The knee has three individual areas, called compartments, that can be impacted by arthritis or osteoarthritis. One of those areas is the knee cap. Arthritis of the knee can affect any of these compartments, including the patellofemoral compartment behind the kneecap. Known technically as patellofemoral arthritis, it occurs when the cartilage becomes worn away beneath the kneecap. Cartilage damage is a key contributor to joint pain and instability in the kneecap. This creates pain with activity, along with instability. Joint problems in the knee, such as those caused by arthritis or cartilage damage, can lead to symptoms like knee locking and other symptoms, such as swelling or stiffness. Many of the individuals seen with kneecap arthritis are young, between 30 and 45. Too young to ideally consider a total knee replacement. Younger patients with early cartilage damage may benefit from specific surgical options. Often, their arthritic knee and worn cartilage is the result of an earlier traumatic knee injury.
Overview
- Understanding the Knee Joint
- Understanding Knee Arthritis
- Patellofemoral Arthritis
- Knee Osteoarthritis
- Risk Factors
Arthritis in the kneecap has long been a challenge for doctors to effectively treat. First, because it often tends to occur in patients who are too young for a total knee replacement and second, because previous implants and techniques did not lead to ideal outcomes. A thorough physical examination and, when needed, MRI scans are important for diagnosing early or subtle changes in the joint surface and soft tissues.
Individuals with severe or bone-on-bone arthritis in the kneecap usually have alignment issues which cause instability in addition to the pain. In treating these patients, we start with conservative treatments, including: physical therapy, bracing, injections or activity modifications. Sometimes weight loss may be recommended if it is thought that may help relieve extra pressure on the knee. Initial treatment and nonsurgical treatment options are preferred before considering surgery. These treatments can often buy some time for the patient before they need to look at other more invasive options. Losing weight can help reduce the risk of developing osteoarthritis or worsening osteoarthritis of the knee.
When these non-operative methods fail to relieve the pain of arthritis, doctors next look at surgical options that can be employed to relieve the pain and keep their patient active. Often, arthroscopic surgery can be considered to “clean out” the knee, and cartilage restoration procedures have also become a popular option, as well as, realigning the kneecap using a procedure referred to as a tibial tubercle osteotomy. These procedures may involve removing loose fragments of bone or other tissue from the joint using small incisions. Lateral release is another surgical option, especially for patients with patellar maltracking or tight soft tissues around the patella. Ultimately, however, in patients with bone-on-bone or end stage osteoarthritis, a total knee replacement has been the gold standard to relieve the pain, instability and get people back to all the activities they enjoy. A total knee replacement offers good long-term results. Severe arthritis with extensive damage to the joint surface may require more invasive procedures. Patients experiencing severe arthritis in other joints may also benefit from procedures such as total ankle replacement, which can help restore mobility and relieve pain.
Because it’s not ideal to have a knee replacement at a young age, doctors continue to look for other better options for treatment. Today, we are able to offer a partial knee replacement for those patients who have arthritis isolated to only the kneecap. The benefit here is that it is a bone-preserving surgery where only a small part of the knee is replaced. This procedure preserves more of the joint and is often considered for younger patients with isolated patellofemoral compartment involvement. A kneecap replacement, along with a bone re-alignment, corrects the instability, kneecap pain, and osteoarthritis, and at the same time helps the knee feel and function in a more natural way.
Understanding the Knee Joint
The knee joint is one of the largest and most complex joints in the human body, essential for everyday movements like walking, running, and climbing stairs. It is formed where the femur (thigh bone), tibia (shin bone), patella (kneecap), and fibula meet. The surfaces of these bones are covered with a smooth layer called articular cartilage, which allows the knee to move smoothly and absorb shock. Supporting structures such as ligaments, tendons, and menisci help stabilize the knee and protect it from injury. Because the knee joint bears much of the body’s weight and is involved in so many activities, it is particularly vulnerable to conditions like knee arthritis, which can damage the cartilage, leading to pain and reduced mobility.
