- Tricompartmental Osteoarthritis Treatment
- Symptoms of Tricompartmental Osteoarthritis
- Diagnosis of Tricompartmental Osteoarthritis
- Treatment of Tricompartmental Osteoarthritis
- Guide to Severe Knee Arthritis (Osteoarthritis)
- General Practitioner
- Orthopedic Surgeon
- Occupational Therapist
- Tricompartmental Knee Replacement
- Tricompartmental osteoarthritis: What you need to know
- Stressful activities
- Traumatic injuries
- Abnormalities at birth
- Tricompartmental Osteoarthritis in the Knee: What Is It?
- Tricompartmental Osteoarthritis Symptoms
- Causes and Risk Factors for Tricompartmental Osteoarthritis
- How Doctors Diagnose Tricompartmental Osteoarthritis
- Treatment for Tricompartmental Osteoarthritis
- Keep Reading
- What Does It Mean If You Have Tricompartmental Osteoarthritis?
- The orthopaedic approach to managing osteoarthritis of the knee
Tricompartmental Osteoarthritis Treatment
Tricompartmental osteoarthritis is a severe form of knee arthritis that affects all three compartments of the knee joint.
The knee is a complex joint made up of three compartments – the patellofemoral where the kneecap (patella) and thigh bone (femur) meet, the medial tibiofemoral on the inside of the knee and the lateral tibiofemoral on the outside of the knee.
Osteoarthritis – sometimes called wear and tear arthritis – occurs when cartilage in the knee joint breaks down over time. It can affect any of the compartments of the knee.
However, if all three compartments are affected it is called tricompartmental arthritis.
This is a more severe form of the disease than unicompartmental or bicompartmental arthritis as the entire knee joint is affected, leading to widespread loss of cartilage as well as damage to the synovium (lining of the knee joint).
Symptoms of Tricompartmental Osteoarthritis
Arthritis is a degenerative disease, which means the symptoms gradually worsen over time. As the cartilage and synovium in the knee wears away, bony spurs may develop which can further exacerbate painful symptoms. If you have tricompartmental osteoarthritis you may experience:
- Knee pain and swelling, which can be severe.
- Weakness in the knee joint which may buckle or give way.
- Joint stiffness, particularly when you have been sitting still or lying down.
- Locking in the knee joint caused by the formation of bony spurs.
- Difficulty walking or walking in a different way to normal
- Water on the knee (joint effusion).
- Overall loss of knee function.
Diagnosis of Tricompartmental Osteoarthritis
During a physical examination, a doctor will be looking for certain signs that could indicate you have osteoarthritis of the knee, including pain, stiffness (especially after periods of inactivity), a grating feeling (crepitus), cracking or popping in the knee, swelling or tenderness in the joint or a feeling of coldness or warmth.
An X-ray will normally be ordered to confirm the diagnosis. This will show any signs of cartilage loss or bony growths. In addition, some patients will be given an MRI scan to check the condition of the knee cartilage and other soft tissues including the synovium and ligaments
Treatment of Tricompartmental Osteoarthritis
The treatment will depend on the extent of damage to your knee joint and how advanced the arthritis is. In the early stages, you may be able to treat the disease using ice or heat packs and elevation to reduce swelling.
Anti-inflammatories and painkillers may provide some relief as well as modification of activities.
For more advanced osteoarthritis, you may be offered an injection of corticosteroid and hyaluronic acid (joint lubricating fluid) into the knee joint to relieve pain and inflammation.
As the disease progresses you may need to avoid exercises that put pressure on your knee, such as running and jumping. You can still do low impact activities swimming or cycling. Using a walking stick, knee brace or insoles can help to reduce the impact on knee joints.
In severe cases, you may need knee replacement surgery. In the case of tricompartmental osteoarthritis you will need a total rather than a partial knee replacement. This involves replacing the entire knee joint with a prosthetic implant.
