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Decision Aid for Knee Osteoarthritis
What you need to know about decisions for knee osteoarthritis:
You can help make decisions about being screened for osteoarthritis. You can also help plan treatment if osteoarthritis is found with screening, or you develop it. Osteoarthritis screening is a test done to find osteoarthritis early. Screening is different from diagnosis because screening is used when you first start to have signs or symptoms. This means management or treatment can start early to help prevent joint damage. Treatments include medicine and surgery, but you can also manage osteoarthritis with lifestyle changes.
What you need to know about knee osteoarthritis:
- Osteoarthritis is a condition that causes tissue between bones to wear away. This can happen slowly over time or quickly because of an injury. The bones rub together when you move. This causes pain and can limit mobility.
- Osteoarthritis is the most common form of arthritis. About 30 million people in the US have osteoarthritis.
- Osteoarthritis is more common in women than in men. Other risk factors include being overweight or having a family history of osteoarthritis.
- Talk to your healthcare provider if you think you have signs or symptoms of osteoarthritis. Examples include joint pain with movement, tender or stiff joint, or a grating feeling with movement. You may also feel hard lumps around the joint, called bone spurs.
How to know if you are a good candidate for osteoarthritis screening:
Screening may be helpful for you if any of the following is true:
- You are 50 years or older.
- You are overweight or obese.
- You do work or play a sport that puts repeated stress on your knee joint.
- You have a family history of osteoarthritis.
- You had a knee joint injury, even if it happened many years ago.
- You were born with a joint or cartilage problem.
- You have mild signs or symptoms of osteoarthritis.
- Your symptoms are starting to affect your ability to do your daily activities.
How osteoarthritis screening is done:
No test is used to diagnose osteoarthritis. Your healthcare provider will check the following:
- How much pain, tenderness, or inflammation you have in the joint
- Range of motion in the joint (how far it can move in every direction)
- Your ability to walk without pain, or how your symptoms changed the way you walk
- The strength of muscles around the joint
Benefits and risks of screening:
Talk with your healthcare provider about the risks and benefits of screening:
- Benefits include finding osteoarthritis early, when you can manage the condition. You may be able to slow the progress of joint damage by losing weight or exercising more. You can also help make a treatment plan that you can change over time as needed.
- Risks include a false belief that you will not develop osteoarthritis. Your screening test may find that you do not have osteoarthritis. This can be because signs and symptoms are mild. You can still develop more severe signs and symptoms over time. It is important to talk with your healthcare provider about how often to have screening.
Questions to ask your healthcare provider to help you make decisions about screening:
- How high is my risk for osteoarthritis?
- How often do I need to have screening?
- Where is the screening done?
- Do I need to do anything to get ready to have screening?
What happens after osteoarthritis screening:
You will meet with your healthcare provider to go over the results of your screening. You, your family or caregiver, and your healthcare provider can talk about your treatment options. Together you can decide which treatment is right for you. You may need more tests to diagnose anything that showed up on the screening test. Common tests include an x-ray or CT scan to check the amount of tissue between bones or to find bone spurs.
How osteoarthritis is treated, and the benefits of treatment:
- Lifestyle changes include weight loss and exercise. Weight loss can help take pressure off the joint. Exercise can help build muscles around the joint. This helps build stability and strength. Your healthcare provider, a dietitian, or a physical therapist can help you make nutrition and exercise plans.
- Devices can help you stay active and relieve your symptoms. Shoe inserts support your joints and take pressure off the joints. This can help reduce pain that happens when you stand or walk. A knee brace can add stability to your knee when you walk. A cane can help take weight off your knee as you walk.
- Medicines include acetaminophen, NSAIDs, and certain antidepressants. NSAIDs, such as ibuprofen, and acetaminophen can be taken as a pill or rubbed into your skin in a cream. Acetaminophen and NSAIDs help relieve pain. NSAIDs also help reduce inflammation. Both medicines are available without a prescription. Do not take these medicines without talking to your healthcare provider first. Stronger forms of these medicines are available with a prescription. Antidepressants are only available with a prescription.
- Therapy includes physical and occupational therapy. A physical therapist can help you strengthen muscles around the joint and increase your range of motion. An occupational therapist can help you find easier ways to do your daily activities. For example, you may be shown how to climb stairs without putting stress on your knee.
- Steroid medicine may be injected into the knee area if your symptoms become worse. This can reduce inflammation and relieve pain.
- Surgery may be done if other treatments do not work and your symptoms become severe. Debridement is surgery to clean pieces of bone and cartilage out of the joint. This is done if you have knee buckling or locking. Osteotomy is surgery to move bones into a different position so they do not rub against other bones. Surgery called arthroplasty is used to remove the damaged joint and replace it with an artificial joint. Surgery can relieve pain by removing the problem that is causing your pain.
Risks of osteoarthritis treatment:
- Lifestyle changes will not reverse the damage to the tissue between your joints. It may prevent symptoms from getting worse. It may also be difficult to exercise if you have severe knee pain.
- Medicines must be taken in limited doses. Acetaminophen can cause liver damage, and NSAIDs can cause kidney damage. The pain may come back before you can take another dose. Antidepressants can cause certain side effects.
- Steroid injections are usually limited to about 4 each year. This is because the medicine can cause joint damage over time. Steroids can also increase your risk for infections, cause changes in your mood, and increase blood sugar levels.
- Surgery increases your risk for an infection or blood clot. Nerves, blood vessels, or tissues around the knee can be damaged during an osteotomy. An artificial joint may wear out over time. It may also become loose. It will need to be replaced if it wears out or comes loose. You will need to do knee exercises to prevent scar tissue from building up in your knee. This can be painful.
Questions to ask your healthcare provider to help you make decisions about treatment:
- How will I know if signs and symptoms are becoming severe enough to need treatment?
- How long will it take for each treatment option to help my knee pain get better?
- Which pain medicines will work best for me?
- Am I a good candidate for steroid injections?
- Am I a good candidate for knee replacement surgery?
- How long is recovery from knee replacement surgery?
- Will I need to have more surgery over time?
- How often will I need to do knee exercises to prevent scar tissue from building up?
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