Osteoarthritis of the kneePatient guide

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Osteoarthritis of the knee is a common ailment. Osteoarthritis is the most common of joint maladies. It is irreversible, which means that once cartilage wears away, it can't be replaced.

Osteoarthritis refers to changes in the joint when the layer of cartilage is attacked or otherwise damaged such that it wears it away. In the end this can also cause changes to the bone itself. Joint mobility is compromised and this can lead to inflammation and pain. Approximately 60% of all OA cases involve the knee. There are various causes: joint malformation, age, overuse (i.e. manual labour or obesity), sports injuries and accidents.

However, the ways of actively combating knee Osteoarthritis are as varied as the causes. Options include exercise, healthy nutrition,medication and much more.

There's no “one size fits all” with osteoarthritis. Patient experi­ence has proven that many options work. What's right for you will be something that you decide with your doctor.

This guide is here to support you. It describes osteoarthritis of the knee in detail and offers useful tips for those living with osteo­arthritis of the knee.

Your Ottobock osteoarthritis team

Dear patient,

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How osteoarthritis of the knee progresses

Bones that come in contact with other bones are covered by cartilage at their contact points. Cartilage is not supplied with blood, and nutrients are supplied through movement of the joint – that's part of the reason regular movement is so important.

Cartilage ensures that the joint surfaces move against each other in the best possible way – and with minimum friction. It cushions and distributes the forces acting on the joint.

If the cartilage becomes damaged and its gliding properties are affected, it can no longer serve its purpose and the joint's freedom of movement can become limited. Because the cause of osteoar­thritis of the knee (poor posture, as a result of an accident, etc.) is permanent, the damage to cartilage is permanent, too.

Ultimately, cartilage can begin to crack, then it begins to break down. At the same time, the bone thickens at the site of the damage. When the cartilage layer is finally worn away, the affected bones come in direct contact and rub against each other. Typical symptoms of osteoarthritis include joint pain and inflammation.

As osteoarthritis (also known as joint deterioration) is a natural part of the aging process, it can't be halted. By taking the right steps, however, you should at least be able to delay onset. Because deterioration is progressive, preventative measures against it should be taken as early as possible.

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A brief description of the four stages of osteoarthritis

The progression of osteoarthritis is described in the medical community as having four stages. Stage one describes the initial cartilage changes. Stages two and three mean that the degenra­tion has progressed, including cartilage damage – which is when knee pain generally begins. Once the cartilage has completely worn away, doctors talk about stage four.

• Healthy joint • Affected knee joint

• Healthy joint • Affected knee joint

Joint capsule

Synovial fluid

Joint spaceSynovial membrane

Joint cartilageJoint space rough and

constricted

Synovial membrane

Joint cartilage

Foreign body

Capsule affected

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Signs of osteoarthritis of the knee

Classical progression of osteo arthritis

As soon as osteoarthritis of the knee appears it creates a vicious circle: To get relief for a painful knee, the person adopts a compensatory posture and limits their knee movement. Because this compensatory posture is unnatural, it can cause problems in other parts of the body, such as the hips. This reduced movement has a further effect, in that it reduces the amount of nutrients provided to the cartilage. As a result, the cartilage breaks down even faster, which increases pain – and so the cycle continues.

There are several common symptoms that signal knee osteoarthritis. They can occur individually or together. With the initial onset of the loss of cartilage, however, you may not notice any of these symptoms.

When symptoms appear, they usually occur in the following order.

1 Cracking in the joint

2 Pain during load­bearing activities, such as carrying heavy objects

3 Pain during daily activities, such as climbing stairs

4 Reduced mobility

5 Swelling and inflammation

Cartilage damage

Inflammation, pain

Compensatory postureand movements

Lack of exercise

Poor cartilage nutrition

Cartilage wear

The viciouscircle of

osteoarthritis

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DIY test for osteoarthritis

Use the following questions to determine whether you might have developed osteoarthritis of the knee or if you might be susceptible to it in the future.