Carrothers Orthopaedics offer Mako robotic arm assisted surgery, to ensure pinpoint accuracy during knee replacement surgery. Clinical studies show Mako helps protect soft tissues and ligaments from damage and patients also report lower pain scores and higher satisfaction levels. We are specialists in this type of surgery.
Following knee replacement surgery you will need regular physiotherapy to build up strength and flexibility in your knee joint.
It is not always possible to prevent osteoarthritis, which is linked to previous joint trauma, ageing and can be hereditary.
The condition is more common in women than men, particularly after menopause.
However, you can reduce the stress on knee joints by maintaining a healthy body weight and avoiding high impact exercises such as excessive running which can increase wear and tear on the knee joint.
If you have suspected tricompartmental arthritis, speak to an orthopaedic surgeon who can provide an accurate diagnosis and advise on the best course of treatment.
Whether you have chronic pain due to an injury, or have developed a condition such as osteoarthritis, there are options available to you to get back to optimum health. Our specialist consultant orthopaedic surgeons treat a wide range of orthopaedic conditions, including arthritis, trauma, limb deformation and sports injuries.
Our consultation fees are clearly presented here.
For your convenience, we offer appointments at both Nuffield Hospital Cambridge and Spire Cambridge Lea Hospital.
Guide to Severe Knee Arthritis (Osteoarthritis)
As with any other medical issue it is best to consult a medical professional for their opinion on the best course of action for your knee.
Seeing a doctor is always a good initial step if possible as they will best be able to provide guidance directly or point you in the right direction.
In this section we will outline the different types of health care professionals that are commonly associated with the management of osteoarthritis.
This would be your primary care doctor or family doctor in many cases. A General Practitioner (GP) is a great first place to help in assessing the situation. GPs are not usually specialized in treating osteoarthritis but are a great first line of defense and will be able to recommend more specialized health care professionals your particular needs.
As a specialist in rheumatic diseases osteoarthritis, a rheumatologist would be someone who would possibly be brought in by a primary care doctor to help with advanced stages of osteoarthritis, or to help with special cases that a GP would be less equipped to help with.
An Orthopedic surgeon is a surgeon specializing in surgeries involving bones and related connective tissue. This type of surgeon becomes involved with osteoarthritis patients when surgery is being considered as part of a treatment plan, especially in late stage osteoarthritis. This would ly start as a consultation after being referred by a primary care physician.
Physiotherapists (or Physical Therapists) are medical professionals that focus on the movement of the body. Physiotherapists often work with people with osteoarthritis on low impact exercise routines to help promote mobility and minimize pain. They can also help with pre/post surgery recovery in many cases.
Physiatrists are doctors that focus on physical rehabilitation through non-surgical means. They would be able to help with a treatment plan that includes exercise and physiotherapy, as well as medications. A primary care doctor may refer to a Physiatrist when surgery is ruled out as being part of the treatment plan that is best for a patient.
Occupational therapists are experts in helping people minimize the impact of their conditions so they are still able to work and participate in other activities. Someone may seek out an occupational therapist if they are still active in the workforce and are having difficulties with advancing osteoarthritis symptoms that are limiting their ability to work.
Specialists in the manual manipulation of the neck and back, chiropractors can help deal with pain in the neck and back that may arise from other osteoarthritis symptoms.
It is not recommended that manual adjustments be performed on joints with active swelling so it is important to be sure that the chiropractor is aware of the medical history and conditions that the patient faces before therapies are administered.
A dietitian is an expert in tailoring a diet to suit specific medical needs. For someone with advanced osteoarthritis that may be a diet geared towards helping them lose weight or reducing inflammation. The inflammation reduction from diet may be more relevant to those with rheumatoid arthritis but following a similar diet is still said to link to a reduction in pain in some cases.
Osteopaths are similar to chiropractors in that they specialize in the manual manipulation of the bones and joints to help improve function and lessen discomfort. They differ from chiropractors in that they take a more holistic approach than chiropractors with a broader focus.
