Knee Osteoarthritis

Knee osteoarthritis is a common disease in elderly people that is found more frequently in women than in men. Most patients visit the doctor with knee pain as the primary symptom, while some patients might arrive with walking difficulty and loud joints. Meanwhile, others do not experience pain much but only feel pain when walking up and down the stairs or when squatting or sitting for a long time and then getting up. The cause of this condition is damage to the joint surfaces due to extensive use and old age. However, sometimes the condition is found in young patients who have prior history of knee joint surgery such as torn anterior cruciate ligament or torn meniscus, or broken bones that penetrated the joint. Some cases might even be caused by misaligned patella, with additional contributing factors from falls, long-distance travel, excessive standing or walking and heavy body weight.

Knee pain and loud noises from the knee joints present themselves in 2 different ways, namely, without pain and with noises accompanying pain or a feeling of knee instability. Sometimes, knee sensitivity might also be present. Cases where loud noises occur in the knee without any pain are encountered only when bending the knees extensively for a prolonged period of time such as when squatting or getting up from a stool. The loud noises are caused by grinding of the cartilage surface or tissues of the ligaments in the knee joints. Normally, they cause no problems, but when there are loud cracking noises or a feeling of popping knees accompanied by knee pain, there might be an abnormality around the knee cap, including knee osteoarthritis due to worn joint cartilage creating a rough joint surface or lack of synovial fluid in the knee joint, which leads to impact between the surfaces and louder noise. Otherwise, the meniscus might be torn due to an accident and also cause loud noises when moving the knee joints.

Check knee pain symptoms for signs of knee osteoarthritis:

1. Knee pain, especially when bending the knees or during cold weather.
2. Knee pain when walking up and down the stairs, running or jumping.
3. Cracking noises when bending and extending the knees.
4. Worsening knee pain when sitting with folded legs, squatting or with the knees significantly bent.
5. Worsening knee pain and sensitivity when having to put weight on the knee or needing to stand on one leg.
6. Lack of strength, poor balance and increased leg curvature.

Primary Causes of Knee Pain, Cracking Knees or Loud Knees

The problem is mostly caused by living behaviors without awareness that the behaviors or activities being performed are directly contributing to knee osteoarthritis, for example:

• Age. There is a high risk of developing this condition in older age due to organ deterioration.
• Females are more likely to have knee osteoarthritis than males.
• Being obese or overweight. The heavier the body weight, the faster the knees deteriorate.
• Sitting in the wrong posture. People who squat or sit with their legs crossed or folded find that their knee joints deteriorate more rapidly.
• In people who suffered from knee injuries, whether resulting in broken knee bones or torn ligament, knee osteoarthritis can develop.
• Low muscle and bone strength. Without regular exercise, there is decreased strength. If the body also does not receive adequate calcium intake, the sooner the knee joint will deteriorate.
• Joint component abnormalities such as loose knee joint and weak thigh muscles.
• Genetics. There is evidence that knee osteoarthritis can be transmitted genetically.
• Heavy alcohol consumption.
• Exercises that cause continuous and repetitive impacts to the joints.
• Continuous use of steroids.

In addition, a natural cause of knee osteoarthritis is old age or older age combined with decreased bone density and strength. For example, people who are 40 years and older start to experience wear in their joint cartilage. Otherwise, this condition can happen in people with congenital hip or knee joint abnormalities, not to mention other factors such as infection, torn meniscus, abnormal tilting of the patella when bending the knee causing the patella cartilage to move and experience more friction than normal to the point that inflammation occurs, etc.

Treatment Guidelines

Reduce pain by using different methods and teaching patients about how to properly use their knees to reduce pain and tension in the muscles surrounding the knees by using hot compresses.

1. Regularly exercise the knee muscles for strength and to help reduce impacts on the knees.
2. Use knee braces in cases where there is loss of knee stability. Knee braces can help keep the knee joints in place while reducing pain. However, when used for an extended period of time, it will be found that the knee muscles have atrophied due to lack of use. As a result, knee exercises should be performed on a regular basis as well.
3. Inappropriate postures trigger more rapid knee joint deterioration, including sitting with the knees folded, kneeling, crossing the legs and squatting. These positions should be avoided or adjusted to be appropriate to each person’s lifestyle.
   • Sitting position. It is appropriate to sit in a chair that has equal height to the knees so that when the legs are hanging down, the soles are in horizontal alignment with the floor. It is inappropriate to sit with the legs folded or crossed or to kneel or squat or sit flatly on the floor, since doing so can accelerate knee joint deterioration.
   • Sleep on a bed that is at knee height such that when the legs hang from the edge of the bed, the soles of the feet just touch the floor. You should not lie flat on the floor, as doing so requires you to bend the knees when lying down or when getting up, which can increase joint friction and lead to more rapid deterioration.
   • Standing. Stand straight with the legs slightly parted with the body weight equally distributed between both legs. It is not appropriate to stand with weight placed on just one leg, as doing so causes the knee to be exposed to excess weight and to experience pain.
   • Walking. Walk on flat ground and avoid walking on uneven areas such as stairs, slopes and rough paths, since doing so can cause more weight to be placed on the knees and easily cause falls and accidents. In addition, wear shoes with short heels (no more than 1 inch in height) or no heels with fairly soft soles and a fitting size.
4. Walking sticks can help reduce load on the knee joints while improving stability when standing and walking. Some people might use an umbrella with a rubber cap covering the tip of the umbrella to prevent slipping.
5. Lose weight. Because when standing and walking the knees have to bear 3-4 times the normal body weight, heavier people have to bear a much larger load than normal. Losing weight can significantly reduce impacts on the knee joints.

In any case, the best symptom relief method is controlling weight from being overly heavy having dietary discipline by eating sufficiently during breakfasts, reducing lunches and making dinners as small as possible.

How can you correct symptoms of knee pain and loud knees?

Treatment depends on the cause. In cases where the condition is caused by knee joint deterioration, the first line of treatment might be knee exercises. However, if the symptoms are not very severe, it might start with exercising the anterior thigh muscles and hip muscles, followed by avoiding excessive knee bending. Once the 2 above muscles are strong enough, the patella will tilt less, which reduces impacts. Moreover, knee joints should be used properly while taking joint supplements, using joint supports, receiving a synthetic synovial fluid injection or undergoing surgery. Otherwise, if the meniscus is torn, knee joint exercises, injection or, in severe cases, video-assisted surgery might have to be chosen instead.