Knee Arthritis

What knee arthritis is

The knee is the largest joint in the body. Where the thigh bone, the shin bone and the kneecap meet, the bone ends are covered by a smooth layer of articular cartilage that lets the joint glide with very little friction. Arthritis is a general term for conditions in which a joint becomes irritated, swollen and often painful; in the knee it usually involves damage or loss of that cartilage.

Osteoarthritis is the form seen most often: the tissue covering the bone ends gradually breaks down, the space between the bones can narrow, and bone spurs and inflammation of the joint lining may develop. Rheumatoid arthritis is a different process, in which the immune system inflames the joint lining. Arthritis may also follow an earlier injury such as a fracture into the joint, a ligament tear or a meniscus injury, and is then called post-traumatic arthritis.

The knee is often described as having separate compartments: the inner side, the outer side and the area behind the kneecap. Arthritis may involve one compartment or all of them, and which are affected influences which treatments are appropriate.

Symptoms that often bring people in

• Aching or deep pain, often worse with walking, stairs or rising from a chair
• Stiffness, especially in the morning or after sitting
• Swelling, warmth or a sense of fullness in the joint
• Grinding, grating or catching with movement
• Difficulty straightening or bending the knee fully
• A knee that feels unsteady, or a leg that appears to bow

How it is evaluated

Evaluation usually begins with a conversation about how long symptoms have been present, what makes them better or worse, any previous knee injury or surgery, and how the knee affects daily life. Examination assesses leg alignment, motion, swelling, tenderness, ligament stability and walking pattern. Standing x-rays are commonly used because they show the joint under load. MRI, or blood work when an inflammatory arthritis is suspected, may also be recommended.

Treatment options in general terms

Non-surgical care is generally considered first, and for many people it can be continued for a long time. Options that may be discussed include:

• Physical therapy and exercise. Strengthening the muscles that support the knee and low-impact conditioning such as cycling or pool-based exercise.
• Activity and lifestyle adjustment. Modifying high-impact activity and addressing body weight where relevant, since load across the knee matters.
• Bracing and support. Braces or offloading devices that change how force passes through the joint, along with footwear or a walking aid.
• Medication and injections. Oral or topical anti-inflammatory options, and injection categories such as anti-inflammatory injections, hyaluronic acid preparations, and biologic options including platelet-rich plasma.

Surgery is generally considered when symptoms remain limiting despite reasonable non-surgical care. Options that may be discussed include:

• Arthroscopic joint preservation. A camera-guided procedure that may address mechanical problems such as loose fragments, inflamed joint lining or scar tissue, in selected cases.
• Partial knee replacement. Resurfacing only the worn compartment, when arthritis is confined to one part of the joint.
• Total knee replacement. Resurfacing the worn bone ends when arthritis is more widespread.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada. A consultation typically includes review of your history and imaging, examination of both knees and your gait, and discussion of your goals. Second opinions are welcome, and telemedicine visits are available.

This page provides general information about knee arthritis and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]