What Is Knee Osteoarthritis?
Knee osteoarthritis (knee OA) is the most prevalent form of arthritis — affecting over 30 million Americans — and is the leading cause of chronic lower extremity disability. It results from progressive degeneration of the articular cartilage that cushions the femoral condyles, tibial plateau, and patella, combined with secondary changes in the subchondral bone, joint capsule, and synovium.
Knee OA is classified radiographically using the Kellgren-Lawrence scale from grade 0 (no changes) to grade 4 (severe joint space narrowing and bone-on-bone contact). However, radiographic severity correlates imperfectly with symptoms — many patients with advanced imaging findings respond well to nonsurgical management, while others with mild imaging changes have significant functional disability.
Symptoms and Functional Impact
- Deep aching knee pain, often worse with weight-bearing, stairs, and prolonged sitting
- Morning stiffness lasting less than 30 minutes and activity-related stiffness after rest
- Joint line tenderness, swelling, and occasional effusion (fluid accumulation)
- Crepitus (grinding) with knee flexion and extension
- Reduced range of motion — particularly difficulty fully straightening or deeply bending the knee
- Quadriceps weakness — muscle atrophy from disuse and pain inhibition
- Malalignment — varus (bowlegged) or valgus (knock-kneed) deformity in advanced disease
Nonsurgical Treatment at CHLMD
Therapeutic exercise is the single most evidence-supported treatment for knee OA — reducing pain and improving function comparably to surgical intervention in many patients. Dr. Lichtblau prescribes individualized quadriceps and hip strengthening programs that reduce joint loading and slow cartilage breakdown. Aquatic exercise and low-impact aerobic conditioning are excellent adjuncts for patients with pain-limited land-based exercise tolerance.
Intra-articular corticosteroid injections rapidly reduce synovial inflammation and effusion, providing weeks to months of significant pain relief. They are most effective during inflammatory flares and are used strategically to allow active rehabilitation to proceed.
Viscosupplementation (hyaluronic acid injections) replenishes the natural joint fluid, improving lubrication and reducing friction in the arthritic knee. A course typically involves 1–3 weekly injections. Some patients experience durable relief for 6–12 months. Viscosupplementation is an excellent option for patients in whom corticosteroids are insufficient or when systemic steroid exposure is a concern.
Delaying or Avoiding Surgery
Many patients referred for knee replacement surgery can achieve excellent functional outcomes with an optimized nonsurgical program. Dr. Lichtblau has extensive experience managing even advanced knee OA nonsurgically, and works with patients to maximize conservative treatment before surgical options are considered. When knee replacement is ultimately appropriate, he coordinates surgical referral and manages post-surgical rehabilitation.
