Progressive loss of cartilage within the knee joint causing pain, stiffness and reduced mobility. Treatment options range from physiotherapy and injections through to partial or total knee replacement depending on severity.
(03) 9573 9659
Knee osteoarthritis is the progressive loss of cartilage within the knee joint. It is one of the most common causes of knee pain and disability in adults, and while it is often attributed simply to ageing or wear and tear, the underlying cause is frequently a mechanical problem that has been placing abnormal load on the joint over many years. Understanding the cause, not just the symptoms, is central to choosing the right treatment.
The knee has three compartments: the medial (inner), lateral (outer) and patellofemoral (kneecap) compartments. Each is lined with articular cartilage that allows smooth, low-friction movement. When this cartilage wears down, the joint surfaces begin to move against each other with increasing friction, causing pain, inflammation, stiffness and progressive loss of function.
Osteoarthritis can be primary, developing from general wear over time, or secondary, arising from a previous injury, leg mal-alignment, inflammatory joint disease or a mechanical problem that has never been corrected. Identifying which compartments are affected and whether there is an underlying structural cause directly influences the treatment options available.
Common symptoms include pain during or after activity, stiffness after periods of rest or first thing in the morning, swelling and a reduced ability to fully straighten or bend the knee. As the condition progresses, pain may be present at rest and at night. Some patients notice the knee feels unstable or gives way, particularly on uneven ground or when climbing stairs.
Diagnosis is based on clinical assessment and weight-bearing X-rays of the knee. Taking X-rays with the patient standing applies load to the joint, which more accurately reflects the true degree of joint space narrowing compared to non-weight-bearing views. Mr Balakumar assesses the degree of arthritis, which compartments are affected, and whether there is associated leg mal-alignment using full-length standing leg X-rays where indicated. MRI may be used to assess the menisci, cartilage and soft tissue structures in more detail.
Non-surgical options are always considered first. Depending on the severity and distribution of the arthritis, these may include physiotherapy, weight management, activity modification, anti-inflammatory medication, bracing, orthotics and injections. Cortisone injection can provide meaningful short-term relief. Platelet-rich plasma (PRP), viscosupplementation and cooled radiofrequency ablation are options for patients who have not responded adequately to standard conservative measures.
When non-surgical measures no longer provide adequate relief and the condition is significantly limiting daily life, surgical options are discussed. For arthritis limited to one compartment with associated leg mal-alignment in younger patients, a femoral or tibial osteotomy may be an option to redistribute load and delay the need for replacement. For single-compartment arthritis without significant deformity, partial knee replacement is an excellent option in suitable patients. For more widespread arthritis affecting multiple compartments, total knee replacement is the more appropriate choice.
Surgery is always a choice. The right time to consider it is when symptoms are significantly limiting daily life and conservative management has been given a genuine opportunity to work. Mr Balakumar discusses all options openly at the consultation and makes recommendations based on the individual clinical picture, including age, activity level, the distribution of arthritis and the patient’s own goals.
(03) 9573 9659
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
(03) 9573 9659
Melbourne Orthopaedic Group is home to a team of experienced orthopaedic surgeons, providing comprehensive care for sports injuries and orthopaedic conditions. Whether it’s joint replacement or sports injuries, our specialists provide comprehensive orthopaedic care.
