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Condition
Osteoarthritis
of the knee
Osteoarthritis
of the knee
This booklet provides information
and answers to your questions
about this condition.
Arthritis Research UK produce and print our booklets entirely from charitable donations.
What is
osteoarthritis
of the knee?
Osteoarthritis is the most common form of joint disease, and the knee is one of the most commonly aff ected joints. In this booklet we'll explain how osteoarthritis of the knee develops, what causes it and how it can be treated. We'll also give some hints and tips to help you manage your arthritis and suggest where you can fi nd out more.
At the back of this booklet you'll fi nd a brief glossary of medical words – we've underlined these when they're fi rst used.
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What's inside?
This is an interactive table of contents. Simply click a title to go directly to the page.
– Dealing with stress Osteoarthritis is a condition that
aff ects the joints, causing pain
and stiff ness. It's by far the most
common form of joint disease,
and the knee is one of the most
commonly aff ected joints.
At a glance
Osteoarthritis
of the knee
aff ects
approximately
8 million people
in the UK.
What are the symptoms
The symptoms of osteoarthritis can include: • stiff ness
• a grating or grinding sensation when
What can I do to help myself?
the joint moves (crepitus) There are several ways you can help • swelling (either hard or soft).
yourself, including: Sometimes the knee may either lock • losing weight if you're overweight
or give way when you put weight on it.
• exercising regularly (both
muscle-strengthening and Who gets it?
general aerobic e Almost anyone can get osteoarthritis, • reducing stress on the aff ected
but it's most likely if: joint (for example by pacing activities, • you're in your late 40s or older
using a walking stick or wearing appropriate footwear) • you're overweight
• using painkillers (analgesi
• you're a woman
anti-infl ammatory creams, gels • your parents, brothers or sisters
and tablets.
have had osteoarthritis • you've previously had a severe
What treatments are there?
• your joints have been damaged
If you still have pain after trying self-help by another disease, for example measures, your doctor may recommend the following treatments: • capsaicin cream
• stronger painkillers, for example tramadol
• steroid injections into the painful joint
• surgery, including joint replacement.
How does a normal
These are called menis sci, which act a bit joint work?
like shock absorbers to spread the load more evenly across the joint.
A joint is where two or more bones meet Your knee joint is held in place by four (see Figure 1). The joint allows the bones ligamen s. These are thick, strong to move freely but within limits. The knee bands which run within or just outside the is the largest joint in the body and also joint capsule. Together with the capsule, one of the most complicated. It needs to the ligaments prevent the bones moving be strong enough to take our weight and in the wrong directions or dislocating. must lock into position so we can stand The thigh muscles also help to hold the upright. But it also has to act as a hinge so knee joint in place.
we can walk and must withstand extreme stresses, twists and turns, such as when Your muscles are attached to your bones we run or play sports.
by strong connecting tissues called tendons. These tendons run on either The knee joint is where your thigh bone side of the joint, which they also help (femur) and shin bone (tibia) meet. The to keep in place. When your muscles end of each bone is covered with ca contract they shorten, and this pulls on which has a smooth, slippery surface the tendon attached to the bone and that allows the ends of the bones to makes the joint move.
move against each other almost without friction. Your knees have two additional rings of cartilage between the bones. A normal joint
(front view)
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Osteoarthritis of the knee
Your kneecap (patella) is fi xed fi rmly in the called arthrosis, osteoarthrosis, middle of the large tendon that attaches degenerative joint disease or wear your thigh muscles (quadriceps) to the bone just below your knee joint at the When a joint develops osteoarthritis, front of your shin bones. The underside of some of the cartilage covering the ends your kneecap is also covered with cartilage.
of the bones gradually roughens and The joint is surrounded by a membrane becomes thin. This can happen over the vium) that produces a small main surface of your knee joint and in the amount of synovial fl uid, which helps to cartilage underneath your kneecap. The nourish the cartilage and lubricate the bone underneath the cartilage reacts by joint. The synovium has a tough outer growing thicker and becoming broader. layer called the capsule, which helps hold All the tissues within the joint become your knee in place.
more active than normal – as if your body is trying to repair the damage.
What is osteoarthritis?
• The bone at the edge of the joint grows
outwards, forming bony spurs called Osteoarthritis is a disease that aff ects t s. This can aff ect your thigh your joints. The surfaces within your bone, shin bone or kneecap.
joints become damaged so the joint doesn't move as smoothly as it should (see Figure 2). The condition is sometimes with mild
(front view)
Mildy thickened, • The synovium may swell and produce
It's unusual, but some people have extra fl uid, which then causes the joint pain that wakes them up at night. This to swell. This is called an eff usion or generally only happens with severe sometimes water on the knee.
osteoarthritis. You'll probably fi nd that • The capsule and ligaments slowly
your pain will vary and that you have thicken and contract as if they were good days and bad days, sometimes trying to stabilise the joint.
depending on how active you've been but sometimes for no obvious reason.
