Invasive Treatments For Knee Osteoarthritis
Your doctor may suggest these treatments if youre having frequent pain that doesnt improve with the strategies mentioned above.
For most invasive treatments, its vital to know the stage of your knee OA. This will guide your doctor into which remedies will be better for you.
The most common are:
Intra-articular injections
Here, the doctor injects a substance into your knee joint, usually for pain relief.
Corticosteroid injections are popular for knee OA. Here, your physician injects a drug that can reduce pain for up to 3 months. But with one downside it can accelerate your osteoarthritis.
Another common injection is hyaluronic acid. The doctor injects this substance into the synovial fluid to ease symptoms and promote healing.
This means it may be best for the early stages, as the cartilage isnt severely damaged.
Surgery
In theory, surgery should be performed on a knee joint with a severe stage of OA. But this is not true in practice.
Nowadays, knee surgeries for osteoarthritis are done when other treatments cant ease symptoms anymore. This is regardless of the stage.
For example, a study found that out of 1329 knees waiting for a total knee replacement, more than 18% of them were in stage 1.
Researchers arent sure why this happens. It can be due to inefficient treatment strategies, or a poor provider-patient relationship.
In any case, the most common surgeries for knee osteoarthritis include:
- Knee replacement surgery partial or total.
Symptoms Of Knee Arthritis
Knee arthritis causes pain and decreased mobility of the knee joint. In the arthritic knee, there is an absent joint space that shows on X-ray. In the normal knee, there is a normal joint space.
The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis. The capsule of the arthritic knee is swollen. The joint space is narrowed and irregular in outline this can be seen in an X-ray image. Bone spurs or excessive bone can also build up around the edges of the joint. The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.
What Causes Bone Spurs
The main cause of bone spurs in the knee is Osteoarthritis. The condition causes wear and tear of the joint over time. The cartilage located at the end of the bone wears away, causing the body to try and repair itself. Bone spurs are the result of new bone material being generated to replace the cartilage. It is the pressure within the joint that triggers bone spurs to form.
Interestingly, those suffering with Rheumatoid arthritis have a lower risk of developing bone spurs than those with osteoarthritis.
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What Is Knee Arthritis
Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint. This surface can wear out for several reasons often the definite cause is not known. Arthritis often affects the knee joint.
When the articular cartilage wears out, the bone ends rub on one another and cause pain. This condition is referred to as Osteoarthritis or wear and tear arthritis, as it occurs with aging and use. It is the most common type of arthritis.
How & Why Bone Spurs Grow In The Knee
As cartilage degenerates, the bony surfaces of the knee cap , the thigh bone and shin bone begin to place direct pressure on each other. As bone on bone pressure occurs, a cascade of cellular reactions cause the formation of cells called osteoblasts which begin building new bone tissue in the areas where the bone has been damaged2. This is where osteoarthritis differs dramatically from another common arthritic condition called rheumatoid arthritis.
Bone spurs do not occur in rheumatoid arthritis because the cellular processes involved are purely degenerative, causing virtually no bone growth at all4. Without the generation of new bone within the knee joint, it will erode and completely stop functioning4. You can think of spurring bone as a rough patch job the body performs in response to joint damage and instability.
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Symptoms To Watch Out For
Although you wont necessarily experience any symptoms with a bone spur in the knee, there are some to keep a lookout for. The main symptoms include:
- Bony areas around the joint
- Weakness or numbness
- Pain near the knee
- Stiffness and reduce range of motion
If you experience any of the symptoms above, it is a good idea to seek advice from a specialist. They will be able to diagnose the problem and determine whether it is bone spurs.
As bone spurs are typically asymptomatic, patients will usually only discover they have them when they undergo an X-Ray.
How Are Bone Spurs Diagnosed
For those suffering from moderate to severe osteoarthritis, bone spurs can be a major contributor to pain and dysfunction. In these cases, diagnostic imaging is often used to examine the structure of the knee joint. Using X-ray imaging, physicians can assess the level of cartilage damage within the knee and identify the extent to which bone spurs have formed over the surface of the joint.
The Kellgren and Lawrence Osteoarthritis Classification 1 is commonly used by physicians to determine the severity of osteoarthritis. Information gathered from diagnostic imaging is examined using the KLOC criteria to provide a severity grade between 1-4. Those with severe or grade 4 osteoarthritis will have multiple large bone spurs within the knee joint. Typically bone spur growth is observed around the joint line where cartilage has degenerated and has led to painful bone on bone friction.
