Loss of cartilage within the knee joint can result in complications affecting the integrity of the knee joint surface due to increased pressure demands, which can lead to the development of bone spurs, subchondral bone sclerosis, and cysts and lesions.
NYU Langone doctors often recommend nonsurgical options as a first-line treatment for a knee cartilage injury. These include anti-inflammatory medication, physical therapy, and injections into the joint, including steroids; hyaluronic acid, also known as synthetic joint fluid; and platelet-rich plasma (PRP).
You might be surprised to learn that people can have virtually no cartilage in a part of a joint (“bone on bone”) and have no pain at all. As a matter of fact, this is very common. We have patients who have completed Ironman triathlons without any cartilage in parts of their knee.
Strength training and aerobic conditioning exercises improve symptoms of loss of cartilage in the knee. Symptom improvement occurs from lowering chronic inflammation in the body and weight loss and muscle strength gain.
Severe knee cartilage loss makes walking, sitting, standing, squatting, and going up and down stairs extremely painful. People with a total loss of knee cartilage can benefit from joint injections. In many cases, surgery including a total knee replacement is needed to treat no cartilage in the knee.
You may be offered knee replacement surgery if: you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced. your knee pain is so severe that it interferes with your quality of life and sleep. everyday tasks, such as shopping or getting out of the bath, are difficult or impossible.
The most common reason for knee replacement surgery is to ease pain caused by arthritis. People who need knee replacement surgery usually have problems walking, climbing stairs and getting up out of chairs. If only one part of the knee is damaged, surgeons often can replace just that part.
Signs you need knee surgery
swelling and inflammation of the knee which no longer responds to medication. stiffness in the knee and immobility. 'bowing' of the leg. non-surgical, non-steroidal anti-inflammatory drugs no longer provide relief from pain.
Damage to the articular knee cartilage can cause pain, inflammation, a clicking noise and catching sensation, and reduced range of motion of the joint. Cartilage injuries that are wider than a centimeter have the potential to get bigger over time, which may lead to osteoarthritis, a degenerative condition of the joint.
The use of a joint leads to wear and eventual degeneration of the cartilage that cover the bones where they meet in the joint. This loss of protective cartilage causes the joint inflammation known as osteoarthritis, as bone starts to rub directly against bone.
What is the recovery after cartilage repair? Very generally speaking, patients will spend 1-3 days in the hospital, then use crutches for 8 weeks. They can return to stationary biking at 4-6 weeks, swimming and elliptical trainer at 8-12 weeks, and light jogging at 1 year.
Cell-based cartilage resurfacing: Matrix-induced autologous chondrocyte implantation, or MACI, is a cell-based cartilage resurfacing procedure. For this procedure, some of the patient's cartilage cells are harvested, grown and re-implanted into the area that has damaged cartilage.
As knee arthritis progresses, the knee becomes much looser and more unstable. In some cases, this is mild. In other cases, it is substantial enough that cause the patient to fall. Patients who have bone-on-bone arthritis and are starting to fall because of it should strongly consider surgery.
Non-Invasive Treatments
Ice and over-the-counter pain medication like acetaminophen or ibuprofen can help. Sometimes physical therapy or a guided exercise program can provide bone-on-bone knee pain relief by strengthening the muscles that support the knee, particularly the quadriceps.
You may NOT be a good candidate if:
Your knee symptoms are not related to joint disease. Your weight is too much for the artificial joint to support. You have fragile skin or poor skin coverage over your knee. You have a severe illness or infection.
Simply put, the longer you wait to get a knee replacement, the more wear and tear you put on your knees – and the longer you live with increasing pain, stiffness or mobility issues. But there are a few other things to consider, including: As your knee condition worsens, your quality of life can also decrease.
arthroscopy – where fluid is flushed into the knee joint to clear out any loose bone and cartilage. osteotomy – where the shape of your shin bone is changed to reduce pressure on the worn or damaged part of your knee. microfracture – where small holes are made in the surface of the bone to help new cartilage grow.
The majority of patients expect to be able to kneel after TKR,2,4,5 however, these expectations are frequently not met,1,6 with between 50% and 80% of patients reporting that they have difficulty kneeling or do not kneel in the months and years after TKR.
Most patients can walk on their own roughly four to eight weeks after knee replacement.
Most people can leave hospital 1 to 3 days after the operation. Before you leave, a physiotherapist or occupational therapist will talk to you about managing daily activities and home exercise programmes. Following the exercises early on in your recovery will help with the long-term strength and movement in your knee.
When quantifying how much pain there is after surgery, it is relative to the patient. The pain after a knee replacement is typically no worse than one of your worst days before you had surgery. However, you can feel this way for the first two to three weeks after the day of surgery.
A standard battery of X-rays and MRI scans will probably be necessary to completely evaluate the knee. An MRI can reveal if there are other causes of the pain and lack of function, such as a stress fracture. But X-rays will reveal most of what your doctor needs to know.
Another thing you can do whilst waiting for your knee replacement surgery is to stay as active as you can. If you can, continue to do gentle exercise, such as walking and swimming, in the weeks and months before your surgery.