Tricompartmental osteoarthritis is a name for a type of knee osteoarthritis that has progressed to three areas of the knee joint, the inside (medial side), the outside (lateral side), and behind the knee cap (patellofemoral). This is one of the most severe forms of knee osteoarthritis. There are other types including unicompartmental and bicompartmental osteoarthritis. Each of these has its own distinct characteristics including levels of pain and stiffness depending on how much of the joint is impacted. Knowing the facts about tricompartmental osteoarthritis and the other types can dictate how you go about treatment.
Learning more about tricompartmental osteoarthritis is important in managing this condition. Considering options and understanding how to best treat it can help you make the best decisions for yourself. Look at the 10 things you need to know about tricompartmental osteoarthritis below.
Knee osteoarthritis can come in different degrees of severity, each of which carries its own symptoms and treatment options. Learning more about each of the types and what to expect can help give you a peace of mind about your arthritis. Let’s review some quick anatomy first so you can better understand.
- Unicompartmental osteoarthritis happens when just one part out of the three parts of the knee joint is affected. This is commonly the inside (or the medial side) and can usually be caused by uneven pressure on your knee joint, potentially because of muscle imbalances, walking pattern abnormalities, and/or obesity . There are many factors typically involved, but these seem to be some of the main contributors to unilateral joint pain.
- Bicompartmental osteoarthritis happens when two parts of the knee joint are affected. This is either the inside or outside along with the space behind the knee cap. This occurs when unilateral osteoarthritis progresses potentially due to continued muscle imbalances, decreased activity levels, inflammation, and/or obesity.
- Tricompartmental osteoarthritis happens when all three parts of knee joint are impacted. Progressing to this stage can be caused by the above risk factors. This is usually the most severe type of knee osteoarthritis but surgery is not necessarily the only option.
2. Symptoms of tricompartmental osteoarthritis
Symptoms of this condition can vary between people but there are some general symptoms that most share. Some may have a more mild form of the condition while others may have a more severe condition. The common symptoms include:
- Knee stiffness, especially after sitting, standing, or staying in position for a long period of time
- Knee pain that is more severe in the morning or at night
- Dull aching or throbbing at night
- Swelling after activity
- Noisy knee especially when bending it- grinding, clicking, crunching
- Feeling unsteady on your knee, weakness or buckling
- Difficulty bending or straightening your knee because of pain or stiffness
- Difficulty walking- limping or anatomical changes such as knock kneed or bow-legged
- Spontaneous catching of your knee
It is important to consider these symptoms and assess how significantly they are impacting your life when considering treatment options. Tricompartmental osteoarthritis doesn’t necessarily guarantee severe symptoms. Even with mild tricompartmental osteoarthritis, you may be able to do the things you need to without significant levels of pain or stiffness. If it has progressed enough, there may be high levels of pain and stiffness that makes walking or doing daily tasks feel like a chore. We will talk about how to best manage these symptoms later.
3. Which healthcare professional should you see?
This is a very common question with any type of arthritis but becomes especially important when dealing with a more severe type of osteoarthritis. I will list out each professional and indicate the best time to see them.
- Primary Care Physician: your family physician should know you best- your history, your lifestyle, and your arthritis pain. They are usually able to handle most osteoarthritis and joint pain cases appropriately for mild-moderate cases. They can give recommendations for treatment and write prescriptions for medications and for physical therapy. If your arthritis is progressing to the point that it is not responding to any treatment and is significantly impacting your life, they will be able to refer you to a surgeon.
- Physical Therapist: it has been shown that one of the most effective treatments with almost the absence of side effects is movement and exercise for arthritis pain. You want to make sure to give physical therapy a try before making more serious decisions. When choosing a physical therapist, make sure they understand how to treat arthritis and are able to prescribe you exercises that don’t increase pain significantly. Exercise doesn’t have to hurt. The number one thing I hear from people when physical therapy doesn’t work for them is that they experienced significant pain during and after. It is crucial that you are given the right exercises to avoid increased pain. When arthritis gets severe, finding movements that don’t cause significant pain does become more challenging but movement is so important.
- Rheumatologist: They are specialists in treating conditions caused by inflammation and osteoarthritis is one of those. They primarily see those with rheumatoid arthritis though. There are circumstances when rheumatoid arthritis and osteoarthritis can overlap in symptoms. You can learn the difference between the two in this quick video. Ultimately, if you are having difficulty getting pain under control and are experiencing full body symptoms including fatigue, nausea, joint warmth, or fever it may be a good idea to talk to a rheumatologist.