Tricompartmental Knee Replacement
Tricompartmental knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of thefemur (thigh bone), the tibia (shin bone), and patella(kneecap).
The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities.
The knee can be divided into three compartments:
- Patellofemoral – the compartment behind the kneecap
- Medial compartment – the compartment on the inside of the knee
- Lateral compartment – the area on the outside of the knee joint
Tricompartmental knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It often affects older people.
In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. All of these factors can cause pain and restricted range of motion in the joint.
Your doctor may advise tricompartmental knee replacement if you have:
- Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).
- Moderate to severe pain that occurs during rest or awakens you at night.
- Chronic knee inflammation and swelling that is not relieved with rest or medications
- Failure to obtain pain relief from medications, injections, physical therapy, or other conservative treatments.
- A bow- legged knee deformity
The goal of tricompartmental knee replacement surgery is to relieve pain and restore the alignment and function of your knee. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.
The surgery is performed under spinal or general anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are cut at appropriate angles using specialized jigs. The femoral component is attached to the end of the femur with or without bone cement.
The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws.
Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, similar to the original meniscus cartilage.
The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion.
The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed, drains are inserted and a sterile dressing is placed over the incision.
Rehabilitation begins immediately following the surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Knee immobilizers are used to stabilize the knee. You will be able to walk with crutches or a walker.
A continuous passive motion (CPM) machine can be used to move the knee joint. Continuous passive motion is a device attached to the treated leg which constantly moves the joint through a controlled range of motion, while the patient relaxes.
Your physical therapist will also provide you with a home exercise program to strengthen thigh and calf muscles.
Risks and complications
As with any major surgery, possible risks and complications associated with tricompartmental knee replacement surgery include:
- Knee stiffness
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Ligament injuries
- Patella (kneecap) dislocation
- Plastic liner wears out
- Loosening of the implant
Tricompartmental osteoarthritis: What you need to know
Tricompartmental osteoarthritis occurs when all three compartments in the knee are affected by arthritis symptoms.
The condition causes degenerative changes in the joint. Because of its widespread nature, tricompartmental osteoarthritis may be more severe than other forms of osteoarthritis.
In this article, we take an in-depth look at tricompartmental osteoarthritis, including the symptoms, causes, diagnosis, and treatment for this painful condition.
Share on PinterestLocalized pain, inflammation, and weakness in the knee may be symptoms of tricompartmental osteoarthritis.
Osteoarthritis, or osteoarthrosis, is the most common condition that affects the joints. According to the Arthritis Foundation, osteoarthritis affects approximately 27 million people in the United States alone.
The condition most commonly affects the knees and is also referred to as wear-and-tear arthritis, as it occurs due to the cartilage in the joints breaking down over time.
This wear-and-tear process is referred to as degenerative changes, and it leads to symptoms that include stiffness, pain, and joint effusion or an increased amount of fluid in the joint.
Four bones meet at the knee. The tibia and fibula connect from below the joint. The femur connects from above, and the patella or kneecap sits just atop the femur and the connecting cartilage.
The meeting of these bones creates the three compartments in the knee:
- patellofemoral compartment, where the kneecap and femur meet
- medial femorotibial compartment, or the inside of the knee
- lateral femorotibial compartment, or the outside of the knee
Osteoarthritis can occur in any of these compartments, but tricompartmental osteoarthritis happens when all three compartments of the knee are affected.
Tricompartmental osteoarthritis is often considered to be worse than other forms of osteoarthritis, as the entire area of the knee is affected and loss of cartilage or the synovium or joint lining may be more widespread.
Osteoarthritis causes the cartilage and synovium in the knee to wear down, often leading to bone spurs growing in their place. The cartilage may also get rough or break down completely. This process gets worse over time and often cause symptoms, including:
- localized pain and inflammation
- joint effusion or water on the knee
- chondrosis, where the soft or smooth cartilage breaks down
- joint stiffness and difficulty moving the joint, especially after long periods of inactivity
- bone spurs or exostosis in the knee that can be seen on X-ray images
- knees that lock up due to bone spurs
- weakness or buckling in the knees
- a change in gait, typically a knock-kneed or bowl-legged walking gait
Symptoms may get worse after sitting or resting for a long time, and impact type of exercises may also cause more pain and swelling in the joint.
