Symptoms of Osteoarthritis of the Knee
Osteoarthritis of the knee (short: knee OA) is a wear disease on the knee joint. It is incurable and leads to progressive changes in the knee. In the initial stage of osteoarthritis, there is no pain or only phases of pain and restrictions in movement. With advanced osteoarthritis of the knee, pain and discomfort can increase. Most people develop wear-related osteoarthritis during the course of life. Risk factors such as obesity, joint malposition, lack of exercise, overloading and incorrect loading of the joints in some types of sports or injuries accelerate joint wear and tear and can also promote the development of osteoarthritis in young people.
Osteoarthritis changes the knee joint
As a degenerative joint disease, osteoarthritis of the knee typically starts with signs of wear and/or tiny damage in the joint cartilage. As time passes, the cartilage surface becomes rough and uneven. The joint no longer moves smoothly. It snags and grinds. Increasing friction leads to painful inflammation in the knee and fluid is effused into the joint capsule. In this condition, also referred to as activated osteoarthritis, there is constant pain. In the advanced stage of osteoarthritis, cartilage damage increases and all tissues involved in the joint are affected. The bones form spurs (osteophytes) to stabilise the joint, but cause ankylosis in the process. Knee pain occurs at increasingly shorter intervals and becomes more severe over time.
The circle of osteoarthritis
Patients with osteoarthritis of the knee frequently get caught in a vicious circle:
To get relief for a painful knee, the affected person exercises less and adopts a compensatory posture. However, restricting movement only provides short-term relief from pain. In the long run, lack of exercise accelerates cartilage wear and increases pain in the knee. The affected person rests their knee even more often instead of exercising it, and the vicious circle closes.
Furthermore, the unnatural posture taken to relieve pain also causes other joints such as the hips to be overloaded, which can cause permanent damage.
Initial symptoms of osteoarthritis of the knee
The sooner osteoarthritis of the knee is recognised and counteracted, the better the chances are for getting knee pain under control, maintaining joint mobility for a long time and slowing down the progressive changes in the knee joint. If the following symptoms occur repeatedly in your knee, you should have it examined by an orthopaedist:
Knee pain after rest (start-up pain)
Knee pain after unusual exertion
Knee pain with certain movements
Grinding and crackling of the knee joint
Swelling and inflammation in the knee
Diagnosis and therapy for osteoarthritis of the knee
If your knee pains or its functions are limited, you should have it examined by an orthopaedist.
What are the symptoms of osteoarthritis of the knee?
There are a number of symptoms which are typical for osteoarthritis of the knee. They can occur individually or in combination. Depending on the level of joint wear, symptoms may be more or less severe. While symptoms of osteoarthritis of the knee are hardly noticeable – or even absent – in the early stages, patients complain of increasing pain and increasingly restricted mobility as the disease progresses. You can take preventive measures to avoid reaching this stage. These include a healthy and balanced diet, and regular activity and sports. Due to the fact that symptoms do not occur straight away, osteoarthritis of the knee often remains undetected for a long time. The first indications of osteoarthritis of the knee become apparent during everyday activities. Joints crackle and grate; climbing stairs and carrying heavy objects causes knee pain. If you observe these symptoms, you should see your doctor and ask to be examined. Doctors can use several methods to determine if your symptoms are caused by osteoarthritis of the knee.
Causes of osteoarthritis
Osteoarthritis of the knee can have many causes. The biggest risk factor for osteoarthritis of the knee is too much strain on the knee joints. Lifting and carrying heavy objects or moving wrongly can place severe strain on your joint cartilage and result in progressive wear and tear. Because they are heavier, people who are overweight place a higher load on their cartilage. This leads to an increased risk of osteoarthritis of the knee. Naturally, age also plays a significant role in the development of osteoarthritis. Cartilage loses elasticity with increasing age and can no longer regenerate as easily as in earlier years, which is why the joint disorder most frequently affects people aged 60 years and over. Nonetheless, young people are most certainly not immune to osteoarthritis of the knee! Genetic predisposition can lead to an early occurrence of the disease. Moreover, joint malalignment (knock knees or bow legs, for example) speeds up the progression of the disease. Accidents or sports injuries which affect the knee joint can also trigger the development of osteoarthritis. These include or meniscus injuries. Osteoarthritis develops slowly, so there is often a period of several years between the early stage and severe osteoarthritis. During this time, symptoms intensify gradually as wear and tear increases.