- Orthopedic Surgeon: I will preface this with saying, if you see an orthopedic surgeon, 8 times out of 10 you will leave with a recommendation for surgery. This is why I have my patients explore their options first and try conservative treatment before going under the knife. With tricompartmental osteoarthritis, you have likely been dealing with this pain for quite some time and surgery may seem very attractive to you. This diagnosis does not necessarily guarantee surgery, especially if you have mild tricompartmental osteoarthritis. Again, everyone is different. It is important to go to someone you trust and talk about your options. Surgery is a big decision. I know some that have been very successful with surgery and some that haven’t. Risks are there with any surgery. Learn more about what you should consider before deciding on a joint replacement here.
- Dietitian: This one is often missed and honestly, it is one of the most important aspects of pain management when it comes to osteoarthritis. Our diet plays a tremendous role in our weight but also in the level of inflammation in our bodies. If you are looking for a way to try to manage pain naturally, even with tricompartmental osteoarthritis, I would highly suggest finding a qualified, registered dietitian. I know so many people who have seen significant decreases in pain, simply by changing their diets.
All of these professionals could be arthritis specialists. If you are having a hard time finding the best person to listen to your goals and manage your symptoms, here are some tips on finding the best arthritis specialist.
4. Activity modifications
It is important to understand that with varying symptoms, the activity modifications can also vary. One of the biggest things to monitor and avoid is overactivity. Trying to do too much activity can lead to increased pain and swelling that may be difficult to control. Here are some tips to help you decide if you’ve done too much.
In this stage of osteoarthritis, a straight cane may be helpful. I highly recommend this one. I usually tell my patients with “unpredictable” knees, meaning they tend to give out frequently to use a cane to prevent falls. If you feel increased pain walking distances longer than just household distances, using a cane when you go out might be extremely helpful to help you go further without being limited by pain. Osteoarthritis can also impact your balance so it is important to feel confidence when walking and canes can help.
If your arthritis has progressed to the point of difficulty walking household distances, a walker might be necessary, especially when pain levels are high. These can also be helpful when you feel very stiff, i.e when getting up in the middle of the night to go to the bathroom.
When you are doing any sort of activity it is important to listen to your body. Discomfort is actually OKAY. If pain levels stay <4/10 you are not doing more damage to your knee. Exercise can actually be very beneficial for both pain and stiffness. Increasing blood flow can help to get rid of the “bad” inflammatory cells. If pain is >5/10, that is your body telling you, “hey I’m not ready for that”.
Breaking tasks up into smaller chunks, although not the most ideal, can be extremely helpful for pain management. For example, when doing laundry, going shopping, or even walking in the neighborhood- doing a little at a time with rest breaks in between can usually keep pain levels much lower. There will be more on pain management below.
There really isn’t any activity you “can’t” do. It’s more about how comfortable you feel with the activity and how much you trust your knee. I have patients who continue to hike and cycle with tricompartmental osteoarthritis and some that are just trying to get through the day. Use significant pain as your guide and your own judgement of safety.
5. Pain management
Pain management with progressive osteoarthritis can include icing, heating pads, NSAIDS, compression sleeves, massage, and/or light movement.
Many times, I get the questions of ice or heat. My answer is, honestly it’s up to you. Most people tend to have better luck with heat compared to ice but it is up to your preference. Use whichever usually brings you the most relief.
Pain medications can be very effective for temporary relief but can have serious side effects. I know it’s easier said than done, but I always encourage people to really try to find other avenues of pain relief aside from just medication. Whether that is heat, ice, elevation, seated light exercise, or massage.
For long term pain management, adopting an anti-inflammatory diet such as the Mediterranean diet and keeping your weight under control can significantly decrease the amount of inflammation in your body, thus decreasing pain.
With tricompartmental osteoarthritis pain may be more severe and may feel like it is difficult to control. It is important to attempt to keep an open mind about other options to find relief.
6. Exercise Options for Tricompartmental Osteoarthritis
There are different options when it comes to exercise, especially with a more advanced condition.
- TRX suspension bands: TRX bands are extremely effective and I use them with almost every one of my patients. I highly recommend these. If you aren’t confident in your balance, are fearful of movement because of pain, and feel leg weakness these may be just what you need! I have a few video examples of how these bands work if you have never heard of them. I highly recommend you also check out his article: 10 Best Leg Exercises with TRX bands for joint pain.
