Knee Osteoarthritis: The Most Common Degenerative Joint Disease in the Elderly

What is knee osteoarthritis?

Knee osteoarthritis, or knee OA , is a common joint disease that is caused by the degeneration of cartilage and damage to the structures around the joint. Roughly 13% of women and 10% of men 60 years and older have symptomatic knee osteoarthritis. (Zhang, 2010) Among those older than 70 years of age, the prevalence rises to as high as 40%.

What causes knee osteoarthritis?

• Osteoarthritis (OA) of the knee can be caused by a combination of factors, including:  
• Age: As people age, the risk of developing knee OA increases.  
• Obesity: Excess weight places added stress on the knee joint, which can increase the risk of developing knee OA.  
• Injury: A previous knee injury, such as a fracture or ligament tear, can increase the risk of developing knee OA later in life.  
• Overuse: Repetitive use of the knee joint, particularly in high-impact activities like running or jumping, can increase the risk of developing knee OA.  
• Other medical conditions: Certain medical conditions, such as rheumatoid arthritis or metabolic disorders, can increase the risk of developing knee OA 
   

Symptoms of knee OA at different stages

Knee OA can be classified into four stages based on the severity of the condition. Each stage is associated with different symptoms.

Stage 1:

At this stage, people may experience occasional pain and discomfort, especially after periods of activity. 

Stage 2:

Symptoms at this stage may include more frequent pain, stiffness, and swelling in the knee joint. The pain may be more noticeable during or after physical activity and may interfere with daily activities such as walking or climbing stairs. 

Stage 3:

People at this stage may experience moderate to severe pain, stiffness, and swelling in the knee joint, even during periods of rest. They may also notice a decrease in range of motion and flexibility in the affected knee. 

Stage 4:

At this stage, people may experience severe pain, stiffness, and swelling in the knee joint, and may find it difficult to walk or even stand. There may also be a noticeable deformity in the affected knee, as well as a decrease in muscle strength and stability.
 

Clinical evidence of using knee OA braces

Knee OA braces are orthotic devices designed to provide support and relieve pain in individuals with knee OA. There is evidence to suggest that knee OA braces can provide some clinical benefits, including:  

• Pain relief: Knee OA braces can help reduce pain by providing support to the knee joint, improving joint alignment, and reducing the load on the affected area. (Hurley, 2012; Laroche, 2014)
• Improved function: Knee OA braces can help improve knee function by providing stability and support (Draper, 2000; Fantini, 2010), which can improve mobility and reduce the risk of falls.
• Delayed disease progression: Some studies have suggested that the use of knee OA braces may help slow down the progression of knee OA by reducing the load on the knee joint and promoting proper joint alignment. (Lindenfeld, 1997; Pollo, 2002) 
• Reduced need for medication: The use of knee OA braces may reduce the need for pain medications or other interventions, such as corticosteroid injections or surgery.

Treatment options for knee OA

The treatment of knee OA can involve both conservative and surgical approaches, depending on the severity of the condition. Here are some common treatments for knee OA:  

A.    Conservative treatment:   

• Physical therapy: Physical therapy can help improve joint range of motion, strength, and flexibility. The physical therapist can provide targeted exercises, manual therapy, and education on how to manage the condition.  
• Assistive devices: Knee braces, orthotics, canes, and other assistive devices can help reduce pain and improve joint function by providing support and reducing pressure on the knee joint.  
• Weight management: Maintaining a healthy weight can help reduce the pressure on the knee joint, alleviating symptoms of knee OA.  

B.    Surgical treatment: 

• Arthroscopic surgery: Arthroscopic surgery involves the insertion of a small camera into the knee joint to remove debris and smooth out rough surfaces. This can help alleviate symptoms of knee OA. 
• Joint replacement surgery: Joint replacement surgery involves the removal of the damaged joint and the insertion of an artificial joint. This can help alleviate pain and improve joint function.  

The choice of treatment for knee OA depends on the severity of the condition, the patient's age and overall health, and the patient's preferences. 

Exercises for knee OA

Exercise can be a helpful component of the treatment plan for knee osteoarthritis. Here are some exercises that can benefit individuals with knee OA:  

• Strengthening exercises: Strengthening exercises, particularly for the quadriceps and hamstrings muscles, can help improve joint stability and reduce pain. Examples of these exercises include leg presses, wall squats, and hamstring curls.  
• Low-impact aerobic exercises: Low-impact exercises such as walking, cycling, and swimming can help improve cardiovascular fitness and overall physical health. These exercises can also help improve joint flexibility and reduce pain. It is important to avoid high-impact exercises, such as running and jumping, which can place stress on the knee joint.  
• Balance and coordination exercises: These exercises can help improve joint stability and reduce the risk of falls. Examples of these exercises include standing on one leg and heel-to-toe walking.

References

1. Zhang Y., Jordan J. M. (2010). Epidemiology of osteoarthritis. Clin. geriatric Med. 26, 355–369. 
2. Laroche D, Morisset C, Fortunet C, Gremeaux V, Maillefert JF, Ornetti P. Biomechanical effectiveness of a distraction-rotation knee brace in medial knee os¬teoarthritis: preliminary results. Knee. 2014;21:710- 6. 
3. Hurley ST, Hatfield Murdock GL, Stanish WD, Hubley-Kozey CL. Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength? Arch Phys Med Rehabil 2012;93:496e502.
4. Draper RC, Cable JM, Sanchez-Ballester J, Hunt N, Robinson JR, Strachan RK. Improvement in function after valgus bracing of the knee. J Bone Joint Surg 2000;82B(7): 1001e5.
5. Fantini Pagani CH, Bohle C, Potthast W, Bruggemann G-P (2010) Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis. Arch Phys Med Rehabil 91:1936–1941
6. Lindenfeld TN, Hewett TE, Andriacchi TP (1997) Joint loading with valgus bracing in patients with varus gonarthrosis. Clin Orthop Rel Res 344:290–297
7. Pollo FE, Otis JC, Backus SI, Warren RF, Wickiewicz TL (2002) Reduction of medial compartment loads with valgus bracing of the osteoarthritic knee. Am J Sports Med 30(3):414–421