These changes in and around the joint are partly the result of the infl ammatory Your knee may feel stiff at certain times, process and partly your body's attempt often in the mornings or after a period of to repair the damage. In many cases, rest. Walking for a few minutes will usually the repairs are quite successful and the ease it. However, many people don't changes inside the joint don't cause much have any stiff ness at all, even with quite pain or, if there is pain, it's mild and may come and go. However, in other cases, You may not be able to move your knee the repair doesn't work as well and your as freely or as far as normal, and it may knee becomes damaged. This leads to creak or crunch as you move. If your instability and more weight being put osteoarthritis is severe, your knee may onto other parts of the joint, which can become bent and bowed. Sometimes cause symptoms to become gradually the joint gives way, either because the worse and more persistent over time.
muscles have become weak or because the joint structure has become less stable.
What are the symptoms
You may notice that your knee looks swollen. The swelling may be hard (caused by osteophytes around the sides The main symptoms of osteoarthritis are of the joint) or soft (caused by extra fl uid pain and sometimes stiff ness, which can in the joint). The muscles at the front of aff ect one or both knees. The pain tends your thigh that help straighten your knee to be worse when you move the joint or may look thin and wasted.
at the end of the day. You may have pain all around your knee or just in a particular place, most likely at the front and sides, and it may be worse after a particular movement, such as going up or down stairs. The pain is usually better when you rest.
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Osteoarthritis of the knee
What causes
that it's directly linked to the menopau It's often associated with mild arthritis of the joints at the ends of the fi ngers (nodal There are many factors that can increase osteoarthritis), which is also more common the risk of osteoarthritis, and it's often a combination of these that leads to the Obesity – Being overweight is an
condition (see Figure 3).
important factor in causing osteoarthritis, Age – Osteoarthritis usually starts from
especially in the knee. It also increases the late 40s onwards. We don't fully the chances of osteoarthritis becoming understand why it's more common in older people, but it might be due to factors like Joint injury – Normal activity and exercise
weakening of the muscles, the body being don't cause osteoarthritis, but very hard, less able to heal itself or gradual wearing repetitive activity or physically demanding out of the joint with time.
jobs can increase the risk. Injuries to the Gender – Osteoarthritis of the knee is
knee often lead to osteoarthritis in later twice as common in women as in men. It's life. A common cause is a torn meniscus most common in women over the age of or ligament, which can result from a 50, although there's no strong evidence twisting injury.
Figure 3 Risk factors for osteoarthritis
Previous joint
injury or disease

A torn meniscus is a common injury in footballers, and an operation to remove the damaged cartilage (meniscectomy) or repair cruciate ligaments also increases the risk of osteoarthritis in later life.
Genetic factors – Genetic factors play a
major part in osteoarthritis of the knee.
If you have a parent, brother or sister with
knee osteoarthritis then you'll have a
greater chance of developing it yourself.
We don't know a lot about the genes that
cause the increased risk, but we do know
that a number of genes will have a small
eff ect rather than one particular gene
being responsible.
Other types of joint disease –
Sometimes osteoarthritis is a result of
damage from diff erent kinds of rarer joint
disease, such as gout, that occurred in
earlier years.
Although there's no evidence that diff erent conditions such as cold or wet weather actually cause or worsen osteoarthritis, many people fi nd that their pain and stiff ness may vary with the weather. This may be because nerve fi bres in the capsule of aff ected joints are sensitive to changes in atmospheric pressure.
What is the outlook?
It's impossible to predict how
osteoarthritis will develop for any one
person. It can sometimes develop over
just a year or two and cause a lot of
damage to a joint, which may cause
some deformity or disability.
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Osteoarthritis of the knee
But more often osteoarthritis is a slow What are the possible
process that develops over many years complications of
and results in fairly small changes in just part of the joint. This doesn't mean it won't be painful, but it's less likely to There can sometimes be rarer cause severe deformity or disability.
complications with osteoarthritis In severe osteoarthritis the cartilage can become so thin that it no longer covers Osteoarthritis with crystals
the ends of the bones. The bones start to rub against each other and eventually Osteoarthritis with crystals occurs when wear away. The loss of cartilage, the chalky deposits of calcium crystals form wearing of bone and the bony spurs can in the cartilage. This is called calcifi cation alter the shape of the joint, forcing the or chondrocalcinosis. It can happen in any bones out of their normal alignment.
joint, with or without osteoarthritis, but it's most likely to occur in a knee that's already In addition, the muscles that move the aff ected by osteoarthritis, especially in joint gradually weaken and become older people. It can cause sudden pain thin or wasted. This can make the joint and noticeable swelling of the joint. The unstable so that the knee gives way when crystals may show up on x-rays and they weight is put on it.
can also be seen under a microscope in Changes in lifestyle can greatly reduce samples of fl uid taken from the joint.
the risk of osteoarthritis of the knee Osteoarthritis tends to become more progressing. Regular exercise, protecting severe more quickly when there are the joint from further injury and keeping crystals present. Sometimes the crystals to a healthy weight will all help.
can shake loose from the cartilage, causing Osteoarthritis doesn't lead to rheumatoid a sudden attack of very painful swelling arthritis or other types of joint disease called acute calcium pyrophosphate and won't spread through the body like crystal arthritis (acute CPP crystal arthritis), an infection might. However, deformity which was sometimes previously caused by osteoarthritis in one joint may lead to uneven loading of other joints. This could result in osteoarthritis See Arthritis Research UK booklet
in those joints. Because there's little, if Calcium crystal diseases including acute ammation in osteoarthritic joints, CPP crystal arthritis (pseudogout) and osteoarthritis doesn't make you feverish acute calcifi c tendinitis. or unwell. However, some people with osteoarthritis will develop other illnesses purely by chance.