- If standing exercise have become too challenging with severe tricompartmental osteoarthritis, you can also try seated exercises. The important part of exercise is to keep your joints moving whatever that looks like for you. Seated exercises can help stimulate blood flow and improve joint stiffness. You do what to make sure the exercises do feel challenging in order to the get the most benefit out of the activity. Here is an example below of a seated kickboxing routine to add a little fun to your seated workout.
7. Preventing further progression
It may be possible to slow the progression of your tricompartmental osteoarthritis. Learn more on the 3 ways you can find hope here.
This can be done by watching what you fuel your body with and how you move it. The longer we rest, the longer we sit, the longer we avoid exercise, we could be making our knee(s) worse! Controlling both activity and food choices can improve the health of our cartilage and help to strengthen our bones.
When we stop all activity and don’t pay attention to what we eat we could not only be at risk for higher pain levels but also for other chronic disease complications such as heart disease, diabetes, high cholesterol, and obesity.
Adopting an anti-inflammatory diet like mentioned above and finding activity you can do for at minimum, 30 minutes a day is absolutely crucial for keeping your joint as healthy as you can. Some supplements may be beneficial but it is important to try to get your vitamins and minerals from real food first. Fish oil and tumeric have been found to be helpful in managing inflammation in some people with arthritis, but always check with your physician before starting any new medications or supplements as they could interact.
You can get a list of the BEST anti-inflammatory foods here.
8. Living with Tricompartmental Osteoarthritis
This type of osteoarthritis can be debilitating and can impact us both mentally and physically. There are 2 most important things to consider when living with this condition.
- Have a healthcare team you trust: Osteoarthritis isn’t best managed by one person. The people I see that have the most success with their arthritis are those that have a team to help them: primary care, physical therapist, dietitian, orthopedic/sports medicine physicians. There are definitely room for others, such as psychologists, pain management, rheumatologists, etc. The more you have on your team, the more people you have looking out for you. You want to make sure they have your best interest at the forefront of all decisions.
- Have a support system: your friends and family are more important than ever, especially with tricompartmental osteoarthritis. This condition can be emotionally taxing and you may need help from those around you. If you have pain flare ups, it can be comforting to know you don’t have to try to get everything done yourself. I know asking for help is not always easy but there are certain situations when you could really use it. When you are having high levels of pain, you are more at risk for falls as well as continued uncontrolled pain with increased irritation of the joint. Also, the more distractions you have, the less time you will have to focus on your pain. Keeping yourself busy with family, grandkids, friends, and hobbies can be extremely effective.
9. Surgical Options
One of the best surgical options for this condition is likely a total knee replacement. In the case of unicompartmental or sometimes bicompartmental osteoarthritis, there may be an option for a partial knee replacement. The partial can be less invasive and have less of a recovery compared to a total. If you have one part of your joint that is more advanced than the others, a partial may be an option but likely with tricompartmental, all 3 parts will likely need replaced.
The one thing I hear from patients the most is they wish they would’ve known more about the recovery process following a total joint replacement. It can be a long process (ranging from 6-18 months) that can make a significant impact on the health of your new joint. It primarily includes physical therapy and a home exercise program to regain range of motion and strength of your new knee.
If range of motion does not return, a manipulation under anesthesia may be warranted. Knowing this may give you some extra motivation during your rehab!
A total joint replacement may be one of the only surgical options for treating tricompartmental osteoarthritis. Cortisone shots, stem cells, and other procedures may not be as effective at this stage.
When deciding on a joint replacement, it can be a big decision. This article walks you through the 3 things you should consider before going with a total joint replacement.
10. Realize there is hope!
Many times, a diagnosis of osteoarthritis can feel hopeless and overwhelming. Whether you have mild tricompartmental osteoarthritis or severe tricompartmental osteoarthritis I want you to know there is hope.
Time and time again, people come to me with so many questions that were never answered because of the limited time in physician’s offices and fear of movement from what they read online.
At Keep the Adventure Alive we are on a mission to give you the power back. To give you the information you need to make the best decision for yourself. We are here to help guide the way to finding hope again. Adventure doesn’t have an age limit and we want to help keep yours alive.
Share this article with anyone else you may know who is struggling with tricompartmental osteoarthritis or is unsure where to go next!
I always find that what we believe about our tricompartmental knee pain can make a dramatic impact on our pain levels. Too often we are actually believing the WRONG things! I have put together the TOP 3 Myths most people believe and the ebook can be downloaded instantly below.
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