If you answer 'yes' to more than three questions, or simply suspect that you may have osteoarthritis, please consult with your doctor.

• Does your knee make any noise during certain movements?

• Do you have pain when you climb stairs?

• Are you over 50 years old?

• Do you often perform load­bearing activities?

• Do you do any sports that involve abrupt movements?

• Do you have joint pain after being on your feet for long periods?

• Do you have any pain when you get up in the morning?

• Have you ever had a joint injury?

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Helpful treatments for osteoarthritis

• Lavage (joint cleaning): Osteoarthritis grinds away cartilage. During a lavage proce­dure, the knee is pumped full of saline solution. This dislodges any blockages and washes loose cartilage particles out of the knee joint.

• Shaving (cartilage smoothing): A shaver – a medical instrument used to remove soft tissue and cartilage – is employed to remove any frayed cartilage and smooth the cartilage edges. A lavage usually follows any shaving procedure.

• Hyaluronic acid: Hyaluronic acid is injected into the knee, improving the consistency of the joint lubrication and thus relieving the cartilage. That reduces discomfort and improves the function of the knee.

• Corrective surgery (joint correction): corrects any incorrect loading within the knee joint. This includes separating misaligned bones and relocating them to the correct position.

Joint replacement

• Endoprosthesis (replacement joint): in this case, the natural knee joint is replaced with an artificial knee joint. In Germany, for example, it is one of the most common orthopaedic interventions overall.

Joint preservation (invasive) therapy

As it’s not possible to regenerate damaged joint cartilage, the treatment of ostoarthritis is generally to treat the symptoms.

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• Joint specific exercises (such as physiotherapy and sports): with regular exercise you'll maintain your mobility, strengthen your muscular system, and make sure your cartilage gets the nutrients it needs, thus breaking the vicious circle of osteoarthritis.

• Temperature: Warm or cold? It depends on the situation. With acute inflammation, cold provides relief and helps control swelling. Warmth is only used when the joint is not inflamed. It relaxes muscles and tendons and increases the flow of nutrients.

• Creams: Various, over­the­counter solutions are available at your local pharmacy, including pain gels and creams that can offer relief for your osteoarthritis.

• Dietary supplements: there are many supplements available that are intended to prevent further deterioration of cartilage. Most of them incorporate glucosamine and chondroitin in various quantities. Their effects are presently under debate.

• Orthopaedic appliances (braces and supports): these are applied externally to the knee or leg and are intended to help relieve pain.

• Lifestyle: one of the most important things you can do for managing your osteoarthri­tis is to live a healthy lifestyle. You can find out more you can do for a healthy lifestyle in the pages that follow.

Joint retaining (non-invasive) therapy

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Lifestyle and diet

With osteoarthritis, there are several things you can do yourself. Living a healthy lifestyle definitely helps. If possible, avoid smoking and drinking. Eat plenty of salad, vegetables and fish and use cold­pressed oils. Apart from that, try to be calorie conscious and limit high fat foods, since every kilo matters and the less you weigh the easier it will be on your knees. If you are severely overweight, it may be advisable to diet under the supervision of your doctor.

The food pyramid below gives a quick overview of how you can eat in a balanced, nutritious way, which, besides other healthy effects, also benefit your joints.

Vitamins and dietary fibre

Sugar-free drinks

Carbohydrates

Protein

Fats

Sweets

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1 Stand upright, with the feet hip width apart.

2 Lift your arms in front of you to shoulder height.

3 Now go into a slight knee bend. Make sure you don't push your knees too far forward. Instead, focus on keeping your seat directed backwards. Your back should stay straight throughout the exercise. Finally, extend your legs and stand up.

4 Repeat the exercise ten times.

2 Light knee bends

Four exercises that can help your kneesTo promote muscle growth and to provide the cartilage with the necessary nutrients, it's important to exercise your knee. How much you can move the knee, of course, is something you’ll have to establish for yourself. Movements that do not load the knee joint are all helpful too.

