OAK sessions are being run as remote sessions via Microsoft Teams and face to face in specific locations – please contact us to find out more

What is OAK Knee?

Here at Aneurin Bevan University Health Board we are offering a session called OAK (Options, Advice, Knowledge) Knee which is dedicated to improving the understanding and management of osteoarthritis of the knee.  OAK knee sessions have been developed with GP’s, Orthopaedic Surgeons, Physiotherapists and people like you, who have osteoarthritis of the knee.

OAK - Options Advice Knowledge logo

The 90 minute group session is delivered by specially trained physiotherapists in community facilities throughout the health board, so there should be one close to you. They offer the opportunity for people who have been diagnosed with osteoarthritis of the knee to learn more about the condition and various ways which can help you effectively manage the symptoms associated with it.

We all appreciate that people are different; we enjoy different things and have different goals in our lives. Similarly, knee osteoarthritis affects people in different ways. So finding the right treatments or management plans to suit your needs is important.

That is why; at OAK we believe you should be at the centre of making the decision about how you want to manage your arthritic knee.  We know that people who are involved in these decisions are more likely to engage in the treatment and to have a more successful outcome.

OAK knee is about sharing information and experiences that will help you to make those decisions. We provide up to date information about osteoarthritis, what it is and what it isn’t. We also bring the science, which tells us which treatments are safe and effective ways of managing knee osteoarthritis. There is also information about what services are available locally to help you. Importantly, you and others can bring your own experiences of knee osteoarthritis, how it affects you and what has or hasn’t been effective in your circumstances.

By the end of an OAK session you should have a better understanding of the condition, what you want to do to manage it and how to go about getting the help you need.

What is osteoarthritis

The knee is the largest and one of the most complex joints in the human body. During simple activities it withstands large loads as it carries the body’s weight. The knee joint is shaped to withstand these forces and benefits from the support of the body’s largest muscles which share and absorb these loads whilst controlling motion. Within the knee there is a layer of cartilage, white shiny slippery stuff that lines and protects the bone ends. This helps to provide smooth movement and absorb these forces.

Osteoarthritis starts when there is damage to the cartilage. The most common factors which cause this are previous injury, obesity and age. The cartilage gets gradually thinner, less able to shock absorb and protect. The joint does not move as smoothly. The bone is under more stress, however it reacts by growing thicker and broader so that it can still bear the load. The lining of the joint may swell to produce more fluid to try and keep the joint lubricated. The capsule and ligaments can become thickened to try and strengthen the joint.  So osteoarthritis is partly a condition of inflammation and partly one of repair. In many cases the repair is reasonably successful and the changes do not cause a great deal of pain or disability.

Osteoarthritis can cause a variety of symptoms, however pain and stiffness are the most common. Pain is usually worse with movement and at the end of the day and typically eases with rest, however the joint often stiffens when not in use.

So now we know what osteoarthritis is, what can be done about it?

Whilst there is currently no cure for Osteoarthritis, there are many treatments that can offer significant relief from the symptoms, helping you to manage the joint and keep it working for you into the future. None of these treatments are able to cure osteoarthritis, however they are all able to relieve pain and stiffness enabling you to do more of what you like.

We cannot say who will respond best to each treatment and so it is up to you to understand what can be done and to decide what you feel would help you, then give it a try and see.

We have summarised the treatments in the pyramid below. The treatments which help the most people and carry the lowest risk are at the bottom, whilst those with higher risk, for use when all others are no longer helping are at the top. We are hoping that using this pyramid will help you understand the options and help you decide which you feel would be best for you.

graphic depicting treatment escalation for knee pain.

In order to make it onto our pyramid treatments have to have been appropriately tested and shown to work. There are several international clinical guidelines which we have used to create the pyramid, so you can be sure that these are well tested and safe interventions that work for most people.

So, how do you decide what you want to do?