Disease progression: Stages of osteoarthritis
Osteoarthritis of the knee is classified into four degrees of severity:
Osteoarthritis degree 1:
The joint cartilage has invisible signs of wear. It is less elastic than healthy cartilage and cannot recover well after being subjected to load. Initial knee pain may occur under high load.
Osteoarthritis degree 2:
The cartilage tissue becomes thinner. The cartilage surface becomes rough and uneven. The bones form initial spurs (osteophytes). The knee is considerably less able to bear weight. At this stage of osteoarthritis, the progression of the disease can be effectively slowed by exercises, weight loss and medical devices such as braces.
Osteoarthritis degree 3:
The cartilage has partly disappeared so that the bones begin to rub against each other in some places. X-rays show pronounced bone spurs and narrowing of the joint space. At this advanced stage, osteoarthritis causes considerable movement restrictions and knee pain.
Osteoarthritis degree 4:
The joint space has narrowed considerably and the joint cartilage has almost completely disappeared. The bones are often damaged. The joint is deformed and often inflamed. In this final stage, joint-replacement surgery – i.e. a prosthetic knee joint – may be the best solution.
Diagnosing osteoarthritis of the knee: How a doctor detects joint wear
Diagnosing osteoarthritis of the knee: How a doctor detects joint wear
If you frequently suffer from knee pain and other symptoms, you may have developed osteoarthritis of the knee. To get to the bottom of the symptoms, you should see a doctor. Only a medical specialist – using a range of examinations – can determine if your symptoms are actually caused by gonarthrosis (osteoarthritis of the knee). In order to get a better overall picture, your doctor will first ask you about your general state of health and existing physical problems. Here it's absolutely essential to be honest! Tell your doctor about any and every physical anomaly you've observed over the past days or weeks. This will enable your doctor to assess if you really have osteoarthritis of the knee, or if your symptoms are perhaps caused by another disease.
Once your doctor has finished asking questions, they will generally turn their attention to the affected joint. Using palpation, they will see how sensitive you are to pressure. They will also look closely at visual anomalies such as swelling, joint effusions and axial malalignment (knock knees or bow legs) to determine whether symptoms are caused by osteoarthritis of the knee. Additional examinations will be required before your doctor can confirm the diagnosis. X-rays are generally used for this purpose. An expert can use X-ray images to determine whether joint cartilage displays irregularities or cracks, or whether osteophytes (bone spurs) have formed. The doctor can also refer you for a CT, MRI or ultrasound examination. Depending on the method used, doctors can detect bone changes, damage to the meniscus or cruciate ligament, and irregularities in the cartilage of your knee joint.
Diagnosing osteoarthritis of the knee
When talking to the physician, you should give a detailed description of your knee problems and answer the physician's questions precisely. In addition to the knee disorder, other health information such as osteoarthritis in other joints, injuries, infections or chronic diseases may also be relevant to knee pain. While performing the examination, the physician will look at the knee and check its functions. He will then x-ray it to see if any visible changes have already developed in the joint. In some cases, further examinations will be necessary to reach a diagnosis. Depending on the case, these include, for example, examinations of the blood or the joint fluid as well as other imaging procedures.
Therapy for osteoarthritis of the knee
There are three basic treatment methods for osteoarthritis of the knee: conservative (non-invasive) therapy, invasive joint-preserving therapy and invasive joint-replacing therapy. The term invasive is used for all treatments in which the doctor makes changes to the knee joint.
Conservative (non-invasive) therapies:
Conservative therapy for osteoarthritis of the knee includes all non-invasive treatments. Conservative therapy is made up of building blocks (modules).
The modules of conservative therapy for knee arthrosis include:
Wearing supports and braces
Light to medium sporting activity
Weight reduction in the case of overweight
Heat and cold treatments as required
Pain-relieving ointments and gels
Analgesics and anti-inflammatory medication
Invasive joint-preserving therapies:
To relieve inflammation and pain in the knee, the physician can inject medication directly into the joint. Hyaluronic acid is frequently used as an active ingredient. Hyaluronic acid occurs naturally in healthy joints. It serves as a nutrient solution for the cartilage and is a natural lubricant for the joint. Malpositioned legs that lead to osteoarthritis can be corrected by surgically realigning the bones (corrective osteotomy).
In certain cases, an endoscopic technique is also used for joint-preserving therapy of osteoarthritis. This procedure is referred to as "arthroscopy" (joint endoscopy). However, because the success of arthroscopy is limited, it is no longer recommended as the sole treatment for osteoarthritis of the knee.
Invasive joint-replacing therapies:
If conservative or invasive joint-preserving therapies no longer provide relief of pain or improve the knee function, joint-replacing therapy should be considered. During this surgical procedure, the natural joint is replaced either fully or partially by a prosthesis (endoprosthesis/ prosthetic knee joint).
