Possible treatment methods for knee osteoarthritis if painkillers and physiotherapy don’t work. A/Prof Tan Mann Hong, Head & Senior Consultant, Department of Orthopaedic Surgery explained that knee aspiration and keyhole surgery may help.
My wife is suffering from pain in her right knee and has been diagnosed with osteoarthritis. Amagnetic resonance imaging (MRI) scan showed degenerative changes in her right knee, with moderate joint swelling and a torn meniscus.
She has been doing her physiotherapy faithfully and swims three times a week. However, the pain is still there and there is swelling in her right knee. She takes the painkillers prescribed by her doctor only when necessary.
Her scan also showed these problems – bone contusion of the medial tibial plateau and sprain of the right anterior cruciate ligament, and medial and lateral collateral ligaments.
Should she go for surgery?
The swelling can result from knee
effusion, which occurs when
excess fluid accumulates around or
in the knee joint due to a reactionary
response of the inflammed joint
lining, worn-out articular cartilage
and the meniscal tear.
The articular cartilage is the
smooth tissue that covers the ends
of the bones.
The meniscus is another type of
knee cartilage that acts as a “shock
absorber”. It is located between the
thigh bone and shin bone.
The bits that are torn can interfere
with knee joint movements,
causing pain, swelling or “locking”.
The patient will be unable to
straighten her knee normally.
A bone contusion of the medial
tibial plateau means that there is a
bone bruise in the upper knee joint.
It could be due to a recent injury as
it is a high-stress area of the knee
joint. This can occur in those who
are bow-legged, for instance.
A sprain of the right anterior
cruciate ligament, and medial and
lateral collateral ligaments refers to
a spectrum of ligament injuries –
from stretching to partial tears.
The MRI findings are important
as they need to be correlated with
the physical findings.
Your wife’s doctor would likely
have prescribed anti-inflammatory
medications, which double as painkillers,
and sent her for physiotherapy.
The latter comprises mainly
quadricep and hamstring strengthening
exercises to help prevent
muscle atrophy and joint stiffness.
If the pain lessens within eight to
12 weeks, she should continue with
her swimming and physiotherapy
But if the pain and swelling
persist, a knee aspiration – which is
a minor procedure to draw out the
excess joint fluid – may help reduce
the swelling. This involves taking
out the knee joint fluid with a
needle and syringe. A reduction of
the knee swelling can sometimes
reduce pain and help improve the
range of motion in the knee.
Pain is a reaction to a torn
meniscus. Some meniscal tears
associated with arthritis can improve
with time. Your wife may
need surgery for the meniscal tear
when the expected recovery time
of, say, six to 10 weeks, has lapsed.
Some patients may benefit from
surgical options to fix the tear.
One such procedure is knee
arthroscopic surgery, or keyhole
surgery, where a camera and
working instruments are introduced
into the knee joint via two or
three small incisions.
This gives the surgeon a complete
view of the knee joint, cartilage,
menisci and ligaments. Depending
on the state of the meniscal tear, it
can be repaired, trimmed or
The small defects of the worn-out
articular cartilage can be dealt with
by smoothening the cartilage with
the use of shavers or devices called
radio-frequency wands. This is also
done through keyhole surgery.
Some centres treat the cartilage
defects by harvesting from a
healthy area of the patient’s joint
for cartilage transplant.
The new cartilage cells are used
to replace those that were lost to
wear and tear in the knee joint.
But the outcome of such procedures
has not been found to be consistent
or durable in the long term.