Share on PinterestA doctor will do a physical exam to diagnose tricompartmental osteoarthritis.
To correctly diagnose tricompartmental osteoarthritis, a doctor may first ask questions and perform a physical exam.
Osteoarthritis involves knee pain and several other symptoms, so doctors may ask if the person has symptoms such as:
- cracking or popping in the knee
- grating feeling whenever the knee is moved
- stiffness in the knees in the morning or after periods of sitting or resting
- tenderness and swelling in the area
- feeling as if the joints are colder than normal
Doctors will often use imaging tests, such as X-rays, to confirm the diagnosis. They will look for any signs of cartilage that has worn away or extra bony growths where the cartilage should be. Osteoarthritis may be more challenging to diagnose in its early stages but easier in later stages.
If there is still any doubt, doctors may recommend a soft tissue scan, using an MRI scanner, to thoroughly check the ligaments, cartilage, and synovium.
Osteoarthritis can occur from normal wear and tear of the joints, so anyone could potentially be diagnosed with the disorder. However, some risk factors may make diagnosis more ly.
Osteoarthritis symptoms develop over time, so the joints of an older person may be more worn than a young person’s, increasing the risk of osteoarthritis.
Staying active and stretching or doing low-impact exercises — such as tai chi, yoga, and swimming — may help keep the muscles strong and slow down the normal degeneration as someone ages.
Carrying extra weight can be hard on the joints, especially on the hips and knees, which are stress-bearing joints. Weight loss may help reduce the impact on the joints and reduce symptoms.
A study in the journal Obesity Reviews indicated that losing just 10% of body weight may reduce symptoms, including pain, and increase the physical function in the joint.
If a person with osteoarthritis also has overweight or obesity, current guidelines recommend losing some weight to help ease the condition.
A person’s genes may also play a role. Someone with a close family member who has or had osteoarthritis may be more ly to experience it themselves.
A review published in the journal Osteoarthritis and Cartilage noted that sex and hormones might play a role in osteoarthritis, with women being more ly to experience knee osteoarthritis than men, though it is unclear why this happens.
Women going through menopause may also be more ly to experience symptoms, leading researchers to believe hormones, such as estrogen, may play a role.
Physical activity that is especially demanding for the knees may be a risk factor for more wear and tear damage. Manual labor, carrying heavy loads, or high-impact exercises such as running may be risks for some people over time.
Injuries directly to the knee or in an area that indirectly affects the knee, such as the foot or leg, may be an influencing factor in osteoarthritis symptoms later in life.
Abnormalities at birth
Some people may be born with abnormalities in the bones, cartilage, ligaments, or synovium that make them more ly to experience symptoms of osteoarthritis later in life.
Share on PinterestAn ice pack may help with the symptoms of osteoarthritis.
There is currently no cure for osteoarthritis because cartilage cannot be replaced once it has eroded.
The optimal treatment for tricompartmental osteoarthritis varies the severity of the condition. Treatment usually involves managing symptoms, preventing progression of the disorder, or surgery.
The following treatments can help with the symptoms of osteoarthritis:
Ice and heat. Pain and swelling in the knee may respond well to ice and heat packs at different times of the day. Elevation may also reduce swelling around the knee.
Pain relievers. Over-the-counter (OTC) anti-inflammatories and painkillers can reduce pain and swelling in many cases. Prescription medications and COX-2 inhibitors may help if OTC versions are not effective.
Corticosteroid injections. A doctor can inject corticosteroids directly into the knee to relieve pain and inflammation if other medications have not worked.
Lifestyle changes. A person can reduce stress on their knee by avoiding high-impact exercises, and replacing these with low-impact ones, for example, swimming or cycling. Low impact exercise may strengthen the areas around the joint to reduce impact on the joint itself.
