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Knee Osteoarthritis Questions & Answers

I recently went to see an orthopaedic surgeon for knee pain. I brought an MRI from my family doctor to the visit, but the orthopaedic surgeon said that I also needed to get X-rays. Are they really necessary? I thought an MRI showed everything.

Dr. DiNubile's response:
MRI technology is amazing because it provides information about the knee and other joints that we once couldn’t see without surgery. However, they don’t always show the whole picture. Regular X-rays provide very useful information and actually complement what you see on an MRI. In fact, the degree of arthritis is better determined on X-rays than on MRI scans. Your doctor is right in wanting X-rays. He or she may also ask for certain special views depending on what is found in a physical exam. X-rays of the knee are very useful, and I rarely ever make a final decision about treatment without seeing them.

More Osteoarthritis Questions

Sometimes my osteoarthritis knee pain gets really bad for a few days. My doctor called it a “flare.” Is that dangerous? Does it mean the arthritis is getting worse?

Dr. DiNubile: “Flare-ups” are extremely common for individuals with osteoarthritis of the knee.  When you have osteoarthritis, your knee can be very temperamental. Inflammation of the joint can occur, something we call synovitis. Sometimes the reason for the flare-up is obvious, like being overactive, taking a long walk, dancing or playing some tennis.  Other times it seems to happen for no obvious or rational reason.

If you have a flare you should contact your doctor, who can usually manage your knee flare easily and with some simple measures. He or she will probably recommend rest and applying ice to your knee. Also, over-the-counter pain relievers like acetaminophen can help the pain, and NSAIDs (over-the-counter or prescription) can both relieve pain and reduce inflammation. Occasionally, a cortisone shot is needed to settle things down.

Viscosupplements can give a more lasting pain relief of osteoarthritis symptoms than cortisone. It is a very simple and quick procedure done in the office with minimal or no discomfort, and it can provide a more lasting relief from your osteoarthritis knee pain. For longer-term relief, Synvisc-One may also be a very good option for you. It helps to lubricate the knee joint and provide pain relief for up to six months. Many of my patients get good results from it and most importantly finding relief from osteoarthritis knee pain helps them start exercising and moving again, which is the best thing you can do for arthritis.

I was just diagnosed with mild osteoarthritis of the knee. Does that definitely mean I’ll need a knee replacement some day?

Dr. DiNubile: Osteoarthritis of the knee is very common, and the good news is that most individuals who have it do not eventually wind up with knee replacements. Certainly, if the degree of arthritis is severe, and if symptoms are significant and not relieved by other options, a knee replacement could be the correct step. With mild osteoarthritis of the knee, your goals should be to try to prevent the arthritis from progressing, and in many instances this is certainly possible. The key is to keep your weight down and keep your legs strong. You should also avoid higher impact activities such as running.

Interestingly, even patients who have more advanced knee osteoarthritis do not all eventually require knee replacements. Some do not have enough symptoms to warrant knee replacement, while others find treatments that can delay or even avoid the need for knee replacement completely. There are many treatments for knee osteoarthritis, so don’t be afraid to try a few until you find one that works for you.

I’ve had osteoarthritis in my right knee for a couple years. What is the chance I’m going to end up with it in my left knee, too? Is there anything I can do to prevent it?

Dr. DiNubile: Having osteoarthritis in one knee does not guarantee that you'll have it in the other knee as well. Knee osteoarthritis has many causes. If you had an old injury to your right knee and that was your predisposing factor for the development of arthritis, then you probably will not get it in your opposite knee. However, if you are bowlegged or knocked-knee or were born with a risk factor for osteoarthritis, then you may be more likely to have it occur in the opposite knee. Talk to your physician about this, and he or she may want to get some X-rays of both knees to see if there are any predisposing factors or signs of early arthritis. If indeed you do have some early osteoarthritis in your opposite knee that isn’t causing you pain, then prevention becomes very important. Your physician can outline a comprehensive preventive program, which would include things like weight management, activity modification and some leg exercises.

My doctor tells me I have "water on the knee." What causes that, and what can I do about it?

Dr. DiNubile: “Water on the knee” is the term used for a knee joint that has accumulated fluid or is swollen. Normally, your knee has only a few drops of clear, yellow fluid that acts as a lubricant and provides nutrients to the joint surface. Anything more than that implies that there is something wrong in the knee and you should get it checked. The lining of the knee joint, called the synovium, will release extra fluid when things are irritated. The knee will look a little full or bloated, and it may feel tight or even painful. Swelling can come from a variety of causes including injury, arthritis, infection and certain medical conditions. It’s very common for individuals with osteoarthritis of the knee to develop some swelling, also known as an effusion, because of some inflammation that occurs in the knee. If your knee is swollen, the most important thing to do is to figure out the exact cause. Your physician can remove, or aspirate, the fluid from your knee, and the color and consistency of the fluid can often help determine what type of problem the knee is having. For example, blood in the knee is usually from a significant injury like a torn anterior cruciate ligament or a torn meniscus. If the fluid is a clear yellow, then it may be related to osteoarthritis. If the fluid is cloudy, there should be concerns about other conditions like infection, Lyme disease or other rheumatologic issues.

I have osteoarthritis in my knee and so does my sister. Does it run in families? Also she seems to do fine, and I suffer quite a bit. Why does it affect us so differently?

Dr. DiNubile: There are many causes of osteoarthritis — from injury, to being overweight, to having problems with your alignment (knock-knees or bowlegs). We also now know that there are genetic predispositions to certain types of knee osteoarthritis. It does indeed run in families at times. However, just because a relative has osteoarthritis does not mean that everyone in the family will get it. Also, symptoms related to osteoarthritis can vary dramatically from one individual to the next, something we don’t really understand. Two individuals with the exact same amount of arthritis can have completely different experiences, with one having a lot of pain and the other being relatively pain-free. If you’re having symptoms, you should talk to your doctor about what you can do to feel better. There are many options to improve your situation. Also, if arthritis runs in your family, you should do all you can to try to prevent it from occurring or worsening, such as staying fit and keeping your legs strong and your weight in a healthy range.

PLEASE NOTE: The views presented herein are solely those of Dr. DiNubile, Orthopaedic Surgeon. Sanofi does not endorse Dr. DiNubile or his book, FrameWork. Dr. DiNubile is a paid advisor for Sanofi. Be sure to consult with your own doctor before starting any exercise program or health regimen.

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Dr. DiNubile is an Orthopaedic Surgeon specializing in Sports Medicine in private practice in Havertown, Pennsylvania, and is a Clinical Assistant Professor of the Department of Orthopaedic Surgery at the Hospital of the University of Pennsylvania. Dr. DiNubile has been chosen in "Best Doctors in America" as well as "Guide to America's Top Surgeons".

He is the author of the bestselling book, Framework—Your 7 Step Program for Healthy Muscles, Bones & Joints (Rodale) and is Executive Producer and host of the award winning national PBS television special, Your Body's FrameWork.