We would like to take you through a process of how you might make that decision. Most people think about how bad the disease or the damage is. We can measure this on an X ray, however the amount of arthritis is not always related to the amount of pain.

There is a far more important indicator. That is the symptoms that you feel, the pain, the swelling, the activities that you are limited in.  Only you know this, it is very individual and importantly it is not always related to how much arthritis you have.

So even if you have a bad X ray, if you can control the symptoms using these treatments, you can feel better, have less pain and a better quality of life. That is why they are recommended for everyone to try. It’s never too late to give them a go.

Each of you is individual and should therefore make an individual decision of what is right for you.

Are you someone whose weight might be contributing to increased stress at the knee? We know that just 5% weight loss can reduce pain when walking.

Are you someone whose muscle are not supporting the knee well? We know that strengthening exercise is a powerful way of reducing pain and improving what you can do.

Are you someone who might benefit from wearing different shoes or a knee brace to support and cushion the knee?

Or are you someone who has tried everything and would now benefit from discussing knee replacement with a surgeon?

There is further information about all these options on the website, or come along to an OAK knee session and find out more.

Activity & Exercise

Activity & Exercise – Mark Hodgson – Video

We know that exercise is one of the most powerful tools for helping people to manage osteoarthritis of the knee.

However for many people with Osteoarthritis this does not always make sense. It is common to think of the condition as a wear and tear process, and therefore using the knee more seems like a bad idea. However as we showed in the earlier video, OA is a mix of a degenerative and a healing response, many of the tissues get stronger, the bone thickens and widens, the ligaments and capsule thicken. This means that using the knee, strengthening the supporting muscles can actually help the healing element and improve symptoms like pain and stiffness.

We know that simple exercise to strengthen the leg muscle or your heart and lungs leads to a significant and predictable reduction in pain and improvement in ability to do things.

So what do we mean by exercise. Well pretty much anything really. As long as it works your leg muscles or your heart and lungs, or preferably both, it will help your knee pain. It is important to get a balance and little and often is usually the best place to start.

Most people who exercise regularly do so because they enjoy it and often because it comes with a social situation or friends that they enjoy spending time with. So it’s worth considering these things.

We have put a lot of information on the website about leisure facilities and groups that might help you find something you enjoy.

One option to help you become more confident to exercise is the National Exercise referral Scheme, or NERS for short. This is available throughout Aneurin Bevan Health Board region. It is a community run scheme supported by most council run leisure centres. It provides a variety of activities and exercise types, there really is something for everyone. To access the scheme, you will need a referral from your GP, physio or another healthcare professional. There is also a small cost associated with the programme. A commitment to attend twice a week for 16 weeks would be necessary. More information can be found on the NERS website.

Physiotherapy is another option for helping with your OA symptoms. Consider physiotherapists as experts in human movement and how pain or disease can affect this. A physio can assess your knee and how it moves, and make recommendations for how to reduce some of your symptoms. Exactly what options are used will vary depending on the person with OA, and what the physio finds. These options will be discussed with you at the time of your assessment.

Physiotherapists will nearly always recommend the use of exercise to build muscle tissue around the knee and leg. They can help you find the right option for you. Throughout ABUHB we have an exercise class called ESCAPE knee pain. This requires you to attend a 1 hour exercise session twice a week for 6 weeks, so 12 sessions in total. Joining in on these classes has been shown to reduce pain and improve function, not just whilst you are doing it, but for several years afterwards too. ESCAPE knee pain is now available on the ESCAPE website or via a Mobile App.

Some people feel confident to exercise without professional support, and we would absolutely support this. So the decision of how to exercise, on your own, with friends, at NERS or with Physiotherapy is up to you and your preferences. Further information can be found on the Arthritis Research UK website.