Medical devices. Using medical devices can help to reduce pressure in the joints. These can include canes for walking, wearing shock-absorbing shoes or wedge insoles, or using a sleeve or brace to stabilize the knee.
Surgery. In well-advanced cases or ones that do not respond to other treatments, surgery may be recommended. It is usually reserved for people who cannot function due to osteoarthritis, as surgery on the knee can be complicated.
If a doctor recommends surgery for tricompartmental osteoarthritis, this often involves a total knee replacement or total knee arthroplasty. In this surgery, doctors replace the damaged bone and joint with a plastic and metal joint.
It can take several months to recover from total knee arthroplasty. Regular physical therapy sessions will help strengthen the legs and allow a person to walk normally again.
Osteoarthritis is a common chronic degenerative condition, currently without a complete cure. Tricompartmental osteoarthritis symptoms affect the entire knee and may be more widespread.
Managing these symptoms may help in many cases, and maintaining a healthy lifestyle may also slow the progression of the disorder. Surgery can help restore function in the affected knee if other interventions do not work.
Tricompartmental Osteoarthritis in the Knee: What Is It?
You or a loved one may have been diagnosed with osteoarthritis in the knee, but there’s more to the diagnosis than just that.
When it comes to knee osteoarthritis, there’s meaningful variation in how much of the knee joint is affected.
The knee is a complex joint that contains three compartments that have their own functions and structures — and any or all of them can be affected by OA. They are:
Medial femoral-tibial compartment, the inner part of the knee where the tibia (shinbone) meets the femur (thigh bone)
Lateral femoral-tibial compartment, the outside part of knee where the tibia (shinbone) meets the femur (thigh bone)
Patellofemoral compartment, the joint between the kneecap and the end of the femur (thigh bone)
The medial femoral-tibial compartment is the part of the knee that is most commonly affected in cases of osteoarthritis. When all three components of the knee are affected, a patient is diagnosed with tricompartmental osteoarthritis.
Tricompartmental Osteoarthritis Symptoms
The signs of OA of the knee are similar regardless of the number of compartments affected. Symptoms of knee osteoarthritis include:
- Knee pain
- Knee stiffness: Usually worst in the morning and after sitting for long periods of time, but it typically eases up within an hour
- Trouble bending or straightening the leg
- Difficulty going up and down stairs
- Crepitus: The medical term for sounds grinding, popping, crunching, etc. your knee may make (they’re harmless)
- Weakness or buckling of the knee
- Bow-legged or knock-kneed gait and appearance
One symptom that may be more commonly seen in people with tricompartmental osteoarthritis compared with other kinds of knee arthritis is loss of proprioception, or the ability to know where your body is in space.
“This hasn’t been proven, but patients who have tricompartmental OA may lose more muscle strength, which could lead to weakness and problems with proprioception,” says Kathryn A.
Miller, MD, medical director for the Knee and Hip Comprehensive Non-Surgical Osteoarthritis Management Clinic at University of Wisconsin Health at The American Center.
Proprioception allows you to move your limbs without looking at them. It’s how you can step onto a curb without looking at your feet, for example. If you’re experiencing loss of proprioception due to tricompartmental osteoarthritis, you may find yourself stumbling and tripping more often.
Causes and Risk Factors for Tricompartmental Osteoarthritis
Little is known about what makes someone susceptible to tricompartmental OA because researchers still have a great deal to learn about the condition. It’s not even clear how commonly this type of osteoarthritis occurs, Dr. Miller says.
Experts do know that osteoarthritis can be caused by years of wear and tear or result from an injury to the knee. Other risk factors for knee osteoarthritis include smoking, genetics, and obesity.
In Dr. Miller’s experience, people with tricompartmental OA are more ly to have developed the condition from lifestyle issues or genetics.
