Knee Pain - Learn the Causes and Treatment
Updated: Sep 9
Knee Pain is a common condition that is seen in primary care. Most people just think knee pain is not treatable and hence they should just "bear with it".
But why should you put up with knee pain? It affects your quality of life. Constant knee pain, especially when you walk, can certainly wear you down. In some people, it may even lead to increased risk of falls.
In this article, we will discuss
Other than injuries or trauma, the most common cause of knee pain that we see in clinic, is that of Osteoarthritis.
What is Osteoarthritis?
Osteoarthritis, is a wear and tear condition of the knee, especially when we get older (but younger at heart).
It is the most common form of arthritis. Apart from the knee joint, osteoarthritis can also occur in the hands and hips.
What happens in Osteoarthritis?
The cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time.
Osteoarthritis causes pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.
What is the biggest risk factor of Osteoarthritis?
By far the biggest risk factor we see in our clinic is that of Obesity.
Extra weight puts more stress on joints, particularly in the hips and knees. This stress in weight bearing joints (hip and knee) increases the risk of osteoarthritis in that joint.
Other risk factors of osteoarthritis include:
Joint injury or overuse. Actions like knee bending and repetitive stress on a joint, can damage a joint and increase the risk of osteoarthritis in that joint.
Older Age. The older you are, the higher the risk of developing osteoarthritis.
Gender. Women are more likely to develop osteoarthritis than men, especially after age 50.
Genetics. People who have family members with osteoarthritis are more likely to develop osteoarthritis. People who have hand osteoarthritisare more likely to develop knee osteoarthritis .
How is Osteoarthritis diagnosed?
A thorough physical examination of the knee needs to be conducted in clinic, to identify the severity of the damage.
Your doctor should be looking out for these features:
Pain or aching in the Knee
Decreased flexibility or range of motion of the knee
Swelling in any part of the knee
Abnormal cracking sounds when moving the knee, like popping or grating
After the thorough physical examination, your doctor may offer some scans like an X-Ray or MRI scan to gauge the severity of osteoarthritis.
X Rays are good to check the general joint structure and assess the severity of the "bone on bone" problem.
Here is a sample X Ray of normal knee joints. As you can see, the space between the femur (the bone on top) and the tibia (bone on bottom) is nice and clear. There is no narrowing of the space. Also, there joint line is nice and smooth.
However, in the following picture we see an abnormal X Ray which shows osteoarthritis of the knee.
The joint space between the femur and tibia is narrowed, and in some areas, the femur is hitting the femur. Also the joint line is jagged and uneven. This patient is likely to have pain in the knee.
In some cases, an MRI of the knee will reveal other structures that may have been damaged by the osteoarthritis. Examples of the structures include the meniscus and ligaments. All these cannot be seen on X Ray and will only be seen on the MRI scan.
So as you can see, an MRI scan gives much more detailed information on the Knee Joint as compared to the X Ray of the knee.
So, let's just say, if you have Osteoarthritis, what are your treatment options now?
If you condition is not so severe, sometimes, a short course of medications may help to alleviate the pain and swelling. If you have no allergies or contraindications to anti-inflammatories, these medications can help temporarily with the pain. But these medications do not reverse the worsening of osteoarthritis.
Physiotherapy should be started with all patients with a diagnosis of osteoarthritis
Pain is a common symptom that occurs at different intensities depending on the individual, it is not necessarily related to severity of osteoarthritis progression.
Exercise has been proven to be effective as a form of pain management and also improves physical functioning in the short term.
Exercises have to take place under the supervision of a trained professional (physician with sports medicine background / physiotherapist) initially
After being properly instructed, these exercises can be performed at home without much equipment.
Viscosupplementation of the Knee Joint
What is Viscosupplementation?
Viscosupplementation is a procedure that involves injecting hyaluronate, a gel-like fluid, directly into the joint.
Hyaluronate is found naturally in the synovial fluid surrounding the joints to reduce friction during movement.
