

Following a knee replacement surgery, the exercise regimen will begin in the hospital in order to strengthen muscles and improve mobility as soon as possible.

Most people are released from the hospital within four days, following a discussion with a physiotherapist or occupational therapist about the best ways to lead daily life without problems.

For the first six weeks, rest is recommended. Walking must be done with crutches, which can be gradually eliminated. After three weeks, one can try to walk outside with appropriate shoes.

It is not encouraged to sit with legs crossed in this initial recovery period, and kneeling is only recommended after three months.

Patients can usually return to work six to eight weeks following surgery in case of sedentary work and 10 to 12 weeks for those doing manual work or standing for an extended period.

Exercising is important following such an operation, with the best sports being cycling and swimming (as they can strengthen muscles significantly without putting too much strain on the knee). Contact sports are not advised, while recreational sports - such as skiing or golf - should be delayed.

In the long term, appropriate moderate exercise joined with awareness about potential problems with the knee replacement (stiffness, swelling or pain) can ensure that the new knee will last for decades.

 

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