Knee osteoarthritis
Cartilage loss is not reversible, but the pain and disability it causes are only partly about cartilage. Muscle weakness, joint loading and inflammation are all modifiable, which is why many patients told they need a replacement can postpone one for years.
Why the X-ray and the symptoms often disagree
Radiographic severity correlates only loosely with pain. Patients with severe joint space narrowing sometimes walk comfortably; others with moderate changes are barely mobile. The difference is usually in the surrounding tissue, quadriceps strength, hamstring balance, hip abductor control, body weight, and how much low-grade synovial inflammation is present.
All of those are treatable. That is the basis of a non-surgical programme: not a claim to regrow cartilage, but a systematic reduction of the load and inflammation the remaining cartilage has to tolerate.
Symptoms
- Deep ache on the inner side of the knee, worse after activity and at the end of the day
- Morning stiffness that eases within about thirty minutes of moving
- Difficulty with stairs, particularly descending, squatting, and floor-sitting or prayer positions
- Grinding or catching sensation; occasional swelling after a long day
- Reduced walking distance and growing reliance on a support
Assessment
We take weight-bearing X-rays, because a knee imaged lying down understates joint space loss. Alignment is assessed. Varus (bow-legged) loading concentrates force through the medial compartment and drives progression. Gait analysis shows compensations, and quadriceps and hip abductor strength are graded, since weakness here both results from and accelerates osteoarthritis.
We also check the spine and hip. Referred pain from a lumbar root or a degenerate hip is regularly mistaken for knee arthritis, and injecting the wrong structure helps nobody.
Treatment options
Regenerative injection (PRP)
Platelet-rich plasma is prepared from your own blood and injected under ultrasound guidance. The intent is to modulate the inflammatory environment inside the joint rather than to rebuild cartilage. Evidence is strongest in mild to moderate osteoarthritis; in advanced bone-on-bone disease the benefit is limited, and we will tell you that rather than sell you a course.
Genicular nerve block and radiofrequency ablation
For patients with significant pain who are not surgical candidates, or who wish to defer surgery, targeting the genicular nerves that carry sensation from the joint capsule can give durable relief without altering the joint itself.
Loading and strength programme
The least glamorous component and the one that changes outcomes most. Progressive quadriceps and hip abductor strengthening, closed-chain work within a tolerable range, gait retraining, and where relevant a frank conversation about body weight, every kilogram lost removes several times that in force through the knee with each step.
When replacement is the right answer
Total knee arthroplasty is an excellent operation for the right patient. If you have end-stage disease, unremitting night pain, deformity and a knee that no longer responds to conservative measures, deferring surgery is not a virtue. Our role in that case is to say so and refer you. If you choose, we can also prepare the surrounding musculature beforehand, which improves post-operative recovery.
Considering a knee replacement?
Come in with your X-rays. We will tell you honestly whether a non-surgical programme is worth your time, or whether you should proceed with surgery.