“Someone who developed knee osteoarthritis from an injury, for example, may have hurt just one part of their knee, so that’s the only compartment affected,” she says. “Whereas tricompartmental OA may be due more to a genetic factor or some other process obesity or smoking that is causing more uniform damage throughout the joint.”
How Doctors Diagnose Tricompartmental Osteoarthritis
While it might seem imaging tests such as X-rays would be the definitive way to identify tricompartmental osteoarthritis, Dr. Miller says these tests are actually of limited use.
That’s because the signs of OA — narrow spacing between the joints due to loss of cartilage and the formation of osteophytes (bone spurs) — may not appear on an X-ray until a person’s osteoarthritis has become severe.
Instead, your doctor will rely more on family history, symptoms, and the results of a physical exam. The exam may include:
- Range-of-motion tests
- Feeling the affected joint for signs of OA such as tenderness and bony lumps
- Evaluating posture and gait
X-rays are frequently ordered, but your doctor may also request a more advanced test such as an MRI if they are uncertain of your diagnosis.
Primary care doctors can diagnose and manage tricompartmental osteoarthritis, though some may prefer to refer you to an orthopedic surgeon, rheumatologist, or sports medicine doctor.
Treatment for Tricompartmental Osteoarthritis
For some patients, over-the-counter pain medication such as ibuprofen or acetaminophen may be enough to manage the symptoms of tricompartmental osteoarthritis. If not, your doctor may recommend prescription-strength anti-inflammatory medication, which is available in oral and topical forms.
While corticosteroid injections and injections of hyaluronic acid (which mimics the cushioning of cartilage) can be helpful, Dr. Miller says doesn’t to rely on them often. “They’re fine to use once in a while, but I’d rather not have patients come in every three months to get injections when they could manage their pain with oral and topical medication and lifestyle changes,” she explains.
Lifestyle changes that benefit tricompartmental OA patients include losing weight if you’re overweight or obese, exercising (a physical therapist can help you get started), and quitting smoking if you smoke.
One thing that’s usually helpful for OA, but *not* for tricompartmental OA is wearing devices braces.
“These are helpful if only one part of the knee if affected because they’re designed to isolate and take pressure off that one part,” Dr. Miller says. “A brace won’t do anything for someone who has OA in all three compartments. It could actually make the OA in the other two compartments worse.”
Undergoing a total knee replacement is an option for people with tricompartmental OA, though surgery is best reserved for those who aren’t helped by medication and lifestyle changes.
But people should stick to these less invasive treatments for a sufficient amount of time before declaring them a failure, she says: “If you haven’t improved after four to six months, then I’ll feel more confident recommending a total knee replacement.”
What Does It Mean If You Have Tricompartmental Osteoarthritis?
B.BOISSONNET / BSIP / Corbis / Getty Images
Osteoarthritis affects the knee joint more than any other joint. The knee joint contains three bones—femur, tibia, and patella—and three compartments. Osteoarthritis can affect one, two, or all three of those compartments. When all three are affected, it is called tricompartmental osteoarthritis.
Each of the three compartments is named after the two bones that join together within the compartment. They are:
- Medial femorotibial compartment (the inside compartment
- Lateral femorotibial compartment (the outside compartment)
- Patellofemoral compartment (the kneecap and femur)
A physical examination may provide the first indication of which compartment is affected. Your doctor will ask you to stand and to walk. While standing, your doctor will look for any postural irregularity, such as a valgus (knock-kneed) or varus (bow-legged) deformity. There may also be obvious or subtle differences in leg length.
When you are asked to walk, your doctor will observe gait abnormalities, such as limping, shuffling, or being unable to walk. Your doctor also will check for signs of joint laxity and check your range of motion. Your doctor will also observe the knee for joint effusion, palpate the knee when in a flexed position, as well as check for signs of muscle atrophy and skin changes.