Although there's
no cure for
osteoarthritis yet,
How is osteoarthritis
a lot can be done
to improve your
It's very important to get an accurate diagnosis if you think you might have arthritis. There are many diff erent types of arthritis and some, such as rheumatoid arthritis, need very diff erent treatments.
Osteoarthritis is usually diagnosed based on your symptoms and the physical signs that your doctor fi nds when examining your joint, for example: • tenderness over the joint
Baker's cysts (popliteal cysts)
• creaking or grating of the joint (crepitus)
Baker's cysts can form when extra • bony swelling
synovial fl uid is produced and it becomes • excess fl uid
trapped in a pouch (hernia) sticking out of the joint lining. They're often painless, • restricted movement
but you may be able to feel a soft-to-fi rm • joint instability
lump at the back of your knee. Sometimes • weakness and thinning of your
a cyst can cause aching or tenderness thigh muscle.
when you exercise.
Occasionally a cyst can press on a blood What tests are there?
vessel, which can lead to swelling in your There's no blood test for osteoarthritis, leg, or the cyst may burst (rupture) and although your doctor may suggest them release joint fl uid into your calf muscle, to help rule out other types of arthritis.
which can be very painful.
X-rays are taken to assess the severity of A cyst may not need treatment, but if the changes caused by osteoarthritis, it does it can generally be treated by although often they won't be needed. They drawing off the extra fl uid from your knee may show changes such as bony spurs using a syringe (this is called aspiration) or narrowing of the space between the and injecting a steroid solution.
bones where the cartilage has worn thin. They may also show whether there are any calcium deposits within the joint. However, x-rays aren't a good indicator of how much pain or disability you're likely to have. Some

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Osteoarthritis of the knee
people have a lot of pain from fairly minor joint damage, while others have little pain There's a great deal of evidence that from more severe damage.
being overweight increases the strain Rarely, a magnetic resonance imaging on your joints, especially your knees. (MRI) scan of your knee can be helpful. Research shows that being overweight This will show the soft tissues or obese not only increases your risk of (for example cartilage, tendons, muscles) developing osteoarthritis but also makes and changes in the bone that can't be it more likely that your arthritis will get seen on a standard x-ray.
worse over time.
Because of the way the joints work, the force put through your knees when you What can I do
walk, run or go up and down stairs can to help myself?
be up to fi ve to six times your body There's no cure for osteoarthritis as yet, but weight. Losing even a small amount there's a lot that you can do to improve of weight can make a big diff erence to your symptoms. Self-help measures play the strain on weight-bearing joints a very important part in relieving the pain and stiff ness, and reducing the chances of your arthritis becoming worse.

No special diet has shown to help There are two types of exercise specifi cally with osteoarthritis, but if you that you'll need to do: need to lose some weight you should Strengthening exercises will improve
follow a balanced, reduced-calorie diet the strength and tone of the muscles that combined with regular exercise.
control the aff ected joint. Osteoarthritis of the knee can weaken your thigh muscles See Arthritis Research UK booklet
(quadriceps), so regular exercising of Diet and arthritis. the muscles, such as straight-leg raises, helps to stabilise and protect the joint. It's also been shown to reduce pain and is particularly helpful in preventing your Even if you don't need to lose weight it's knee giving way, reducing the tendency very important to keep moving if you have to stumble or fall.
osteoarthritis of the knee. You'll need to fi nd the right balance between rest and Aerobic exercise is any exercise that
exercise – most people with osteoarthritis increases your pulse rate and makes you fi nd that too much activity increases their a bit short of breath. Regular aerobic pain while too little makes their joints exercise should help you sleep better, is stiff en up. Little and often is usually the good for your general health and well- best approach to exercise if you have being and can reduce pain by stimulating the release of pain-relieving hormones called endorphins.

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Osteoarthritis of the knee
iotherapi tt can advise you on the Tablets and creams
best exercises to do, but you'll need to There are a number of tablets and build them into your daily routine to get creams that can help the symptoms of the most benefi t from them. The pull-out osteoarthritis, and because they work in section at the back of this booklet will diff erent ways you can combine diff erent give you some simple exercises to try at treatments if you need to. Your chemist home. You can also talk to your GP about can advise you and supply paracetamol the Exercise on Prescription scheme that's and some low-dose tablets and creams available in some areas.
without a prescription.