The injection goes into effect by lubricating the joint and assisting the synovial fluid to create more cushion. This works to reduce pain and improve mobility of the joint.
Will Viscosupplementation cure my osteoarthritis?
Unfortunately, it is unlikely that Viscosupplementation will cure osteoarthritis
However, it is thought that hyaluronate will improve the lubricating properties of the synovial fluid, reduce the pain from osteoarthritis of the knee, improve mobility, and provide a higher and more comfortable level of activity.
When is Viscosupplementation offered?
Viscosupplementation is usually reserved until other treatment options have been tried and have not relieved your pain.
This treatment seems to work best in people with mild or moderate arthritis. That is why the earlier you seek treatment, the less "invasive" the treatment will be. After all, everyone wants to avoid surgery, especially Joint Replacement Surgery!
Viscosupplementation may be an alternative form of treatment to reduce pain if you don't want surgery.
How soon after Viscosupplementation injections do patients report pain relief?
Not all patients are helped by the injections. Of those who are, many report feeling some pain relief 3 to 5 weeks after the injections, while pain relief is delayed in others.
Most patients report the greatest pain relief 8 to 12 weeks after the treatment.
The length of pain relief varies; some patients have reported benefits for more than 6 months following the injections.
What are the risks for Viscosupplementation treatment for arthritis?
Most people don’t have any problems from Viscosupplementation, but a small percentage of people do have problems.
The most common problem you might encounter, and its not that common actually, is a flare-up of your arthritis just after your injection. This might cause additional pain and swelling in the short term.
Less common risks include:
Pain at the injection site
Infection (you should delay your injection if you have any active infection to help prevent this)
There is also a chance that the treatment will not effectively help your symptoms, especially that of knee pain.
How is Viscosupplementation done in Paddington Medical?
Before the treatment is done, the area around the knee will be cleaned with antiseptics to reduce the chance of joint infection.
Local anesthesia will then be applied to the area of injection to numb the area. This is done to ensure your comfort during the procedure.
During a Viscosupplementation treatment, our team will administer a single injection using our advanced ultrasound machine to guide the injection into the knee joint.
This can be seen in the ultrasound image where we will inject the hyaluronate directly into the joint space.
After the injection, you should not expect to relieve your pain symptoms immediately. It may take several weeks before you begin to notice a difference. Your relief from symptoms may last for several months.
Many patients report feeling a decrease in pain over the course of a 3 to 5 week period after the injections are administered. Patients report that the most significant level of pain relief comes 2 to 3 months after the injection.
Depending on the patient, the length of pain relief will vary. Patients often report improvement of symptoms for 6 months or more after the treatment.
As with other types of injections, patients who receive Viscosupplementation generally report feeling slight pain at the site of the injection. Swelling, heat, itchiness and bruising around the joint can also occur.
Viscosupplementation serve as a minimally invasive treatment option as an alternative to surgery, for many patients who experience pain related to osteoarthritis.
The earlier the earlier you seek treatment, the less "invasive" procedures are needed.
If you have knee pain, don't wait anymore, seek medical attention today!
What is Paddington Fast Care and how Fast Care can help you?
At Paddington Medical, we understand that having knee pain is distressing hence we have created Paddington Fast Care, for you.
In the assessment of knee pain, to speed up diagnosis and treatment, we are equipped with an advanced Ultrasound System to conduct immediate Ultrasound scans in clinic.
To speed up the diagnostic process, and only if necessary, we arrange expedited X-Rays or MRI scans for our patients to get same day or next day results, so that our doctors can review the results with you in Paddington Medical.
We are also able to safely conduct Ultrasound Guided Knee Viscosupplementation to help with the pain from Osteoarthritis. Viscosupplementation is just one of the many options we offer for the effective treatment of osteoarthritis pain.
Paddington Medical works with a team of trusted Orthopaedic (Bone) Surgeons to provide integrated and comprehensive care for our patients should you need knee replacement surgery. Paddington Fast Care can arrange for expedited care for you with this team of Orthopaedic Surgeons if needed.