According to the American College of Rheumatology (ACR), knee osteoarthritis can be diagnosed if the knee pain is accompanied by at least three of the following symptoms:
- Knee stiffness in the morning lasting up to 30 minutes
- Crepitus (a cracking sound or sensation in the knee)
- Knee tenderness
- Enlargement of the bony part of the knee
- Lack of joint warmth seen with other types of arthritis
- Being 50 or older
X-raysmay be needed to confirm cartilage loss and joint damage associated with the abnormalities observed during your physical examination. On X-ray imaging, cartilage loss will be visualized as a narrowing of the joint space. Often, the narrowing will develop unilaterally (on one side).
Medial (inner knee) narrowing is observed in 75 percent of cases, resulting in a bow-legged gait and appearance. Lateral (outer knee) narrowing is far less common and is associated with a knock-kneed appearance.
Close to half of all knee osteoarthritis patients have evidence of inner knee cartilage damage (patellofemoral damage) on X-rays.
Treatment options for knee osteoarthritis depend on the severity of joint damage, pain level, and activity level. Before surgical options are considered, non-surgical treatments should be considered and possibly tried, including:
- Medications: This is traditional treatment, aimed at controlling pain and managing other osteoarthritis symptoms. Drugs to slow disease progression are still lacking.
- Exercise: Low-impact exercise helps to preserve strength and range of motion of affected joints.
- Weight management: Carrying extra pounds adds force to your joints as you move. That is exactly the burden you want to avoid with knee osteoarthritis.
- Topical pain relievers: Topical creams, gels, and ointments provide alternative pain relief for people who have had an inadequate response or cannot tolerate oral medications.
- Lateral wedge insoles: Special insoles are designed to help reduce pain associated with medial knee osteoarthritis by changing the mechanics of the knee.
- Viscosupplementation: A series of knee injections with a gel- substance (hyaluronates) is used to supplement the properties of synovial fluid in knees affected by osteoarthritis.
- Intra-articular steroid injections: An injection into the affected knee joint with a corticosteroid medication is performed to reduce inflammation and pain.
- Dietary supplements: Several supplements are marketed for joint health. While they are generally considered safe, their effectiveness has not been proven.
- Transcutaneous electrical nerve stimulation (TENS): This is a small device that directs mild electric pulses to the nerves in or around a painful area.
- Acupuncture: Various techniques which are used to stimulate specific anatomical points on the body. Pain relief is the goal for people with arthritis.
When conservative treatments yield inadequate results, the next step may be surgery. Arthroscopic debridement or osteotomy may be considered appropriate in certain cases, prior to considering total knee replacement.
When only one knee compartment is involved, your doctor and an orthopedic surgeon may recommend a partial knee replacement, also known as a unicompartmental knee replacement.
Besides a unicompartmental or total knee replacement, there is also a bicompartmental knee replacement. The bicompartmental knee replacement is an option for people with knee osteoarthritis of the medial and patellofemoral compartments.
The main advantage of a partial knee replacement is that normal bone and the two anterior cruciate ligaments are preserved. Hospitalization time, recovery time, and the risk of complications are also reduced.
While the decision to have a partial knee replacement may seem reasonable and straightforward, there are factors to consider. Among the questions to ask your doctor:
- How long will it be before the other compartments wear out?
- Am I at an age where I will ly be faced with revision surgery in the future?
- Might I be able to maintain normal mobility with a partial knee replacement?
In the end, your doctor will assess the severity of your condition and recommend the best course of action for your individual case.
Most people with knee osteoarthritis have unequal involvement of the three knee compartments. Treatment options, especially surgical options, depends on whether you have unicompartmental, bicompartmental, or tricompartmental knee osteoarthritis.
Knee pain is a common medical complaint which takes people to their primary doctor for an initial evaluation. An accurate diagnosis is essential to managing knee osteoarthritis. Appropriate treatment follows the diagnosis.
An orthopedic specialist may ultimately be needed to optimize the treatment plan. There are numerous conservative treatments to try. When it is time to consider surgery, find the best orthopedic surgeon available to you.
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Arthritis Foundation. What is Osteoarthritis?
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