Braces can relieve knee pain
Knee or lower-leg-foot-braces, such as the Agilium Freestep, specifically relieve the painful areas in the knee joint and can provide sustainable relief from knee pain. This is also confirmed by studies. In many cases of osteoarthritis of the knee, braces can help to discontinue the use of analgesics or the dose of medication can be reduced. Side effects from the medication are effectively avoided or reduced. Knee or lower-leg-foot-braces enable patients with osteoarthritis of the knee to move around and do sports largely without pain. It is thus possible to break the vicious circle of pain, lack of exercise and progressive deterioration of the osteoarthritis.
Quote Dr Stinus: "Most of my patients are very happy with the new brace. More than half of them have been able to avoid surgery so far.”
Treading new paths with braces from Ottobock
Have a look at experiences made by patients with osteoarthritis of the knee and how they are treading new paths with Ottobock braces.
Braces from Ottobock: Solutions for different knee problems
Ottobock has developed precisely fitting braces for different knee problems. Get an overview of the range of Ottobock braces for osteoarthritis of the knee. By means of simple questions, Agilium Select takes just a few minutes to determine which brace fits your knee problem and your lifestyle.
How can osteoarthritis be treated?
Joint-preserving (non-invasive) osteoarthritis treatment
In order to avoid or delay a knee operation, osteoarthritis patients should manage their symptoms with non-invasive, joint-preserving therapy options for as long as possible. These include a healthy and balanced diet and moderate activity and sport on a daily basis. Dietary supplements, creams or tablets for pain relief, special exercises for osteoarthritis of the knee and cold/heat therapy can also contribute to a reduction of the symptoms. In conjunction with therapy, braces are also a judicious option. In combination with other forms of treatment, orthopaedic devices can significantly reduce pain and improve mobility. In this way, they contribute to increased well-being.
What can I do to relieve osteoarthritis?
Many people with osteoarthritis of the knee ask what they can do to slow down the progression of the disease and keep symptoms in check. Because it is impossible for damaged cartilage to regenerate, any treatment for osteoarthritis can only alleviate the symptoms. The aim of all joint-preserving osteoarthritis therapy options is to retain or improve knee function and minimise knee pain. This in turn will enable you to reduce your intake of painkillers and delay a knee operation for as long as possible. Because once the cartilage is worn down completely, surgery is the only way to treat osteoarthritis. In order to avoid surgery if at all possible, patients should reduce their risk by identifying and combating the factors which contribute to osteoarthritis. A healthy lifestyle, a balanced diet, orthopaedic devices and physical exercise can help alleviate many symptoms of osteoarthritis and slow down the progression of the disease. Depending on the stage to which the disease has progressed, osteoarthritis can be treated in a variety of ways.
Active against osteoarthritis
Osteoarthritis of the knee cannot be cured, but you can effectively alleviate pain and discomfort and significantly improve your quality of life if you actively counteract osteoarthritis by means of conscious nutrition and adapted exercise.
Your meals should primarily consist of fruit and vegetables, salads, plant oils, nuts and seeds. Fish like mackerel, salmon and herring are rich in nutrients and Omega-3 fatty acids that curb inflammation. Healthy fish can therefore be served twice a week. Some spices not only improve the taste of food, they are also good for the joints: turmeric, nutmeg, cinnamon and coriander have an anti-inflammatory and decongestant effect. Chilli and ginger help to relieve pain. Meat can be eaten in moderation, but poultry is preferable. Beef and pork should rarely be consumed. It is best to avoid high-sugar and high-fat processed convenience foods and to avoid alcohol and nicotine. In case of overweight, losing weight will take the strain off your joints and help you have less knee pain and feel lighter and fitter overall.
Exercise in everyday life
Regular exercise is essential to counteract the progressive changes caused by osteoarthritis, maintain knee function and relieve pain. It is important to integrate more exercise into your daily routine. Take the stairs instead of the elevator, run small errands on foot or by bike instead of using the car and relax with an evening walk rather than sit in front of the TV. At work, you can do short gymnastic exercises during breaks – you will see that this is not only good for your knee, it also refreshes the mind.
Quote from Christian Krone: "Exercise is essential for osteoarthritis patients because muscle inactivity leads to joint instability, lack of power and getting off axis. And that's why exercise, muscle training and balancing axle situations must be at the forefront to counteract osteoarthritis."
