The stages of osteoarthritis of the knee

Osteoarthritis is a common form of arthritis that often affects the knee. In the first stage, symptoms are mild, but by the fourth, a person may need surgery.

Osteoarthritis (OA) of the knee affects the bones, the cartilage, and the synovium in the knee joint.

Cartilage is a slippery tissue that provides a smooth surface for joint motion and acts as a cushion between the bones.

Synovium is soft, and it lines the joints. It produces fluid, called synovial fluid, for lubrication, and it supplies nutrients and oxygen to the cartilage.

As these functions break down, they no longer protect the bones of the knee joint, and bone damage occurs.

OA of the knee can cause pain and stiffness. The symptoms worsen over time.

Stages

OA of the knee takes several years to develop, and it progresses in stages.

The condition can be hard to treat because symptoms may not appear until OA reaches an advanced stage.

People with OA of the knee should be on the lookout for any changes in symptoms and other indications that the condition is advancing.

Stage 1: Minor

Small lumps of bone called osteophytes may grow in the knee area. There may be slight damage to the cartilage.

There will be no apparent narrowing of the space between the bones to indicate that the cartilage is breaking down.

People with stage 1 OA are unlikely to feel pain or experience discomfort. The joint will appear normal on an X-ray.

Stage 2: Mild

During this stage, a person may start to notice symptoms, and doctors can see some signs of wear.

X-rays and other scans of the knee joints will clearly show more osteophyte growth, and the cartilage will begin to thin.

The space between the bones will still appear normal, but the area where the bones and the tissues meet will start to harden.

When the tissues harden, this makes the bone thicker and denser. A thin layer of bone will also develop beneath the cartilage in the joints.

The person may experience stiffness or joint pain. The area around the knee joint may start to feel particularly stiff and uncomfortable after a person has been sitting for extended periods.

Though there may be some minor damage, the bones are not rubbing or scraping against each other. Synovial fluid is present, and it helps to reduce friction and support the movement of the knee.

Stage 3: Moderate

The damage to the cartilage has progressed, the gap between the bones has narrowed, and X-rays will show cartilage loss.

Pain and discomfort may occur while performing daily activities, such as running, walking, kneeling, and bending. There may be early signs of joint inflammation.

As OA progresses, the cartilage will continue to thin and break down. The bones will respond by thickening and growing outward to form lumps.

The tissue that lines the joint will become inflamed, and it may produce extra synovial fluid, resulting in increased swelling. This is called synovitis, and it is commonly known as water on the knee.

Stage 4 - Severe

Knee replacement surgery may be the only option for late-stage OA of the knee.

This is the most advanced stage of OA, and the symptoms are very visible. The space between the bones in the joint has continued to narrow, causing the cartilage to break down further.

As a result, there is stiffness in the joint, constant inflammation, and less fluid around the joint. There is more friction in the joint and more significant pain and discomfort while moving.

X-rays will show bone on bone, meaning that either the cartilage has completely worn away or there is very little left.

The individual will likely develop more bone lumps and experience pain that is often intense during simple activities, such as walking.

In severe cases, the bones may become deformed and angulated because of asymmetric loss of cartilage.

At this stage, surgical treatment is often the only option.

Treatment

Treatment options depend on the stage of OA and how quickly the condition is progressing.

Stage 1

Any symptoms are usually minor, and acetaminophens or other over-the-counter (OTC) medications can often relieve the pain.

Performing certain exercises can help to build strength and mobility.

Some sources recommend taking supplements, such as glucosamine and chondroitin. However, the AAOS have concluded that there is not enough evidence to show that supplements help.

Stage 2

Treatments can include:

• taking pain relievers
• attending physical therapy sessions to build or maintain strength and flexibility
• wearing a knee brace designed to relieve pressure on the joints' surfaces
• wearing shoe inserts to relieve stress on the knee

At this stage, people with OA of the knee may need to change their daily activities to avoid pain.

Stage 3

Treatments can include:

• taking OTC pain relievers, such as acetaminophen
• taking prescription pain relievers, including oxycodone or codeine
• receiving injections of corticosteroids

A doctor will administer three to five injections over 3–5 weeks. It can take time for results to show, but relief can last for 6 months.

Stage 4

At this stage, the cartilage has either significantly diminished or disappeared completely.

The person may need surgery to replace or realign the joint.

Reference: https://www.medicalnewstoday.com/kc/stages-osteoarthritis-knee-310579

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