Sign of knee osteoarthritis. The age of the patient and the mechanism of the onset of pain are the first two factors an orthopaedic surgeon would consider when deciding whether or not one’s knee pain is caused by knee osteoarthritis (OA). Knee OA is a degenerative joint disease, characterised by wear and tear of the cartilage and the subsequent inflammation of the knee joint. Osteoarthritis could develop from 40 years old onwards. 

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Asians have been observed to be more prone to knee osteoarthritis than their Caucasian counterparts, possibly due to a higher incidence of bow-leggedness and a lifestyle involving frequent squatting and kneeling, said orthopaedic surgeon Henry Chan. 

When should one see an orthopaedic specialist for knee pain?

Most patients would seek treatment from their family doctors when they first develop knee pain. Usually, a short course of anti-inflammatory medication would alleviate the symptoms. A lot of patients would turn to alternative treatments such as tuina, massage or acupuncture as well. However, if your knee pain persists for more than two weeks, or does not respond to the standard treatment, you should consult an orthopaedic surgeon. An orthopaedic surgeon is a specialist doctor who takes care of bones and joints. 

A weight-bearing X-ray showing frontal view of a patient’s knees. Source: https://radiopaedia.org

During one’s consultation with an orthopaedic surgeon, he will be able to determine the root cause of knee pain by asking a detailed medical history of your problem. A special weight-bearing X-ray, which is taken with the patient standing up to simulate walking, will be taken to establish if there is OA, and the degree of its severity. Occasionally, an MRI scan would be needed if the X-rays are insufficient. 

Treatment of early-stage OA knees

Painkillers could never be a long-term solution to knee pain as they have many side effects. They can damage the stomach lining, causing stomach ulcers or gastric bleeding, and they can damage your kidneys irreversibly. In treating early stage osteoarthritic knees, the surgeon will try to determine the main aggravating factors which brought about the condition in the first place: 

• Lifestyle – avid running could have hastened wear and tear
• Obesity – extra weight can put strain on one’s knees
• Diet – a high-purine diet could have triggered gout attacks, which are damaging to the knees

To further manage pain and improve knee function, the patient can discuss intraarticular viscosupplementation injections with the surgeon, which is a very safe and effective treatment option of early osteoarthritis. Some patients actually reported total relief of their knee pain lasting several years after a complete course of such lubricant injections. 

Treatment of late-stage OA knees

However, in advanced knee osteoarthritis, significant loss of the joint cartilage would cause bones to rub against each other while moving, leading to severe pain and inflammation. The patient’s knees usually would become crooked. At this stage, knee replacement surgery would be recommended as the most reliable form of long-term treatment. A skilled orthopaedic surgeon would be able to perform a successful knee replacement and help the patient achieve better mobility, relieve pain and enjoy a better quality of life. 

This article has been verified medically by Dr Henry Chan, orthopaedic surgeon at Surgi-TEN Specialists, Farrer Park Hospital (Singapore).

Disclaimer: According to the 2019 guideline published by the American College of Rheumatology (ACR), intraarticular hyaluronic acid injections are conditionally recommended against in patients with knee osteoarthritis. This is because the ACR finds that best evidence from individual reviews has failed to establish a benefit, and that harm may be associated with these injections. Please discuss with a specialist doctor for the best treatment of your condition.