Diagnosing and Treating Osteoarthritis of the Knees

Osteoarthritis of the knee has a tremendous impact on a patient’s ability to function in routine daily activities. According to the American Academy of Orthopedic Surgeons, over 13 million adults in the U.S. presented with OA symptoms in 2001. The majority of these patients were senior adults.

Pain, swelling and stiffness are the most common symptoms associated with OA of the knee. These symptoms limit the patient’s ability to bend or straighten the knee, and they may also feel grinding, popping, locking, or giving way.

Dr. Harry Derderian, an orthopedic surgeon at Lexington Clinic East in Lexington, Kentucky, specializes in both hip and knee replacement surgeries. As one of Dr. Derderian’s clinical assistants, I have seen many patients suffering from the effects of OA.

When patients are initially seen in consultation for knee pain, Dr. Derderian uses the following protocol for diagnosing and treating OA of the knee:

1. X-rays of the knees are taken to look for characteristics of OA, such as bone spurs or joint space narrowing. Normal cartilage appears as a “gap” between the thigh (femur) and lower leg (tibia) bone. Advanced OA of the knee shows a “bone on bone” appearance on x-ray.

2. Physical examination of both knees includes evaluating and comparing the patient’s range of motion in each knee. Dr. Derderian also determines if a patient is experiencing swelling (effusion) of the knee joints. He then checks for points of maximum tenderness along the medial (inside of the knee) joint lines and lateral (outside of the knee) joint lines.

Grinding (crepetation) occurs when the patient’s knee is flexed or extended. This is most commonly due to chondromalacia patella (wear and tear underneath the kneecap).

3. In addition to conventional x-rays and physical examination, an MRI of the knee may be ordered to look for tears of the meniscus, the C-shaped, shock-absorbing cushion.