Swimming can be very good for Painkillers (analgesics) and
osteoarthritis. Because the water supports non-steroidal anti-infl ammatory
the weight of your body, you won't be putting a lot of strain on your joints as Painkillers often help with the pain and you exercise. Your physiotherapist may stiff ness, although they don't aff ect also recommend special exercises in a the arthritis itself and won't repair the drotherapy pool. This can help get damage to the joint. They're best used muscles and joints working better and, occasionally when the pain is very bad because the water is warmer than in a or when you're likely to be exercising. typical swimming pool, it can be very Paracetamol is usually the best and most soothing and relaxing.
well tolerated painkiller to try fi rst, but If you know you're going to be more make sure you take the right dose as active than usual, try taking a painkiller most people take too little. You should try before you start to avoid increased taking 1 g (usually two tablets) three or four times per day. It's best to take them before the pain becomes very bad but See Arthritis Research UK booklets
you shouldn't take them more often than Hydrotherapy and arthritis; Keep every four hours.
moving; Physiotherapy and arthritis. Combined painkillers (for example co-codamol) contain paracetamol and codeine and may be helpful for more severe pain. They're stronger than paracetamol on its own, but codeine can cause side-eff ects such as constipation or dizziness.
Over-the counter non ibuprofen, can also help. You can use these for a short course of treatment (about 5–10 Anti-infl ammatory
gels and creams are
Anti-infl ammatory creams and gels
You can apply anti-infl ammatory creams
especially helpful
and gels directly onto painful joints three for osteoarthritis
times a day. There's no need to rub them in – they absorb through the skin on of the knee.
their own. They're especially helpful for osteoarthritis of the knee, and they're extremely well tolerated as very little is absorbed into the bloodstream. If you have trouble taking tablets then anti-infl ammatory creams are a particularly good option to try. You can decide if they help your pain within the fi rst few days of trying them.
days), but if they've not helped within this If you're already taking NSAID tablets, time then they're unlikely to. If the pain speak to your doctor about non-NSAID returns when you stop taking the tablets, creams (for example capsaicin cream) try another short course.
to avoid taking too much of one type of drug.
You shouldn't take ibuprofen or aspirin if you're pregnant, or if you Reducing the strain on your knees
have asthma, indigestion or a stomach Apart from keeping an eye on your (gastrointestinal) ulcer, until you've weight, there are a number of other ways spoken with your doctor you can reduce the strain on your knees.
or pharmacist.
• Pace your activities through the day
– don't tackle all the physical jobs at See Arthritis Research UK
once. Break the harder jobs up into drug leafl ets Non-steroidal anti-
chunks and do something more gentle infl ammatory drugs; Painkillers. in between. Keep using your knee, but rest it when it becomes painful.
• Wear low-heeled shoes with soft, thick
soles (trainers are ideal). Thicker soles will act as shock absorbers. High heels will alter the angle of your hip, knee and big toe joints and put additional strain on them.
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Osteoarthritis of the knee
• Use a walking stick to reduce the weight can help to stabilise the kneecap and
and stress on a painful knee. A therapist make it move correctly. You can buy knee or doctor can advise on the correct braces from sports shops and chemists, length and the best way to use the stick.
but you should speak to your doctor or • Use the handrail for support when
physiotherapist fi rst. They may also be going up or down stairs. Go up stairs able to provide braces or recommend the one at a time with your good leg fi rst.
best ones for you.
• Don't keep your knee still in a bent
position for too long as this will There are many diff erent complementary eventually aff ect the muscles.
and herbal remedies that claim to help • Think about modifying your home,
with arthritis, and some people do feel car or workplace to reduce unnecessary better when they use them. However, tional therapi tt can on the whole these treatments aren't advise you on special equipment that recommended for use on the NHS will make your daily tasks easier.
because there's no conclusive evidence that they're eff ective.
• Learn to relax your muscles and
get the tension out of your body. Glucosamine and chondroitin
A physiotherapist can advise you on Many people try glucosamine and chondroitin tablets. These are compounds that are normally present in See Arthritis Research UK booklets
joint cartilage, and some studies suggest Feet, footwear and arthritis; Looking that taking supplements may improve the after your joints when you have arthritis; health of damaged cartilage. Glucosamine Occupational therapy and arthritis. and chondroitin, which are similar to each other, are available from your chemist Applying warmth to a painful knee or health food store. You'll need to take often relieves the pain and stiff ness of a dose of 1.5 g of glucosamine sulphate osteoarthritis. Heat lamps are popular, but a day, possibly for several weeks before a hot-water bottle or reheatable pad are you can tell whether they're making a just as eff ective. This can be helpful if you diff erence. Glucosamine hydrochloride have a fl are-up of pain when you've done doesn't appear to be eff ective, so always a bit too much. An ice pack can also help. check that you're taking the sulphate.
Don't apply ice/heat packs or hot-water Most brands of glucosamine are made bottles directly to your skin.
from shellfi sh. If you're allergic to shellfi sh, More evidence to support the use of knee make sure you take a vegetarian or braces for osteoarthritis is becoming shellfi sh-free variety. Glucosamine can available. There are several types that

aff ect the level of sugar in your blood, so benefi ts, you may need to have regular if you have diabetes you should keep an sessions of acupuncture. There's also eye on your blood sugar levels and see some evidence that electro-acupuncture your doctor if they increase. You should may be eff ective for pain associated with also see your doctor for regular blood osteoarthritis of the knee. This technique checks if you're taking the blood-thinning is similar to conventional acupuncture drug warfarin.
except that an electrical impulse is applied via the needles.