1 Warm-up/Marching on the spot

1 Before you begin joint exercises, you should warm up well. Your body will be prepared for the exercises, which will help you avoid injury.

2 For this reason, perform this warm-up for at least half a minute.

3 Take a short break, then repeat this exercise.

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1 Stand upright and support yourself with a wall or chair. This will help you maintain your balance.

2 Lift your leg from the floor and bend it slightly.

3 Now, stretch your leg as shown in the illustration. The foot should be flexed, with the toes pointing upwards.

4 Repeat the exercise ten times. Also perform the exercise with your other leg.

1 Sit down on a stable stool or chair.

2 Extend your leg forwards by sliding your heel along the floor. Do not overextend the knee. The other leg should remain bent, with the foot flat on the floor.

3 Repeat with the other leg.

4 Repeat the exercise for about one minute.

3 Leg stretches

4 Alternating steps while sitting

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What are mobility aids and what is available?

Orthopaedic mobility aids for the knee normally refer to orthoses – or braces – and supports. Both orthoses and supports refer to medical aids that are applied externally to the knee (and in the case of an brace, to the leg, too).

The difference between braces and supports is fluid. In general, one can say that supports are made from a textile material, while braces employ additional stabilising materials.

A knee brace relieves the knee joint and thus can slow the progression of the osteoarthritis. A knee support, on the other hand, offers only limited aid for reducing pain. During sports (such as cycling) they can be applied for both prevention and support.

• Wraparound knee brace • Sleeve style support

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Avoid surgery – but how?

The Agilium Freestep from Ottobock is a revolutionary way of treating knee OA.

Developed to treat knee osteoarthritis, it is applied not to the knee but to the foot ­ right inside the shoe. In order to provide targeted relief for the damaged cartilage in the knee, the Agilium Freestep changes the load line of the knee, which is the location where the body weight has the greatest impact on the cartilage.

Agilium Freestep relieves the knee dynamically, which means only when necessary

• During standing, as well as during walking and running (that is, when the knee joint is bearing weight)

Agilium Freestep is applied below the knee, meaning

• Optimal comfort

• The knee is not restricted

• No limitations during sitting

• It cannot slip down the leg

• Can be worn underneath the clothes

Agilium Freestep provides reliable support

• During daily activities such as shopping and walking

• During activities with higher impact, such as running or hiking

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Dr. Hartmut Stinus, Specialist in orthopaedics and trauma surgery

“ The majority of my patients are very satis­fied with the new brace. And about half of them have, at this point, not had to have an operation.”

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Shopping, walking, exercisingHeike remains mobile in spite of her osteoarthritisLiving knee­OA – just going to the super market – meant knee pain for Heike. The 49­year old developed osteoar­thritis in her left knee four years ago after meniscus surgery, which was made worse by having bowed legs. She wanted to avoid an operation, and even a knee brace was a burden, in spite of her pain.

Heike laughs now thinking back on the moment her orthotist applied the Agilium Freestep to her leg. The brace stretches from her foot to the outside of her calf, and is about as light as a sandal. The other benefits of the Agilium Freestep? Heike says, “I can just put it on. When I wear it, the effect is instantaneous and the pain reduces. And, at the moment, the brace is saving me from having to have an opera­tion.”

With the Agilium Freestep Heike is mobile again – in spite of her osteoarthritis – whether she's walking with her daughter in the woods, or working as a tennis instructor at the court. The orthosis fits comfortably inside her shoe.

“ As soon as I put the brace on, the pain in my knee reduces.”

Although she initially wore the Agilium Freestep for up to eight hours a day, she's now down to an average of three hours, in part because her higher activity level has developed her muscles and made her stronger. “I'm really happy that I got this brace,” she says, “because it simply helps.”

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