This joint is one of the most commonly affected joints by osteoarthritis, often presenting with complaints of knee pain. Symptoms such as stiffness and swelling in the knee joint, limited range of motion, crackling sound during movement, and deformity in the knee joint or legs may indicate osteoarthritis.
Osteoarthritis and Its Stages:
Joint osteoarthritis can occur in any joint, including the shoulders, fingers, hips, and knees, due to gradual wear and tear of the joint over time. Patients with osteoarthritis usually feel pain in their joints even after moderate movements. The knee joint is one of the most commonly affected joints by osteoarthritis and often presents with complaints of knee pain. However, it is important to note that not all knee pain is caused by osteoarthritis, as there can be various other causes for knee pain.
Symptoms such as stiffness and swelling in the knee joint, limited range of motion, crackling sound during movement, and deformity in the knee joint or legs may indicate osteoarthritis. Osteoarthritis of the knee is classified into grades 1-4 based on the extent of damage in the joint. A healthy knee does not fall within this range and is typically labeled as “grade 0.” The highest grade, grade 4, indicates “severe” knee osteoarthritis. Knee osteoarthritis that has progressed to grade 4 causes severe knee pain and impairs the joint’s ability to move.
In the stage considered as normal knee health, there are no signs of osteoarthritis, and the joint continues to function without any deterioration or pain.
Grade 1:
In individuals with grade 1 knee osteoarthritis, the formation of small bone protrusions called osteophytes begins. Osteophytes are irregular bone growths that typically form at the junction where bones meet in the joint. These bony protrusions can also arise due to causes such as joint inflammation. When the cartilage tissue in the joint starts to deteriorate, our body tries to compensate for this loss, leading to irregular bone growths at the ends of existing bones. Individuals with grade 1 knee osteoarthritis usually do not experience any pain or discomfort due to the mild wear in their joints.
Treatment:
If osteoarthritis does not cause any bothersome symptoms, grade 1 osteoarthritis generally does not require any specific treatment. However, if you are predisposed to osteoarthritis or at high risk, your doctor may recommend various supplements or an exercise program to alleviate osteoarthritis symptoms and slow down its progression.
Degree: 2
Grade 2 osteoarthritis is considered a “mild” stage of knee degeneration. When an X-ray of the knee joint is taken at this stage, it can be observed that the bone spurs (osteophytes) have further grown. The cartilage is generally healthy, meaning that the space between the bones is normal, and the bones do not rub against each other. However, grade 2 osteoarthritis is the stage where patients may start experiencing initial symptoms. Pain after a long walk or run, increased stiffness in the joint after being inactive for a few hours, and tenderness when kneeling or bending the knee can be felt.
Treatment
In grade 2 osteoarthritis, which indicates mild knee degeneration, it is important not to overlook speaking to your doctor whenever you experience any symptoms. Your doctor can diagnose the condition at an early stage and develop a treatment plan to prevent its progression. Several different treatment options can help alleviate the pain and discomfort caused by this stage of osteoarthritis. If you are overweight, reducing weight through diet and exercise can help alleviate symptoms caused by excess weight and improve your quality of life. Even those who are not overweight can benefit from planned exercise. Low-impact aerobic and strength training exercises can help strengthen the muscles around the joint, increase stability, and reduce the risk of additional joint damage. Avoiding excessive movement by avoiding kneeling, squatting, or jumping can protect your joint from excessive stress. Knee braces and wraps can help stabilize your knee. Shoe inserts (orthotics) can help realign your leg and relieve some of the pressure on your joint. Some people may require mild pain medications, which are usually used in conjunction with non-drug therapies such as exercise. For example, if you need to take NSAIDs (non-steroidal anti-inflammatory drugs) or acetaminophen (such as Tylenol) as pain relievers, you should also try exercising, losing weight, and avoiding unnecessary stress on your knee. Prolonged use of these medications can cause other problems. Long-term use of pain relief medications can lead to stomach ulcers, cardiovascular problems, and kidney and liver damage. Taking acetaminophen can cause liver damage.