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How Do Bone Spurs Form
Without adequate cartilage around the knee joint, the bones of the knee become irritated and inflamed due to the increased pressure and friction within the joint during movement and weight-bearing of the leg as the bones rub against each other. Bone cells react to this increased pressure by producing more bone growth in an attempt to provide more protection to the joint, forming bone spurs that can change the appearance of the joint and limit mobility by restricting movement.
How Do Health Care Professionals Diagnose Bone Spurs
A doctor will likely begin with a medical history and physical examination. The medical history is a series of questions about someone’s condition and a review of any other medical problems. The physical examination will include testing the joints that are affected to determine how much motion an individual has, how much pain one experiences with motion, and a check of muscle strength.
Based on the results of the medical history and physical, a physician may recommend obtaining imaging studies to diagnose bone spurs. This often starts with plain radiographs . These are typically able to show if bone spurs have formed and if the joint is affected. If there is a question of possible tear of a tendon such as a rotator cuff tear, an MRI may be ordered. An MRI or CT scan may also be ordered in the spine to assess for possible nerve or spinal cord compression.
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How Long Does It Take To Recover From Bone Spur Surgery
The recovery time for bone spur surgery depends on the type of surgery and the site of surgery. In general, recovery is faster after minimally invasive surgery compared to open surgery. Full recovery from bone spur removal in the spine can take anywhere from 10 days to a few weeks.5 Severe osteoarthritis and bone spur formation in the knee may require total knee replacement. This can take up to 1 year of recovery time.6 Recovery from a heel bone spur removal takes about 3 months. During the recovery period, you may need to be non-weight-bearing on the affected leg with crutches or a cane. You may need to wear a cast, splint, or walking boot for a few weeks.7
How Do We Treat Osteophytes If You Have Them
People sometimes ask us if we can chip off the osteophytes in surgery. The answer is that we very rarely do that, largely because its not treating the underlying issue. For instance, if osteophytes are occurring in reaction to arthritis in your knee, we would want to investigate the extent of the arthritic damage and create a comprehensive plan to help you manage it. That might include conservative treatments, such as:
Simple painkillers like paracetamol, to manage the pain or irritation
Anti-inflammatories like ibuprofen, a non-steroidal anti-inflammatory drug
Physiotherapy to improve movement and build up strength in muscles surrounding the joint
If theres significant degeneration and its causing you a lot of pain and mobility problems in day-to-day life, we would then discuss the possibility of partial or total knee replacement surgery with you.
Its worth adding that osteoarthritis isnt the only factor in osteophyte growth. They can be related to other, rarer conditions, such as diffuse idiopathic skeletal hyperostosis . Again, we would want to properly diagnose and manage these conditions through a tailored treatment plan.
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What Are Symptoms Of Bone Spurs
Some people have bone spurs and dont even know it. Spurs start to create symptoms when they:
- Put pressure on nearby nerves.
- Restrict movement.
- Rub against other bones or tissues.
When that happens, you may feel some:
- Knobby or bumpy areas, especially in the fingers or toes.
- Numbness and weakness, especially in the legs if the spine has spurs.
- Pain near the affected joint, like heel pain.
- Reduced range of motion .
What Are The Possible Risks And Complications During The Bone Spur Removal Surgical Procedure
There are general factors that increase the risk of getting complications during the surgical procedure and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history , the greater the surgical risk
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension , especially if it is poorly controlled
- Poor nutritional status
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Bone Spur Removal surgical procedure include:
- Injury to the neighboring structures
- Anesthetic complications
- Need for further procedures
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What Are The Treatment Options For Osteoarthritis And Bone Spurs
When looking at treatment options it is important to consider the condition of the knee relative to current and future lifestyle demands. If pain and discomfort interfere with recreational activities, activities of daily living, mood and psychological health then an appointment with a physician to discuss treatment options is warranted. Since bone spurs and osteoarthritis progress over time prevention is also an important aspect to consider. Typically the earlier treatment is started the more successful it is in reducing pain and maintaining function.
Treatment can be divided into two categories: surgical and non-surgical. The former is usually reserved for patients with severe osteoarthritis where conservative treatment has failed to provide relief from symptoms. Surgical removal of osteophytes ranges from minimally invasive arthroscopic techniques to full knee replacements which can require up to 1 year of recovery time.
Arthroscopic Osteophyte Excision: This surgery involves a small incision in the knee joint where various medical tools are inserted to shave down bone spurs thought to be driving knee dysfunction. This surgery is recommended only in very specific scenarios and does not provide a long term solution. Also, there is a limited amount of research into its effectiveness14.