OAK Knee Patient Lyn – Video

OAK Knee Patient Helen – Video

Pain Relief

Pain is often the primary reason that Osteoarthritis becomes a problem. Pain can often be effectively managed with simple over the counter medications, although a discussion with your GP or pharmacy is important before starting any new medication to ensure it is not harmful for you. There are other options too, heat and cold packs can give relief of pain when applied and a TENS machine can also be applied to the knee as a way of reducing pain without medicines.

About this information | Information for the public | Osteoarthritis: care and management | Guidance | NICE

Versus Arthritis – Osteoarthritis of the knee

NHS – Treatment and support

National Exercise Referral Scheme (NERS)

Better Health – Healthier Families website is excellent for families to access healthy lifestyle advice and free resources.

NHS Choices – Lose Weight: This website has useful information about losing weight and has a free 12 week online weight loss programme.

The British Dietetic Association: This website was developed by the British Dietetic Association and has great advice on losing weight in a healthy way.

We are also working with the third sector to provide services for health and well-being in your community – GAVO.

For those that have not been as successful as they wanted with these methods may be able to access the local adult weight management service. Your body mass index (BMI) must be 30 or over. Your GP can work this out or you can go online to the NHS Choices website (link opens in a new window) to access a BMI healthy weight calculator. You must be able to commit to regular appointments or a group session. You can find out more at: Weight Management Service.

Knee Replacement

I’m John Lloyd, Consultant knee surgeon at Aneurin Bevan University Health Board.

The knee joint is the largest and probably most complex joint in the human body.

There are various designs of knee replacement which aim to replace the arthritic joint but none are able to truly replicate a normal knee.

A knee replacement is the final treatment option for managing severe end stage arthritis.   It is firstly a pain relief operation, which also hopes to improve function and mobility.

Nationally 86,000 knee replacements were performed in 2013 with the average age of the patient being 70.

The ideal person for a knee replacement would be a fit, motivated, non-smoking elderly individual with healthy weight and a diagnosis of end stage arthritis.

The pain and symptoms should match with the x-ray changes and they should have exhausted all other treatment options.

If you have surgery you can expect to stay in hospital for 3 to 4 days.  You will be assisted to get out of bed and to start exercising your knee joint as soon as possible.

A physiotherapist will show you a series of exercises and help you to start walking on your new joint. To get the best possible outcome it is very important that you work to increase the movement and strengthen your knee by following these exercises and the advice of the physiotherapists.
The aim is to achieve a functional bend in the knee so that you are able to stand up and sit down out of a chair and get in and out of a bed before going home.

Knee replacements are painful procedures.  It is important that pain levels are controlled to enable exercise. In the first 6 weeks following surgery many patients will say that they wish that they had not had the operation.  The pain slowly settles and the strength returns as the range of movement in the knee increases and walking patterns return to normal.   It can take up to a year to restore normal function in the knee.  Following advice on pain relief, exercise and walking practice is essential for this process.

Information from the National Joint Registry has shown that there is about a 5% risk of revision surgery at 10 years following their knee replacement.  This means that for 5% of patients who have the surgery – the knee replacement may have to be changed within 10 years.  The risk is halved if you are over 75 at the time of your first operation and it’s double if you are under the age of 55 – in other words, the older you when you have your knee replacement, the less likely you are to require further surgery.

Your first joint replacement is likely to be your best one which means that any re-do surgery is a more complex undertaking and the results are less satisfactory.  Most people are very pleased with their new knee replacement.  For some people, the new replacement doesn’t always meet their hopes and expectations or relieve all of their pain.  In a very small number of people, they will wish they never had one.  Sadly it is impossible to turn back the clock.

Final outcome and satisfaction is based on technically sound surgery but most importantly there has to be a realistic expectation of what can be achieved and a great deal of patient motivation and hard work in order to regain good function.

If you wish to discuss this further then please ask your GP for a referral.

OAK Surgeon talks about Knee Replacement – Video

OAK Knee Surgery Patients Helen & Margaret – Video

If you are still interested in attending an OAK session you can contact us here