Homeopathy
Many people are interested in
Chiropractic and osteopathy
homeopathic remedies, and a number are Although manipulat used for osteoarthritis. However, there's th may be helpful for back or no conclusive scientifi c evidence that neck pain, the use of manipulation for they're eff ective.
osteoarthritis in other joints is limited. If you do want to try it, make sure you choose a practitioner who is registered There's some research showing that with the appropriate regulatory body.
ure can sometimes provide relief Generally speaking complementary and from arthritis pain, although the eff ect alternative therapies are relatively well may be short-lived. For longer-lasting tolerated, although you should always discuss their use with your doctor before starting treatment. There are some risks associated with specifi c therapies.
In many cases the risks associated with complementary and alternative therapies are more to do with the therapist than the therapy. This is why it's important to go to a legally registered therapist, or one who has a set ethical code and is fully insured. If you decide to try therapies or supplements, you should be critical of what they're doing for you, and base your decision to continue on whether you notice any improvement.
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Osteoarthritis of the knee
See Arthritis Research UK booklet
and special reports
Complementary and alternative If you have severe pain, for example while medicine for arthritis; Complementary you're waiting for a knee replacement and alternative medicines for the operation, and other medications aren't treatment of rheumatoid arthritis, giving enough relief, your doctor may osteoarthritis and fi bromyalgia; recommend stronger painkillers (or Practitioner-based complementary and opioids) such as tramadol, nefopam or alternative therapies for the treatment meptazinol. Stronger painkillers are more likely to have side-eff ects – especially of rheumatoid arthritis, osteoarthritis, nausea, dizziness and confusion – so fi bromyalgia and low back pain. you'll need to see your doctor regularly and report any problems you have with What treatments are there these drugs.
for osteoarthritis?
Some opioids can be given as a plaster patch that you wear on the skin. These Many people fi nd that self-help can give pain relief for a number of days.
measures, such as those listed above, are enough to help them manage their Non-steroidal anti-infl ammatory
symptoms, but your healthcare team will be able to suggest other treatments tion in the joint is contributing if you need them.
to your pain and stiff ness, a short course of NSAID tablets (for example ibuprofen, naproxen) may be useful.
Capsaicin cream is made from the pepper plant (capsicum) and is an eff ective and Like all drugs, NSAIDs can sometimes have very well-tolerated painkiller. It's only side-eff ects, but your doctor will take available on prescription. It needs to be precautions to reduce the risk of these applied three times a day to be eff ective – for example, by prescribing the lowest and, like NSAID creams and gels, it's eff ective dose for the shortest possible particularly useful for osteoarthritis period of time.
of the knee.
NSAIDs can cause digestive problems Most people feel a warming or burning (stomach upsets, indigestion or damage sensation when they fi rst use capsaicin, to the lining of the stomach) so in most but this generally wears off after several cases they'll be prescribed along with a days. The pain-relieving eff ect starts drug called a proto prot n pump inhibito on pump inhibit r (P after several days of regular use and you which will help to protect your stomach.
should try it for at least two weeks before deciding if it has helped.
Because a lot of drug
treatments for osteoarthritis
work in diff erent ways,
they can be combined to
help ease your symptoms.
Figure 7 An X-ray showing the fi nger of a
person with a nodal osteoarthritis
Self-help methods
like looking after
your joints will also
help to prevent
further damage.
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Osteoarthritis of the knee
NSAIDs also carry an increased risk of heart Health and Clinical Excellence (NICE) and attack or stroke. Although the increased isn't widely used because the evidence risk is small, your doctor will be cautious that it works isn't convincing.
about prescribing them if there are other factors that may increase your overall Transcutaneous electrical nerve
risk – for example, smoking, circulation problems, high blood pressure, high Some people fi nd that tra cholesterol or diabetes.
help to relieve pain, although research If you have trouble opening childproof evidence on its eff ectiveness is mixed. A containers, your pharmacist will put TENS machine is a small electronic device them in a more suitable container for that sends pulses to the nerve endings you. Contact us for our special request via pads placed on your skin. It produces card which you can hand to your a tingling sensation and is thought to pharmacist with your prescription.
modify pain messages transmitted to your brain. TENS machines are available from pharmacies and other major stores, but a Steroid injections are sometimes given physiotherapist may be able to loan you directly into a particularly painful knee one to try before you decide whether to joint. The injection can start to work within a day or so, and it may improve pain for several weeks or even months. This is mainly used for very painful osteoarthritis Surgery may be recommended if pain where the knee is swollen, for sudden is very severe or you have mobility painful attacks caused by the shedding of problems. Many thousands of knee calcium pyrophosphate crystals or to help replacements are performed each year people through an important event (such for osteoarthritis, and the operation can as a holiday or family wedding). However, give substantial pain relief in cases where it's important to remember that steroid other treatments haven't helped enough. injections can't be given frequently or Surgical techniques are improving all indefi nitely. If you need repeated steroid the time and replacements now last on injections into an osteoarthritic knee then average over 15 years.
you may need to consider surgery.