Types of sports
In addition to everyday exercise, regularly doing certain types of sports is ideal for keeping osteoarthritis under control. Swimming, water gymnastics, Nordic Walking, biking or long walks, for example, maintain knee mobility and prevent pain. They also strengthen your leg muscles and promote your mobility and endurance overall. The most important rule is to keep moving, without overexerting yourself. This will have a positive effect on your knee joints, and you'll feel better and more mobile in general.
However, it is better to avoid sports that put a lot of burden on the knee joint due to abrupt stops, tight turns or high pressure at certain points. This includes most ball sports, martial arts or downhill skiing.
Agilium Move: Special training for osteoarthritis of the knee
Get your knee fit: Watch the Agilium Move-Videos featuring special exercises for balance, power and endurance for osteoarthritis of the knee. Our "Agilium Move" programme is designed especially for osteoarthritis patients. It will help you strengthen the muscles in your legs and around the knee joint, increase the stability of your knee joints and become more mobile as a result. Join Christian Neureuther, the former professional skier, and get moving with Agilium Move!
Notice: Your health is important to us. Please take care not to overburden yourself. If in doubt, consult your physician or physiotherapist.
In our Agilium Move balance exercises, former professional skier Christian Neureuther shows you how to target your quadriceps and the muscles that control the knee joint. The exercises for osteoarthritis of the knee will improve your proprioception (self-awareness) of your knee. In turn, this will improve the interplay between the dynamic muscles and the stabilising muscles used in different movement patterns.
Frequently asked questions about osteoarthritis of the knee
Osteoarthritis is the most common of all joint diseases. Approximately 60% of all osteoarthritis patients are affected by osteoarthritis of the knee (also known as “gonarthrosis”). Osteoarthritis can be caused by excessive strain, joint malalignment or injury to one or more joints. Mechanical stress – caused by poor posture or overuse – wears down the cartilage in the joint, resulting in progressive damage to the joint.
Osteoarthritis is a joint disorder which develops progressively. To slow down the progression of the disease, you should avoid being overweight, avoid alcohol and nicotine and try not to place excessive strain on your joints. Movement, special osteoarthritis exercises and a healthy diet should be part of your everyday life. Cycling and swimming, for example, are accessible activities for most people and are easy on your joints. In addition, make sure to wear shoes with flexible soles or shock-absorbing insoles.
Once cartilage has worn down, it is impossible for it to regenerate naturally. This means osteoarthritis cannot be cured completely. Joint wear develops progressively and is irreversible. However, by leading a healthy lifestyle you can slow down the progression of the disease. Make sure you get enough physical exercise and avoid activities that might damage your cartilage or place excessive strain on your joints for an extended period of time.
The aim of joint-preserving therapy is to reduce symptoms and pain, and avoid knee surgery and the insertion of an implant. Treatment options include physiotherapeutic measures and orthopaedic devices. The use of braces can lead to a noticeable decrease in knee pain, reducing the need for painkillers. You should consult your doctor to find the best possible course of treatment for your osteoarthritis.
Our website provides you with an overview of the orthotic devices supplied by Ottobock. In the section, you can find out more about our range, individual models and how braces can help you if you have osteoarthritis of the knee. A doctor or medical supply company can assist you in making the right choice.
Numerous medical supply companies stock suitable Ottobock braces. Have a look in our dealer directory for suppliers in your area. Local staff will be happy to advise you and tell you whether a trial fitting with a brace can be arranged.
As is the case with many medical devices, braces can have minor side effects which affect the appearance of the skin. In order to avoid side effects from a brace, you should discuss the use of a brace with your doctor and ensure that the product is tailored precisely to your needs. A good fit is important; you'll also need to take good care of your brace and use it correctly. This will help to keep skin irritation or similar symptoms to a minimum.
Braces can reduce the pain caused by osteoarthritis and improve your mobility. As a result, you won't need to take so many painkillers. Braces also support and stabilise your knee joint and reduce pressure on the joint cartilage. This leads to a significant reduction in symptoms and increases your quality of life.
The treatment of osteoarthritis symptoms relies on several approaches. Through dietary change, you can supply your body with healthy nutrients and lose weight, while targeted exercises will strengthen your muscles and help stabilise the joint. A brace is a useful addition to both measures; it helps to alleviate pain and can delay the need for an operation.
Braces can help to delay the disease progression of osteoarthritis. If joint wear is very advanced, knee surgery may be needed to replace part or all of the joint with an endoprosthesis. An endoprosthesis is an implant which removes the symptoms of osteoarthritis, so that you no longer need a brace. Your doctor will inform you about the procedure, risks and side effects involved in such an operation.