Knee Osteoarthritis

Knee Osteoarthritis

Osteoarthritis (OA) is the result of mechanical and biologic events that destabilize the normal process of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix, and subchondral bone. It involves the entire joint, including the articular cartilage, subchondral bone, pericapsular muscles, capsule, and synovium. The condition leads to loss of cartilage, sclerosis and eburnation of the subchondral bone, osteophytes, and subchondral cysts. It is clinically characterized by joint pain, stiffness, and functional limitation. (Hunter et al, 2006) (Sharma et al, 2006)

Approximately 1 in 5 adults over 45 years in England have osteoarthritis of the knee affecting 4.11 million people (18.2% of adults). 6.1% of whom are affected by the severe form of the condition. (Versus Arthritis, 2019)

It is estimated that a total of 39,523 people aged 45 or over in Buckinghamshire live with knee osteoarthritis. This means that of the total Buckinghamshire population aged 45 years or over, 17.4% are estimated to have knee osteoarthritis (overall prevalence). This is similar to the overall England prevalence of 18.2%.  (The MSK Calculator 2015, Arthritis Research UK)

Musculoskeletal conditions account for the third largest area of NHS programme spending at £4.7 billion in 2013-14   (CCG Programme Budeting Benchmarking Tool 2013/14) There does not appear to be a relationship between osteoarthritis prevalence and hip / knee replacement rates across local authority areas. (Versus Arthritis, 2019)

Nice guidelines recommend core treatments for people with clinical Osteoarthritis which include: physiotherapy with activity and exercise, interventions to achieve weight loss if overweight or obese and verbal and written information to enhance understanding. Manipulation and stretching and intra-articular corticosteroid injections should be considered as an adjunct to core treatments. (OA guidelines, CG177,  Nice 2014).

A review of the literature has suggested that muscle strengthening and aerobic exercises are effective in reducing pain and improving physical function in patients with mild to moderate OA of the knee. (Bennell et al, 2011) (Zhang et al, 2010)

There is substantial evidence for CSI providing short-term pain relief and limited evidence for more durable benefit up to 12 months. (Bellamy et al, 2006 ) (Chang et al, 2012)

When investigating  the effectiveness of CSI prior to supervised knee exercise, patients with knee OA found no additional benefit from CSI compared to placebo injection before a course of supervised exercise at 2,14 or 26 weeks. (Henriksen et al, 2015)


Bellamy N, Campbell J, Robinson V et al. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006;(2):CD005328. 

Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011

Cheng OT, Souzdalnitski D, Vrooman B et al. Evidence-based knee injections for the management of arthritis. Pain Med 2012;13:740–53. 10.1111/j.1526-4637.2012.01394

Dawson J, Fitzpatrick R, Carr A, Murray D. Questionnaire on the perceptions of patients about total hip replacement J Bone Joint Surg Br. 1998 Jan;80(1):63-69

Henriksen M, Christensen R, Klokker L et al. Evaluation of the benefit of corticosteroid injection before exercise therapy in patients with osteoarthritis of the knee: a randomized clinical trial. JAMA Intern Med 2015;175:923–30. 10.1001/jamainternmed.2015.0461

Hunter DJ, Felson DT. Osteoarthritis. BMJ. 2006;332:639-642

(NICE) National Institute of Clinical Excellence, CG177., 2014. Osteoarthritis: care and management in adults.

Sharma L, Kapoor D, Issa S. Epidemiology of osteoarthritis: an update. Curr Opin Rheumatol. 2006;18:147-156

Sun Y, Sturmer T, Gunther KP et al. Reliability and validity of clinical outcome measurements of osteoarthritis of the hip and knee–a review of the literature. Clin Rheumatol 1997;16:185–98. 10.1007/BF02247849 

Veenhof C, Bijlsma JW, van den Ende CH et al. Psychometric evaluation of osteoarthritis questionnaires: a systematic review of the literature. Arthritis Rheum 2006;55:480–92. 10.1002/art.22001] 

Versus Arthritis, 2019 –

Zhang, W., Nuki, G., Moskowitz, R.W., Abramson, S., Altman, R.D., Arden, N.K., Bierma-Zeinstra, S., Brandt, K.D., Croft, P., Doherty, M. and Dougados, M., 2010. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis and cartilage, 18(4), pp.476-499.