Understanding Knee Arthritis
Knee arthritis is a common condition that affects the knee joint, leading to discomfort and limiting daily activities. It develops when the articular cartilage that cushions the bones in the knee wears down, causing the bones to rub against each other. This bone-on-bone contact results in inflammation, swelling, and knee pain. There are different types of knee arthritis, including osteoarthritis, which is degenerative, and rheumatoid arthritis, which is an autoimmune disease. Common symptoms include persistent knee pain, stiffness, swelling, and sometimes a grating sensation when moving the joint. The main goals in managing knee arthritis are to relieve pain, reduce inflammation, and restore function to the arthritic knee, helping patients maintain an active lifestyle.
Patellofemoral Arthritis
Patellofemoral arthritis is a specific form of knee arthritis that affects the patellofemoral joint—the area where the kneecap (patella) meets the thigh bone (femur). This condition often causes anterior knee pain, especially during activities that put pressure on the front of the knee, such as climbing stairs, squatting, or kneeling. Patellofemoral arthritis can result from factors like patellar misalignment, repetitive stress, or previous injuries. Treatment typically begins with conservative approaches, including physical therapy to strengthen the muscles around the knee, pain relief medications, and activity modifications. In cases where these measures do not provide sufficient relief, surgical treatments such as partial knee replacement or patellofemoral replacement may be considered to restore function and reduce pain in the affected joint.
Knee Osteoarthritis
Knee osteoarthritis is the most prevalent type of knee arthritis, characterized by the gradual breakdown of cartilage in the knee joint. As the cartilage wears away, bone spurs may develop, leading to increased knee pain, stiffness, and reduced range of motion. This degenerative process can make everyday activities challenging. Nonsurgical treatments, such as weight loss, regular exercise, and physical therapy, are often recommended to manage symptoms and improve joint function. Losing weight can make a big difference by reducing the load on the knee joint, while a physical therapist can design specific exercises to strengthen the muscles supporting the knee and enhance mobility. For severe cases where conservative measures are not effective, surgical options like total knee replacement may be necessary to restore function and relieve pain.
Risk Factors
Several risk factors can increase the likelihood of developing knee arthritis. Age is a significant factor, as the risk rises with advancing years. Carrying excess body weight puts additional stress on the knee joint, accelerating the wear and tear that leads to osteoarthritis. A family history of arthritis, previous knee injuries, and certain autoimmune diseases such as rheumatoid arthritis also contribute to the risk. Understanding these risk factors is important for prevention and early intervention. Maintaining a healthy body weight, staying active with regular exercise, and protecting the knee from injury can help reduce the risk of knee arthritis. Some people may consider dietary supplements like glucosamine and chondroitin to help reduce inflammation and support joint health, but it’s important to consult with an orthopedic surgeon or healthcare provider before starting any new supplement or treatment plan.
Knee Surgery Recovery – What to Expect
If you are looking at surgery on your kneecap, the first thing people want to know is -what is the recovery? Following surgery, the patient will wear a hinged knee brace for the first 6 weeks after surgery. The patellar tendon and surrounding soft tissues are protected during the early recovery phase. The first 2 weeks you can expect to be partially weight bearing but will progress to full weight-bearing at the end of 6 weeks. For most patients, a continuous passive motion device is fitted by a therapist and used to increase range of motion over the next 6 weeks. After 6 weeks you can expect to work with a physical therapist to increase your range of motion and begin strengthening exercises. You may be encouraged to begin the stationary bike or pool therapy, and you will begin to walk normally, once again. Over the following 6 weeks, the focus will be to continue to increase activity and intensity and move into the final stage of rehabilitation, which focuses mainly on strengthening. At week 20, individuals may even begin a gentle jog or running program, if desired. While a full return to sport or activities is different for each person, depending on their goals or level of activity, but it is typically expected at 6 months. Patients should be aware of potential complications such as blood clot formation after surgery.
If you are young and have knee pain that is starting to restrict you or your activities because of pain or instability, take the time to see a sports medicine doctor and have it evaluated. Before you know it, you’ll be on the road to recovery and back to doing all the things you love.
Your path to recovery starts here. Schedule an appointment with our specialized orthopedic surgeons today. Book your appointment online or call (972) 492-1334
