Signs and Symptoms
Knee osteoarthritis usually develops slowly over months or years. Common symptoms include:
- Aching pain in the knee that is worse with walking, stairs, kneeling or getting up from a chair
- Stiffness first thing in the morning or after sitting, which usually loosens within about 30 minutes
- Swelling or a feeling of fullness in the knee after activity
- Grinding, clicking or crackling (called crepitus) when you bend the knee
- A knee that feels weak or gives way, or that no longer straightens or bends fully
- A gradual change in the shape of the leg, such as becoming more bow-legged or knock-kneed
Symptoms often come and go in flares. Many people have good weeks and bad weeks, especially after a change in activity.
What Causes It?
Cartilage is the slick, rubbery tissue that lets the bones of the knee glide against each other. In osteoarthritis, that cartilage thins and roughens, the bone underneath reacts by thickening and forming small bony growths (bone spurs), and the joint lining can become inflamed.
Several factors raise your risk:
- Age, since cartilage changes are more common after middle age
- Extra body weight, which increases the load on the knee with every step
- A past knee injury, such as a meniscus tear, ACL tear or fracture
- Leg alignment, family history and years of heavy kneeling, squatting or lifting
How We Diagnose It at POPB
Your visit starts with a conversation about how the knee affects your daily life and what you have already tried, followed by a hands-on exam of motion, swelling, alignment and stability. Standing X-rays are taken on site, usually at the same visit, because they show how much joint space is left and where the wear is.
MRI and diagnostic ultrasound are also available in our office when the picture is unclear, for example to check for a meniscus tear or another cause of pain. Knee arthritis is evaluated by Dr. Martin, Dr. Kerr, Dr. Press and Dr. Adelman, depending on your goals and whether you are looking for non-surgical care or a surgical opinion.
Non-Surgical Treatment Options
Most people with knee osteoarthritis do well with a combination of non-surgical treatments, adjusted over time:
- Physical therapy in our office, focused on strength, flexibility and walking mechanics. Your therapist shares your chart with your physician.
- Weight management, activity changes and low-impact exercise such as cycling, swimming or walking on level ground
- Anti-inflammatory medication or acetaminophen, if safe for you
- Bracing, a cane or shoe changes to reduce load on the worn part of the knee
- Cortisone injections for flares, and hyaluronic acid injections, which are FDA-approved for knee osteoarthritis
- iovera° cryoneurolysis, which uses extreme cold delivered through small needles to temporarily block pain signals in targeted nerves around the knee for up to 90 days
- PRP (platelet-rich plasma, prepared from your own blood). Evidence is still developing, results vary, and insurance usually does not cover it.
If you have Medicare, you may qualify for our Care Management program for osteoarthritis. A physician assistant or nurse practitioner calls you monthly, updates your care plan and reports to your physician, without extra office visits. Your usual Medicare cost sharing may apply.
Surgical Options
When pain limits your daily life despite a fair trial of non-surgical care, knee replacement may be discussed. If the arthritis is limited to one part of the knee, a partial knee replacement may be an option. If it involves more of the joint, a total knee replacement resurfaces the worn bone ends with metal and plastic parts.
Dr. Martin, Dr. Kerr and Dr. Press perform knee replacement. Dr. Martin offers personalized knee replacement, including customized partial knee replacement, and Dr. Kerr is trained on robotic-assisted systems. Arthroscopy (a scope procedure) is generally not recommended for arthritis alone.
Recovery
With non-surgical care, many people notice improvement within 6 to 12 weeks of consistent therapy and home exercise, though osteoarthritis is a long-term condition and flares can return. Injection relief lasts for different lengths of time in different people.
After knee replacement, most people walk with support the same day or the next day and continue physical therapy for several weeks. Many return to most daily activities within about 6 to 12 weeks, and improvement often continues for a year. Timelines vary.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, physical therapy, cortisone injections, hyaluronic acid injections for the knee and medically necessary knee replacement, subject to your co-pay, co-insurance and deductible. Coverage for iovera° varies by plan, so ask our team.
PRP and other biologic injections are usually not covered. If you have an HMO or managed-care plan, a referral from your primary care physician must be in our office before your visit. Our staff verify your benefits when you call.
When to Be Seen
Call our office if knee pain has lasted more than a few weeks, keeps you from walking or sleeping well, or has not improved with rest and over-the-counter medication. A sudden hot, red, very swollen knee with fever needs same-day care; if you cannot reach our office, go to the emergency room. If you cannot bear weight after a fall or the leg looks deformed, go to the emergency room or call 911.