Sometimes keyhole surgery techniques may be used to wash out loose fragments Hyaluronic acid injections
of bone and other tissue from your knee. When steroid injections don't work, some This is called arthroscopic lavage, and it's doctors give injections of this lubricating not recommended unless your knee locks.
substance into the knee joint, either as a single injection or as a course of several See Arthritis Research UK booklet
injections. However, this form of treatment Knee replacement surgery. isn't approved by the National Institute for Self-help and daily living
Dealing with stress
Living with a long-term condition like
osteoarthritis can lower your morale and If pain is a problem at night, heat may may aff ect your sleep. It's important to help. Try a hot bath before going to bed, tackle problems like these as they could or use a hot-water bottle, wheat bag lead to depression and will certainly make (which you can heat in a microwave) or the osteoarthritis itself more diffi electric blanket. Taking a painkiller before going to bed can ease night-time pain so It often helps to talk about negative you can get to sleep more easily. Placing a feelings, so it could be useful to speak to pillow between your knees can also help your healthcare team, or your family and to ease pain.
friends. Support groups are also available – your doctor may be able to tell you See Arthritis Research UK booklet
about organisations in your area.
Sleep and arthritis. See Arthritis Research UK booklets
and guide Fatigue and arthritis; Pain
Most people with osteoarthritis are able and arthritis; Living with long-term pain: to continue in their jobs, although you a guide to self-management. may need to make some alterations to your working environments, especially if you have a physically demanding job. Research and new
Speak to your employer's occupational health service if they have one, or your local Jobcentre Plus can put you in touch Research has already shown the with Disability Employment Advisors who importance of exercise and weight can arrange work assessments. They can management in reducing the pain of advise you on changing the way you work osteoarthritis, particularly of the knee. and on equipment that may help you to There are many studies going on around do your job more easily. If necessary, they the world to fi nd and test new treatments can also help with retraining for more for osteoarthritis. These include studies suitable work.
funded by Arthritis Research UK looking into the benefi ts of vitamin D (the VIDEO See Arthritis Research UK booklet
study) and a large national study to Work and arthritis. fi nd the genes responsible for causing osteoarthritis (the arcOGEN study), which could lead to new therapies.

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Osteoarthritis of the knee
Arthritis Research UK is also funding Noisy knees
early trials of stem cell research, which Researchers funded by Arthritis Research aims to regenerate cartilage using the UK have developed a prototype device body's own cells.
that could help detect the onset of Researchers are looking into ways osteoarthritis in the knee by measuring to help GPs make a quicker diagnosis the sounds it makes, which could help of osteoarthritis. A new technique, GPs to make a quicker diagnosis of the dGEMRIC (delayed gadolinium- condition. It works by scanning the knees enhanced MRI of cartilage), which for sounds that indicate a deterioration aims to diagnose osteoarthritis at in the knee joint. The device is still being an earlier stage, is currently being developed and is undergoing extensive investigated by Swedish scientists. tests, so it's not widely available yet.
Arthritis Research UK researchers are also looking into improved methods of diagnosis, which could help to delay the condition's progression.
My doctor examined my knee and sent me for an x-ray. She told me I'd got John is a 68-year-old
osteoarthritis, and I'd also got some calcium crystals in the joint. She said it When I was 25 I injured my knee playing was probably because of my old injury football. It locked and was very painful for and the operations I'd had. She gave me several weeks. My doctor sent me to see some paracetamol for the pain and some an orthopaedic surgeon, and he removed NSAID cream to put on, which helped. some damaged cartilage (meniscus) from I've also had some physiotherapy to help my knee. I was still in quite a lot of pain strengthen my thigh muscles. The physio and had to have another operation on said these muscles often get weak when the same knee a few years later, when I you've got arthritis in your knee. The was 30. After that, I didn't really have any exercises certainly made walking and problems for some years. My knee used to climbing stairs a lot easier.
ache occasionally and it was sometimes Now I'm retired I don't have to rush stiff , but it didn't stop me doing the things around so much, and I'm fi nding things I wanted to.
easier. I like gardening and do some Then, about 10 years ago, the discomfort home decorating, which is fi ne as long and stiff ness started getting worse. As I take it gently. I use the tablets and the time went by the knee got quite painful cream most days, and I've kept on with when I was exercising and it also started the exercises I was shown. I get more pain to swell a little. By the time I was 64, and some days than others. It usually seems coming up to retirement, it was getting worse when the weather's damp. And my cult to get up and down stairs, and if I knee does tend to stiff en up if I sit still for walked more than about half a mile I'd be in a lot of pain afterwards.

Arthritis Research UK
Osteoarthritis of the knee
Hydrotherapy – exercises that take
place in water (usually a warm, shallow
Acupuncture – a method of obtaining
swimming pool or a special hydrotherapy pain relief which originated in China. bath) which can improve mobility, help Very fi ne needles are inserted, virtually relieve discomfort and promote recovery painlessly, at a number of sites (called from injury.
meridians) but not necessarily at the painful area. Pain relief is obtained by Infl ammation – a normal reaction
interfering with pain signals to the brain to injury or infection of living tissues. and by causing the release of natural The fl ow of blood increases, resulting in painkillers (called endorphins).
heat and redness in the aff ected tissues, and fl uid and cells leak into the tissue, Aerobic exercise – any exercise that
causing swelling.
increases your pulse rate and makes youa bit short of breath.
