What to know about tri-compartmental osteoarthritis

Tricompartmental osteoarthritis occurs when all three compartments in the knee are affected by arthritis symptoms. Localized pain, inflammation, and weakness in the knee may be symptoms of tricompartmental osteoarthritis.

By Jon Johnson, Medical News Today 21 May 2018
Reviewed by William Morrison MD

The condition causes degenerative changes in the joint. Because of its widespread nature, tri-compartmental osteoarthritis may be more severe than other forms of osteoarthritis.

In this article, we take an in-depth look at tri-compartmental osteoarthritis, including the symptoms, causes, diagnosis, and treatment for this painful condition.

What is tricompartmental osteoarthritis?

Osteoarthritis, or osteoarthrosis, is the most common condition that affects the joints. According to the Arthritis Foundation, osteoarthritis affects approximately 27 million people in the United States alone.

The condition most commonly affects the knees and is also referred to as wear-and-tear arthritis, as it occurs due to the cartilage in the joints breaking down over time.

This wear-and-tear process is referred to as degenerative changes, and it leads to symptoms that include stiffness, pain, and joint effusion or an increased amount of fluid in the joint.

Four bones meet at the knee. The tibia and fibula connect from below the joint. The femur connects from above, and the patella or kneecap sits just atop the femur and the connecting cartilage.

The meeting of these bones creates the three compartments in the knee:

• patellofemoral compartment, where the kneecap and femur meet
• medial femorotibial compartment, or the inside of the knee
• lateral femorotibial compartment, or the outside of the knee

Osteoarthritis can occur in any of these compartments, but tri-compartmental osteoarthritis happens when all three compartments of the knee are affected.

Tri-compartmental osteoarthritis is often considered to be worse than other forms of osteoarthritis, as the entire area of the knee is affected and loss of cartilage or the synovium or joint lining may be more widespread.

Symptoms

Osteoarthritis causes the cartilage and synovium in the knee to wear down, often leading to bone spurs growing in their place. The cartilage may also get rough or break down completely. This process gets worse over time and often cause symptoms, including:

• localized pain and inflammation
• joint effusion or water on the knee
• chondrosis, where the soft or smooth cartilage breaks down
• joint stiffness and difficulty moving the joint, especially after long periods of inactivity
• bone spurs or exostosis in the knee that can be seen on X-ray images
• knees that lock up due to bone spurs
• weakness or buckling in the knees
• a change in gait, typically a knock-kneed or bowl-legged walking gait

Symptoms may get worse after sitting or resting for a long time, and impact type of exercises may also cause more pain and swelling in the joint.

Diagnosis

To correctly diagnose tri-compartmental osteoarthritis, a doctor may first ask questions and perform a physical exam.

Osteoarthritis involves knee pain and several other symptoms, so doctors may ask if the person has symptoms such as:

• cracking or popping in the knee
• grating feeling whenever the knee is moved
• stiffness in the knees in the morning or after periods of sitting or resting
• tenderness and swelling in the area
• feeling as if the joints are colder than normal

Doctors will often use imaging tests, such as X-rays, to confirm the diagnosis. They will look for any signs of cartilage that has worn away or extra bony growths where the cartilage should be. Osteoarthritis may be more challenging to diagnose in its early stages but easier in later stages.

If there is still any doubt, doctors may recommend a soft tissue scan, using an MRI scanner, to thoroughly check the ligaments, cartilage, and synovium.

Causes and risk factors

Osteoarthritis can occur from normal wear and tear of the joints, so anyone could potentially be diagnosed with the disorder. However, some risk factors may make diagnosis more likely.

