Knee arthritis and Total knee replacement

Netcare Sunninghill Hospital
Tel: 011 257 2179

Sandton MediClinic Hospital
Tel: 011 463 8830 | 011 463 8833

Knee arthritis and

Total knee replacement

Normal Anatomy of the knee

The knee joint is a complex weight bearing joint that relies on ligaments and muscles to provide stability. The knee is made up of three bones: The thigh bone (femur), the shin bone (tibia), and the kneecap (patella). There are 4 major ligaments in the knee: the Anterior cruciate (ACL) and posterior cruciate ligaments (PCL), Medial collateral (MCL) and lateral collateral ligaments (LCL). There are a number of other smaller ligaments as well as tendons around the knee which contribute to stability and function.

The surfaces of the femur, tibia and patella inside the joint are covered by articular cartilage which is smooth, and together with the joint fluid, act to reduce friction inside the knee during movement.

Inside the joint there are 2 “C-shaped” discs of cartilage attached to the tibia known as the medial and lateral meniscus. The meniscus gives extra cushioning to the cartilage inside the joint to prevent wear and tear. The menisci become soft with age and can tear or become frayed. This will accelerate the progression of arthritis and can result in pain, clicking or locking of the knee.

Arthritis

Arthritis is an age related degenerative condition which results in the cartilage covering the femur, tibia and patella to wear out. This leaves a rough joint surface with the formation of bony spurs. End-stage arthritis is painful and can cause stiffness and a grinding or grating feeling in your knee.

In some patients arthritis may develop early. This is called ‘secondary arthritis’ and may be as a result ofan autoimmune condition, such as rheumatoid, gout, or a previous injury around the knee.

As arthritis worsens you may notice that your legs start to become ‘bow-legged’ or ‘knock-kneed’, this is due to unequal wear of the cartilage on one side of the joint.

Symptoms:

- - Pain – often a dull ache which is worse at night and with activity.
  - Reduced movement – a loss of full extension and reduced bending of the knee.
  - Mechanical symptoms – such as clicking, grating or a catching sensation inside the knee.

Treatment:

Unfortunately this condition is not reversible and worsens over time. Mild to moderate arthritis is typically managed with non-surgical management, however severe arthritis is best managed with a joint replacement.

Non-surgical management

- - Weight loss
  - Activity modification – Avoid activities that cause pain including vigorous weight bearing activity. Cycling, swimming and elliptical trainers will put less force through the knee, whilst helping to maintain joint range of movement, muscle strength and weight loss.
  - Non steroidal anti-inflammatory medication – Medication such as Voltaren and Naproxen can reduce pain and swelling.
  - Physiotherapy – Specific exercises under the guidance of a physiotherapist can restore movement and strengthen your knees. Strengthening the thigh and hamstring muscles can relieve pain and increase movement.
  - Steroid injection – If weight loss, medication and physical therapy do not relieve your pain, an injection of a local anaesthetic and a cortisone inside the knee joint may be helpful. Cortisone is a very effective anti-inflammatory medicine; however, it is not effective for all patients and should be used with caution in diabetics.

Surgical management

A total knee replacement is considered the “Gold Standard” surgical treatment for advanced arthritis of the knee.

For more information please read the booklet below

Netcare Sunninghill Hospital
Tel: 011 257 2179

Mediclinic Sandton Hospital
Tel: 011 463 8830
or 011 463 8833