What Are The Causes Risk Factors And Symptoms Of A Bone Spur In The Knee
There is no one answer to the question of what causes bone spurs in the knee. Each case of bone spur can be different but the list we provide here covers the most common causes. These causes are associated with a disease/condition that leads to cartilage degeneration or is a reaction to a bone injury.
Knee osteoarthritis: This is a form of arthritis that is caused by constant wear and tear of the knee joints. With excessive pressure, friction between the knee joints, as well as stretching of the joints, the cartilage in the bones can wear out. When the body attempts to repair itself, it can create bone spurs between the joints.
Knee injuries: A trauma or injury to the knee and specifically the cartilage tissue can cause bone spurs. There are crescent-shaped shock absorbers between the femur and the tibia that when damaged or torn, can cause bone spurs. This is what is often referred to as a meniscus injury.
Age: Data shows that knee pain bone spurs can be a result of natural wear and tear associated with aging. In other words, the older we get, the more likely we are to experience a bone spur.
Other causes: Some people get a bone spur in the knee due to lack of physical activity, nutritional deficiencies, structural abnormalities during birth, or a build-up of calcium deposits in the body. Obesity has also been linked to bone spurs.
- Severe pain in the knee
- Numbness, tingling, or weakness in the knee joint
- Pain when bending or extending the knee
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How Is Bone Spur Of Knee Diagnosed
Bone Spurs of Knee may be diagnosed by the following observations and tests:
- A complete physical examination with thorough evaluation of medical history
- X-ray of the knee: X-rays are noninvasive medical tests that use radiation to produce images of the bone
- Computerized tomography scan of the knee: A CT scan takes a series of X-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues with the body
- Magnetic resonance imaging scan of the knee: An MRI is a more detailed scan that uses radio waves and a magnetic field that generates thorough images of interior bones and soft tissues
- Electromyography : An EMG shows the electrical activity of the muscle during rest and muscle contraction. This test may be performed if the signs and symptoms indicate that there is muscle or nerve damage
- Nerve conduction velocity studies: Nerve conduction velocity shows the speed at which electrical signals move through the affected nerve. Slow nerve signal speed may indicate nerve damage
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
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Causes Of Knee Arthritis
There are numerous conditions that can cause arthritis but often the exact cause is never known. In general, but not always, it affects people as they get older .
The causes include:
- Increased stress such as overuse and overweight
- Infection of the bone
- Connective tissue disorders
- Inactive lifestyle and obesity . Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles and feet.
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Bones Of The Lower Extremity
The lower extremity includes the femur, the tibia, and foot and ankle bones.
We call the segment between the hip and knee the thigh, and we call the segment between the knee and ankle the leg.
Some people confuse the words leg and lower extremity, but in anatomic terms the leg spans only the distance from the knee to the ankle.
What Are Treatment Options For A Bone Spur
Treatment for bone spurs depends on the symptoms one is having. Pain is the most common symptom and is often initially treated with medications. Anti-inflammatory medications are typically used first. These help both to relieve pain and to reduce the inflammation caused by the bone spurs.
A doctor may also recommend physical therapy to help with bone spur symptoms. The physical therapy is not able to remove bone spurs, but it can help with some of the symptoms related to them. If one has a loss of motion in a joint caused by bone spurs, physical therapy can help strengthen the surrounding muscles and increase the motion in the joints. Physical therapy can include ice or cold packs, stretching exercises, ultrasound treatments, or massage.
In some cases, an injection of a steroid such as cortisone into the joint can help reduce pain from bone spurs. These injections can often be performed in a doctorâs office, depending on the joint involved. If the hips or spine are involved, the injections usually are performed using an X-ray machine to help guide the placement of the injection.
Over-the-counter anti-inflammatory medications can be used to treat pain. A doctor or physical therapist can provide a patient with simple stretching exercises to perform at home. Other home remedies for bone spurs include applying ice to the affected joint.
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How And Why Do Bone Spurs Grow In The Knee Joint
As cartilage degenerates, the bony surfaces of the knee cap , the thigh bone and shin bone begin to place direct pressure on each other. As bone on bone pressure occurs, a cascade of cellular reactions cause the formation of cells called osteoblasts which begin building new bone tissue in the areas where the bone has been damaged2. This is where osteoarthritis differs dramatically from another common arthritic condition called rheumatoid arthritis. Bone spurs do not occur in rheumatoid arthritis because the cellular processes involved are purely degenerative, causing virtually no bone growth at all4. Without the generation of new bone within the knee joint, it will erode and completely stop functioning4. You can think of spurring bone as a rough patch job the body performs in response to joint damage and instability.