Ligaments – tough, fi brous bands
anchoring the bones on either side of a
Analgesics – painkillers. As well as dulling
joint and holding the joint together. In the pain they lower raised body temperature, spine they're attached to the vertebrae and most of them reduce infl ammation.
and restrict spinal movements, therefore Cartilage – a layer of tough, slippery
giving stability to the back.
tissue that covers the ends of the bones Magnetic resonance imaging
in a joint. It acts as a shock absorber (MRI) scan – a type of scan that uses
and allows smooth movement high-frequency radio waves in a strong between bones.
magnetic fi eld to build up pictures of the Chiropractor – a specialist who
inside of the body. It works by detecting treats mechanical disorders of the water molecules in the body's tissue that musculoskeletal system, often through give out a characteristic signal in the spine manipulation or adjustment. The magnetic fi eld. An MRI scan can show up General Chiropractic Council regulates soft-tissue structures as well as bones.
the practice of chiropractic in the UK.
Manipulation – a type of manual
Gout – an infl ammatory arthritis caused
therapy used to adjust parts of the body, by a reaction to the formation of urate joints and muscles to treat stiff ness crystals in the joint. Gout comes and and deformity. It's commonly used in goes in several fl are-ups at fi rst, but if physiotherapy, chiropractic, osteopathy not treated it can eventually lead to joint and orthopaedics.
damage. It often aff ects the big toe.
Arthritis Research UK
Osteoarthritis of the knee
Menisci (singular meniscus) – rings
freely. The General Osteopathic Council of cartilage, like washers, lying between regulates the practice of osteopathy in the cartilage-covered bones in the knee. They act as shock absorbers and help the Osteophytes – an overgrowth of new
movement of the joint. Each knee has bone around the edges of osteoarthritic an inside (medial) and an outside joints. Spurs of new bone can alter the (lateral) meniscus.
shape of the joint and may press on Menopause – the time when
nearby nerves.
menstruation ends, usually when a Physiotherapist – a trained specialist
woman is in her 50s. This means the who helps to keep your joints and ovaries stop releasing eggs every four muscles moving, helps ease pain and weeks, and it's no longer possible to have keeps you mobile.
children. If this happens before the age of 45, it's known as premature menopause.
Proton pump inhibitor (PPI) – a drug
that acts on an enzyme in the cells of the
Non-steroidal anti-infl ammatory
stomach to reduce the secretion of gastric drugs (NSAIDs) – a large family of drugs
acid. They're often prescribed along with prescribed for diff erent kinds of arthritis non-steroidal anti-infl ammatory drugs that reduce infl ammation and control (NSAIDs) to reduce the side-eff ects of pain, swelling and stiff ness. Common those drugs.
examples include ibuprofen, naproxen and diclofenac.
Rheumatoid arthritis – a common
infl ammatory disease aff ecting the joints,
Occupational therapist – a trained
particularly the lining of the joint. It most specialist who uses a range of strategies commonly starts in the smaller joints in a and specialist equipment to help people symmetrical pattern – that is, for example, to reach their goals and maintain their in both hands or both wrists at once.
independence by giving practical advice on equipment, adaptations or by Synovium – the inner membrane of the
changing the way you do things (such joint capsule that produces synovial fl uid.
as learning to dress using one handed Transcutaneous electrical nerve
methods following hand surgery).
stimulation (TENS) – a small battery-
Osteopath – a trained specialist who
driven machine which can help to relieve treats spinal and other joint problems pain. Small pads are applied over the by manipulating the muscles and joints painful area and low-voltage electrical in order to reduce tension and stiff ness, stimulation produces a pleasant tingling and so helps the spine to move more sensation, which relieves pain by interfering with pain signals to the brain.
Where can I fi nd
• Pain and arthritis
out more?
• Practitioner-based complementary and
alternative therapies for the treatment If you've found this information useful of rheumatoid arthritis, osteoarthritis, you might be interested in these other fi bromyalgia and low back pain (66-page titles from our range: special report) • Sex and arthritis
• Calcium crystal diseases including acute
• Sleep and arthritis
CPP crystal arthritis (pseudogout) and acute calcifi c tendinitis • Work and arthritis
• Osteoarthritis
Drug leafl ets
• Local steroid injections
Therapies
• Hydrotherapy and arthritis
• Non-steroidal anti-infl ammatory drugs
• Occupational therapy and arthritis
• Physiotherapy and arthritis
You can download all of our booklets and leafl ets from our website or order them by contacting: • Knee replacement surgery
Arthritis Research UK
Self-help and daily living
• Complementary and alternative medicine
for arthritis • Complementary and alternative
medicines for the treatment of Derbyshire S41 7TD.
rheumatoid arthritis, osteoarthritis and Phone: 0300 790 0400 fi bromyalgia (63-page special report) • Diet and arthritis
The National Institute for Health and Clinical Excellence (NICE) issued • Fatigue and arthritis
guidelines to GPs in 2008 on how • Gardening and arthritis
best to treat osteoarthritis based on available evidence.
Keep moving The NICE guidance is available at Living with long-term pain: a guide to www.NICE.org.uk/CG59. Printed copies of the NICE osteoarthritis patient guide • Looking after your joints when
you have arthritis Arthritis Research UK
Osteoarthritis of the knee
can be ordered from 0845 003 7783 or at Disabled Living Foundation
[email protected] quoting 380–384 Harrow Road reference N1460.
