Arthritic knee - what am I to make of this report?

NormanCastle

I am an active retired bloke aged 74 with no significant afflictions apart from mild arthritic pain in my wrists from time to time and a wonky left knee which is prone to giving me grief. I am not one for sitting still: I am up and down stairs at home at least 20 times a day, and because of issues my wife has, I do all the “hard” work in our large veg garden and on the allotment. I either walk or cycle everywhere as we have no car. I am not on any medication and my BMI is currently 25 (and going down as I aim to lose 4Kg).

Over the last year or so I my left knee has taken to hurting occasionally (night or day) for no apparent reason, and quite often when walking down steep hills, particularly on uneven ground. I have also noticed that despite my best efforts I am now walking differently with my left leg, and that I am nowadays going for daily walks of only a mile or so whereas previously it would have often been 3-4 miles. I have for some time been doing the knee exercises shown on this site.

The offending knee was X-rayed last week and I have just got the report, which says

“Almost total loss of joint space in medial compartment of main knee joint with minor degenerative remodelling and subtle appearances on the lateral projection suggesting almost bone-on-bone articulation. The lateral compartment shows minor joint space narrowing. Minimal osteophytic lipping is seen at the tibial plateau and minor degenerative change at the patellofemoral joint. Bone texture is uniform. Vascular calcification is noted.”

My GP has now referred me to triaging for physiotherapy or whatever, and I would like to have a better understanding of how this all leaves me. If a knee was to be rated on a scale of dereliction where 0 is perfect and 10 is a total mess, whereabouts would that report put mine?

Obviously the knee is not going to get any better, but am I right in assuming that my best bet now is to do anything I can to push for surgery ASAP ? I ask this particularly in view of my age, the fact that we have no car, and that my wife is dependant upon me for most of the heavy work in the home and garden. We have no family.

(with apologies for the long post!)

Mike1

This may help https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/

NormanCastle

Thank you. I'd actually read the OA of the knee section earlier this year and have been doing the exercises recommended on there for some time now, while at the same time moving steadily towards my target BMI of 23.8 which I will achieve next month.

Because of our particular circumstances (and our relative poverty), my wife and I need to start ASAP making contingency plans for me being temporarily crocked up. What's bugging me right now is how best to start doing that when both the likely progression of and the treatment offered for the problem with my knee are complete unknowns. It's obviously going to be a considerable time before I reach the point at which my referral leads to me getting answers, hence me fishing now for any clues I can get.

Mike1

There are 4 stages of OA in the knee and surgeons do not operate until Stage 4 is reached and even then it may take some time, my baby sister has had stage 4 of the knees for 3 years and has another 7 years to wait until knee replacement as the NHS down here will not perform such procedures until she is 67! Bear in mind that each NHS district appears to be different. She has had special, custom made knee braces made for her which help a bit along with pain meds and she continues to work in a supermarket as she lives alone like me and has no choice!

Stage 1 – Minor - patients will develop very minor wear & tear and bone spur growths at the end of the knee joints. However, at this stage it is unlikely you will feel pain or discomfort.

Stage 2 – Mild - diagnostic images or X-rays of knee joints will show more bone spur growth, and though the space between the bones appear normal, people will begin experiencing symptoms of joint pain. Typically, the area around the knee joints will feel stiff and uncomfortable, particularly when sitting for an extended period, after rising in the morning, or after a workout.

Stage 3 – Moderate - where there is obvious erosion to the cartilage surface between bones and fibrillation narrows the gap between the bones. There are proteoglycan and collagen fragments released into the synovial fluid as the disease progresses, wherein the bones develop spurs at the joints as it becomes rougher. With the progression of osteoarthritis of the knee, there is obvious joint inflammation which causes frequent pain when walking, running, squatting, extending or kneeling. Along with joint stiffness after sitting for long or when waking up in the morning, there may be popping or snapping sounds when walking.

Stage 4 – Severe - In stage 4 the joint space between the bones are considerably reduced, causing the cartilage to wear off, leaving the joint stiff. The breakdown of cartilage leads to a chronic inflammatory response, with decreased synovial fluid that causes friction, greater pain and discomfort when walking or moving the joint. There is increased production of synovial metalloproteinases, cytokines and TNF that can diffuse back into the cartilage to destroy soft tissue around the knee. The advanced stage of the disease shows development of more spurs causing excruciating pain, which makes even everyday chores, including walking and descending stairs a challenge.

NormanCastle

Brilliant! Thank you. That's exactly what I needed to know 😀

(Sorry about the double posts. For some reason the first one disappeared from my computer so I started again ...)

helpline_team

Hi NormanCastle,

Thank you for posting on the Helpline forum. I am sorry to hear about the pain you are experiencing in your knee and wrists. It sounds as if your knee pain is the main problem at the moment and is beginning to affect your walking.  I am glad that you have had an X-ray and have been given a clear diagnosis of osteoarthritis (OA). However, I am sorry to hear that this has progressed to a later stage especially in the medial (inner) part of your knee joint and it is understandable that you have concerns about the possibility of future surgery and want to make plans.

It is good that you are still managing to keep quite active and you are doing exercises to help, and have lost some weight to put less strain on your joints. I am glad you have found the information on our website helpful and  Mike1 has also given some helpful responses to your post. It may help to talk things through further with your GP who could explain the X-ray result in more detail.

It is good that you have been referred to physiotherapy. When you mention triage, I’m wondering if you have been referred to the musculoskeletal (MSK) service? This can be the route to seeing an orthopaedic specialist. You could check this with your GP. If this referral is just for physio, you may wiish to ask your GP to refer you to an orthopaedic specialist. A private consultation is another option. 

If you would like to talk things through informally and in confidence, you are welcome to call our Free Helpline on 0800 5200 520 weekdays 9am – 6pm.

I hope you find the information given below of some help. 

https://www.versusarthritis.org/about-arthritis/treatments/surgery/knee-replacement-surgery/

Best wishes,

Fiona, Helpline Advisor 

NormanCastle

Thank you Fiona. The referral for triage is actually to the MSK service, with which my wife is very well acquainted so I know the score there!

I think with the help I've got here we're now OK for the time being, thank you, having gained enough understanding of what's what to at least be able to make realistic plans to cover most eventualities.

Best wishes to you and Mike1.

Lilymary

Thanks for that explanation @Mike1 , I can't believe I've got this far down the arthritis journey without knowing this. I have seen others mention stage 2 or stage 4 diagnoses, but given that mine appeared to go from zero to 4 in one leap, and none of my medics ever mentioned those classifications to me, I never got round to looking it up. But in retrospect, thinking about past pains and mobility, and from what my surgeon described from my xrays, I can now see how my hips had been gradually working their way through the grades in the background. If only we'd known sooner, I could perhaps have fended it off for a bit longer. 20/20 hindsight is a wonderful thing. 🙄

Sorry @NormanCastle I didn't mean to hijack your thread. I can relate to the knee pain you describe though, particularly on the down hill stretches, which is what usually gets the knees complaining first on long fell walks. I've been strapping my knee cap away from the head of my tibia for years if I know I'm in for a long descent - it's slightly gross but it works. I've never had my knees xrayed as it's fine the rest of the time, but I'm pretty sure what it would look like!

Good luck with the physio and weight loss, it all helps. When my hip packed up I had no hesitation in starting to use a stick, as it meant I could walk longer and faster than hobbling about without it, so at least it kept me moving. You may want to replace walking with swimming or cycling, which are kinder on the knees.

NormanCastle

It's now 9 years since we could afford to run a car, so I already do a fair amount of cycling. It's either that or walk 🙂