The Elderly Knee

Plymouth Orthopaedic and Sports Injury Clinic

This sadly implies degenerative arthritis and whilst it may be age related it can also be caused by old sports injuries, or may present at a younger age often associated with a family history, implying a genetic pre-disposition.
The majority of humans will develop some signs of osteoarthritis with age, but it is not always a cause of symptoms. Increased loads will clearly accelerate this process, so weight is an important issue, and excessive running will also play an important role.

The majority of patients with early to moderate arthritis can be managed without surgery.

Weight loss, keeping fit, non-impact exercise all play a role. Physiotherapy may also be invaluable. Simple painkillers (Paracetamol) and anti inflammatory gels should be used; surgery is rarely appropriate prior to trying all the above.

Steroid injections will reduce inflammation within the knee and therefore reduce symptoms, but tend to work less well each time they are repeated and eventually cause more damage than they treat.

A newer type of injection called a Viscosupplement may “lubricate” the knee and reduce pain, but these drugs are expensive and work in perhaps 50-60% of cases.

Arthroscopy ("key-hole" surgery) may have a role especially if a patient is suffering from mechanical symptoms (locking or giving way) caused by a meniscal tear or a loose body. Arthroscopy cannot cure arthritis, however.

Knee replacement is a reliable way of alleviating arthritic pain but replaces a natural knee with a bionic knee. Sadly, patients cannot be turned back into 21 year olds but knee replacement is reserved for patients over 60 years. In time a knee replacement will wear out and younger patients do more and therefore tend to wear things out faster.

The mainstay of knee replacement is Total Knee Replacement, implying that all the articular surfaces are replaced. Many surgeons do not routinely replace the back of the knee cap. It is possible in appropriate cases to replace one part of the knee, eg Medial Uni Compartmental Knee Replacement. This potentially has some advantages in terms of function, but is not always appropriate.