Degree: 3
Grade 3 osteoarthritis is classified as “moderate” knee degeneration. At this stage, the cartilage between the bones starts to deteriorate, and the space between the bones narrows. Individuals with grade 3 osteoarthritis in their knees often experience frequent pain while walking, running, bending their knees, or kneeling. They may also experience joint stiffness after prolonged sitting or upon waking up in the morning. Joint swelling can also occur after prolonged physical activity.
Treatment
If non-pharmacological treatments and pain relievers no longer provide relief, your doctor may recommend a class of medications called corticosteroids. Corticosteroid medications contain a hormone called cortisone, which has been shown to alleviate osteoarthritis pain when injected near the affected joint. Cortisone is used as a medication and is also naturally produced by our bodies. Some corticosteroid injections can be administered three or four times a year, while others may be administered only once. The effects of corticosteroid injections typically fade within around two months. Care should be taken when using corticosteroid injections, as studies indicate that prolonged use can worsen joint damage. If these pain-relieving methods no longer work, more potent prescription pain medications may help alleviate increased pain in Grade 3 osteoarthritis. In the short term, these medications can be used to treat moderate to severe pain. However, these medications are not recommended for long-term use. Common side effects of these medications include nausea, drowsiness, and fatigue.
For individuals who do not respond to non-surgical treatments (such as physical therapy, weight loss, and use of pain relievers) for knee osteoarthritis, injection methods can be tried. Injection methods for knee pain include intra-articular corticosteroid injections, platelet-rich plasma (PRP) injections, stem cell injections, and cryoanalgesia-induced nerve block. PRP injections provide a slow but long-lasting effect. In stem cell injections, stem cells transform into damaged cartilage tissue in the region, promoting tissue regeneration. These regenerative treatments, which are non-surgical treatment methods, are effective and current approaches depending on the condition of osteoarthritis.
Grade: 4
Grade 4 Osteoarthritis is considered “severe” knee osteoarthritis. Individuals with Grade 4 osteoarthritis experience significant pain and discomfort when walking or moving the affected joint. This is due to a substantial reduction in the joint space between the bones. In this severe stage of knee osteoarthritis, the cartilage tissue is almost entirely lost, leaving the joint stiff and immobile. Synovial fluid, which is important for reducing friction between the movable components of the joint, significantly decreases and no longer provides much assistance. The joints start rubbing against each other. At this stage, symptoms such as knee pain, limited mobility, and difficulties in performing daily activities are more pronounced.
Treatment
In severe cases of grade 4 knee osteoarthritis, a surgery called osteotomy may be performed to reshape the knee joint. This surgery removes the weight from the areas with bone protrusions and damage, reducing the pressure on the knee joint.
For most patients with severe knee osteoarthritis, the most reliable long-term solution is total knee replacement or partial knee replacement surgery. During a knee replacement surgery, the damaged joint is removed by the doctor and replaced with an artificial joint called a prosthesis. Recovery after the surgery usually takes several weeks or months and requires extensive physical therapy.
Obtaining the best results from the prosthesis, experiencing pain-free and natural knee sensations, and ensuring the longevity of the prosthesis are crucial for both the patient and the doctor. When deciding to undergo knee replacement surgery, there are options and factors to consider, such as the technology used in the surgery, the surgical technique employed, and the characteristics of the prosthesis to be used.
Robotic surgical systems are advanced technologies that assist the doctor in designing and implementing the most suitable placement of the prosthesis according to the patient’s joint anatomy. Nowadays, robotic surgery is used to perform total knee replacement, partial knee replacement, and knee prosthesis revision surgeries with the utmost precision and safety. With the next-generation robotic surgical system, patients can return to their mobile and active lives much faster without knee pain.
When deciding to undergo knee replacement surgery, it is natural to desire relief from knee pain, fast recovery, optimal results, and the ability to use the prosthesis comfortably and safely for many years. The “best choice” for everyone may vary based on the individual’s condition, needs, and expectations from the surgery. Ultimately, the most accurate decision will be made together by you and your doctor.