•  Age.  Osteoarthritis symptoms develop over time, so the joints of an older person may be more worn than a young person’s, increasing the risk of osteoarthritis. Staying active and stretching or doing low-impact exercises may help to slow down the normal degeneration as someone ages.
•  Obesity.  Carrying extra weight around can be hard on the joints, especially on the hips and knees, which are stress-bearing joints. Weight loss may help reduce the impact on the joints and reduce symptoms. A recent study posted to the journal Obesity Reviews indicated that losing just 10 percent of body weight may reduce symptoms, including pain, and increase the physical function in the joint.
•  Genes.  A person’s genes may also play a role. Someone with a close family member who has or had osteoarthritis may be more likely to experience it themselves.
•  Sex.  A review published in the journal Osteoarthritis and Cartilage noted that sex and hormones might play a role in osteoarthritis, with women being more likely to experience knee osteoarthritis than men, though it is unclear why this happens. Women going through menopause may also be more likely to experience symptoms, leading researchers to believe hormones, such as estrogen, may play a role.
•  Stressful activities.  Physical activity that is especially demanding for the knees may be a risk factor for more wear and tear damage. Manual labor, carrying heavy loads, or high-impact exercises such as running may be risks for some people over time.
•  Traumatic injuries.  Injuries directly to the knee or in an area that indirectly affects the knee, such as the foot or leg, may be an influencing factor in osteoarthritis symptoms later in life.
•  Abnormalities at birth.  Some people may be born with abnormalities in the bones, cartilage, ligaments, or synovium that make them more likely to experience symptoms of osteoarthritis later in life.

Treatment

There is currently no cure for osteoarthritis because cartilage cannot be replaced once it has eroded.

The optimal treatment for tri-compartmental osteoarthritis varies based on the severity of the condition. Treatment usually involves managing symptoms, preventing progression of the disorder, or surgery.

The following treatments can help with the symptoms of osteoarthritis:

•  Ice and heat.  Pain and swelling in the knee may respond well to ice and heat packs at different times of the day. Elevation may also reduce swelling around the knee.
•  Pain relievers.  Over-the-counter (OTC) anti-inflammatories and painkillers can reduce pain and swelling in many cases. Prescription medications and COX-2 inhibitors may help if OTC versions are not effective.
•  Corticosteroid injections.  A doctor can inject corticosteroids directly into the knee to relieve pain and inflammation if other medications have not worked.
•  Lifestyle changes.  A person can reduce stress on their knee by avoiding high-impact exercises, and replacing these with low-impact ones, for example, swimming or cycling. Low impact exercise may strengthen the areas around the joint to reduce impact on the joint itself.
•  Medical devices.  Using medical devices can help to reduce pressure in the joints. These can include canes for walking, wearing shock-absorbing shoes or wedge insoles, or using a sleeve or brace to stabilize the knee.
•  Injection to the knee.  A doctor can administer an injection, a form of hyalagan, into the knee to improve symptoms.
•  Surgery.  In well-advanced cases or ones that do not respond to other treatments, surgery may be recommended. It is usually reserved for people who cannot function due to osteoarthritis, as surgery on the knee can be complicated.

If a doctor recommends surgery for tri-compartmental osteoarthritis, this often involves a total knee replacement or total knee arthroplasty. In this surgery, doctors replace the damaged bone and joint with a plastic and metal joint.

It can take several months to recover from total knee arthroplasty. Regular physical therapy sessions will help strengthen the legs and allow a person to walk normally again.

Outlook

Osteoarthritis is a common chronic degenerative condition, currently without a complete cure. Tri-compartmental osteoarthritis symptoms affect the entire knee and may be more widespread.

Managing these symptoms may help in many cases, and maintaining a healthy lifestyle may also slow the progression of the disorder. Surgery can help restore function in the affected knee if other interventions do not work.

Source Medical News Today

References

Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review, Obes Rev. 2014 Jul; 15(7): 578–586. H Bliddal, AR Leeds, and R Christensen. Published online 2014 Apr 22. doi: 10.1111/obr.12173

Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis, Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Osteoarthritis Cartilage. 2015 Apr;23(4):507-15. doi: 10.1016/j.joca.2014.11.019. Epub 2014 Nov 29. Full text

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