London W9 2HUPhone: 020 7289 6111Helpline: 0845 130 9177 The following organisations may be able to provide additional advice and information: General Chiropractic Council
44 Wicklow Street
Floor 4, Linen Court Phone: 020 7713 5155 General Osteopathic Council
Phone: 020 7380 6500 176 Tower Bridge Road Helpline: 0808 800 4050 Phone: 020 7357 6655 DIAL Network (formerly
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Advice Line or Dial UK)
Links to sites and resources provided by third Phone: 01302 310 123 parties are provided for your general information only. We have no control over the contents of those sites or resources and we give no warranty about An independent network of local their accuracy or suitability. You should always disability information and advice consult with your GP or other medical professional.
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Exercises for
of the knee
This handy section contains exercises
that are designed to stretch, strengthen
and stabilise the structures that
support your knee.
The following exercises are designed
to stretch, strengthen and stabilise the
structures that support your knee.
Muscle stretch: Do this at least once a
day when lying down. Place a rol ed-up
towel under the ankle of the leg to be
exercised. Bend the other leg at the knee.
Use the muscles of your straight leg to
leg. This exercise helps to strengthen your quadriceps and prevents your knee from Straight-leg raise (sitting): Get into
becoming permanently bent.
the habit of doing this every time you sit down. Sit well back in the chair with a good posture. Straighten one leg, hold for a slow count to 10 and then slowly lower your leg. Repeat this at least 10 times easily, straighten and raise one leg, before holding for a count of 10. As you improve, try the exercise with light weights on your ankles and with your toes pointing towards you.
Leg stretch:
stretched out in front. Keeping your foot
Straight-leg raise (lying): Get into the
you feel it being comfortably stretched. habit of doing this in the morning and at night while lying in bed. Bend one leg at the knee. Hold your other leg straight Repeat 10 times with each leg. If you can't use a board or tea tray as a surface to slide your foot along.
and evening.
Step ups: Step onto the bottom step
Leg cross: Sit on the edge of a table
of stairs with your right foot. Bring up or bed. Cross your ankles over. Push your left foot, then step down with your your front leg backwards and back leg right foot, fol owed by your left foot. forwards against each other until your Repeat with each leg until you get short thigh muscles become tense. Hold for of breath. Hold on to the bannister if 10 seconds, then relax. Switch legs and necessary. As you improve, try to increase repeat. Do four sets with each leg.
the number of steps you can do in one minute and the height of the step.
Knee squats: Hold onto a chair or work
surface for support. Squat down until your
kneecap covers your big toe. Return to
standing. Repeat at least 10 times. As you improve, try to squat a little further. Don't Sit on a chair. Without using bend your knees beyond a right angle.
your hands for support, stand up and then sit back down. Make sure each movement is slow and control ed. Repeat for one minute. If the chair is too low, start with rising from a cushion on the seat and remove when you don't need it any more. As you improve, try to increase the number of sit/stands you can do in one minute and try the exercise from lower chairs or the bottom two steps of a staircase.
Keeping active
It's important to keep active – you should
try to do the exercises that are suitable for you every day. Try to repeat each exercise exercises two to three times each day.
Start by exercising gradual y and build up over time, and remember to carry on if your symptoms ease to prevent them returning. If you have any questions about exercising, ask your doctor or We're here to help
Arthritis Research UK is the charity
projects that we're funding and giving leading the fi ght against arthritis.
insight into the latest treatment and We're the UK's fourth largest medical research charity and fund scientifi c and We often feature case studies and medical research into all types of arthritis have regular columns for questions and musculoskeletal conditions. and answers, as well as readers' hints We're working to take the pain away and tips for managing arthritis.
for suff erers with all forms of arthritis and helping people to remain active. We'll do this by funding high-quality Tell us what you think
research, providing information Please send your views to: Everything we do is underpinned or write to us at: Arthritis Research UK, Copeman We publish over 60 information booklets House, St Mary's Court, St Mary's Gate, Chesterfi eld, Derbyshire S41 7TD.
which help people aff ected by arthritis to understand more about the condition, its treatment, therapies and how A team of people contributed to this to help themselves. booklet. The original text was written by We also produce a range of separate consultant rheumatologist Prof. Tim Spector leafl ets on many of the drugs used who has expertise in the subject. It was for arthritis and related conditions. assessed at draft stage by clinic champion We recommend that you read the for osteoarthritis Dr Mark Porcheret, GPwSI relevant leafl et for more detailed (MSK disorders) Dr Chandu Prasannan, information about your medication. physiotherapist Ros Teweleit. An Arthritis
Research UK editor revised the text to make
Please also let us know if you'd like it easy to read, and a non-medical panel, to receive our quarterly magazine, including interested societies, checked it Arthritis Today, which keeps you up for understanding. An Arthritis Research
to date with current research and UK medical advisor, Prof. Anisur Rahman, is
education news, highlighting key responsible for the content overall.
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Source: http://ramdharmarajan.co.uk/pdf/Osteoarthritis%20Of%20The%20Knee.pdf