Tibiofemoral Knee Arthritis: What Are the Consequences?

I write this article primarily for people who have read “tibiofemoral arthritis” (knee arthritis) on their X-ray report and are wondering what the consequences are for them: what does it mean concretely?

Is it serious? Can it be cured? Can it worsen? What does it cause? Is there a treatment?

As a physical therapist by initial training, I spend a lot of time reviewing medical studies published around the world. Here, I try to synthesize our knowledge on knee arthritis (the more commonly known name for the famous “femorotibial arthritis”).

Happy reading 🙂!

Last update: 4 June 2024
Disclaimer: no Affiliate links. Complete disclosure in legal notices.
Written by Nelly Darbois, physical therapist and scientific writer

Summary

What Does Tibiofemoral Arthritis Mean?

Let’s clarify the terms we’re discussing:

Arthritis = Osteoarthritis
Knee Arthritis
Tibiofemoral Knee Arthritis

What Is the Difference Between Arthritis and Knee Arthritis?

Arthritis refers to the disease that causes cartilage wear.

When we talk about knee arthritis, we are specifically referring to arthritis in the knee joint.

When We Talk About the Knee Joint

There are actually several sub-joints in the knee, and all of them can be affected by arthritis:

The joint between the femur (thigh bone) and the tibia (the larger bone in the leg). This is the tibiofemoral joint, and this is the one we will discuss in this article, as we are talking about femorotibial arthritis.
The joint between the patella (kneecap) and the femur. This is the patellofemoral joint; hence, there is femoropatellar arthritis.
The joint between the top of the tibia and the fibula (the smaller bone in the leg). This is the tibiofibular joint, and arthritis can also occur here.

Location of Knee Arthritis	Arthritis Name
Between the femur and the tibia	Femorotibial Arthritis (or Gonarthritis)
Between the patella and the femur	Femoropatellar Arthritis (or Gonarthritis)
Between the tibia and the fibula	Tibiofibular Arthritis (or Gonarthritis)

The Different Types of Knee Arthritis (= Gonarthritis)

You can have arthritis in only one of these knee sub-joints or in several.

In this article, I focus on arthritis between the femur and the tibia: the famous femorotibial arthritis = knee arthritis between the femur and the tibia!

What are the different types of tibiofemoral knee arthritis?

There are also subtypes of this form of arthritis. These are the terms you may read on your X-ray report if you have had one.

Medial tibiofemoral knee arthritis =This is arthritis in the inner part of the knee, also called the medial compartment.
Lateral tibiofemoral knee arthritis = This is arthritis in the outer part (lateral side) of the knee, also called the lateral compartment.
Bilateral medial tibiofemoral knee arthritis: Both medial compartments are affected by arthritis, one in the left leg and one in the right leg.
Tibiofemoral joint narrowing = degenerative narrowing = This is another way of talking about arthritis at this level, but specifying that the main involvement is the loss of cartilage thickness (while arthritis can have other consequences as well). Narrowing of the femorotibial joint occurs when both compartments are affected.
Tibiofemoral osteophytosis = This means that the arthritis presents in the form of osteophytes. These are small bony outgrowths that form at the joint.
Tibiofemoral knee arthritis stage 1, 2, 3, or 4

Knee chondropathy is a broader category of knee cartilage problems that includes arthritis.

You may also sometimes read on your X-ray report “internal femorotibial joint narrowing in schuss”: the term “in schuss” refers to the specific position in which the imaging is taken; it’s not an additional “issue.”

Once again, you may have arthritis in only one of these locations, or in several, or even in all of them.

What are the different stages of tibiofemoral arthritis?

There are various classifications of knee arthritis based on its severity or rather the extent of wear and tear.

Stage 1: The cartilage begins to show minimal signs of deterioration. There may be slight irregularities on the surface of the cartilage, but there is no significant loss of cartilage thickness yet.

Stage 2: There is a beginning loss of cartilage thickness (the famous narrowing), and osteophytes may start to develop.

Stage 3: The loss of thickness is more pronounced. There may be more osteophytes taking up more space in the joint.

Stage 4 (referred to as advanced/severe medial femorotibial arthritis): There is almost no cartilage left, or none at all. This means bone-on-bone contact between the femur and the tibia.

This classification refers to the anatomical state. However, one can have stage 3 arthritis with little pain and discomfort: there is a difference and sometimes a mismatch between what is observed in exams and what is felt, the symptoms.

X-rays (or other imaging tests such as CT scans or MRI) allow for the staging of arthritis. In essence, it is not essential because it is more the symptoms and personal preferences that guide towards one treatment or another rather than the anatomical stage of arthritis.

Photos of tibiofemoral knee arthritis

Here are X-rays of knees showing different degrees, types, and locations of femorotibial arthritis.

It's bilateral internal femorotibial arthritis: the inside of the knee is affected on both sides (right and left leg). This involves joint space narrowing. It's an advanced stage of arthritis, especially on the left side. This is evident because there is almost no space between the two bones (less black space where the cartilage is usually located). — It’s bilateral internal femorotibial arthritis: the inside of the knee is affected on both sides (right and left leg). This involves joint space narrowing. It’s an advanced stage of arthritis, especially on the left side. This is evident because there is almost no space between the two bones (less black space where the cartilage is usually located).

This time it's an external femorotibial gonarthritis (affecting the outside of the knee). There is slight joint space narrowing (though there is still considerable space between the two bones) and the presence of osteophytes indicated by the arrows. Arthritis stage 2. Image: Guermazi 2010. — This time it’s an external femorotibial gonarthritis (affecting the outside of the knee). There is slight joint space narrowing (though there is still considerable space between the two bones) and the presence of osteophytes indicated by the arrows. Arthritis stage 2. Image: Guermazi 2010.

On the left, a frontal X-ray, on the right, a lateral X-ray. Osteophytes and a certain degree of narrowing of the joint space are visible on both sides, associated with femorotibial arthritis. Image: Kwee 2016.

How is tibiofemoral knee arthritis diagnosed?

Typically, the diagnosis of femorotibial knee arthritis is made by your general practitioner or a specialist (rheumatologist, sports medicine doctor, or sometimes an orthopedic surgeon).

Symptoms of tibiofemorall knee arthritis

Symptoms are what you feel or what can be observed visually or through manual tests on your knee. Most often, it is these symptoms that suggest arthritis. However, they are not very specific and can be caused by other conditions as well.

Here are the main symptoms of knee arthritis:

Pain: In front, behind, or on the sides of the knee. It usually worsens with activity, especially weight-bearing activities such as walking, climbing stairs, or standing for long periods.
Stiffness: Especially after periods of inactivity, which can improve with movement. Difficulty in bending or straightening the knee.
Swelling: The knee appears larger.
Limited mobility: Difficulty in fully bending or straightening the knee.
Crepitus: A sensation or sound of cracking or grinding during knee movements.
Instability: A feeling that the knee might “give way” during certain movements.
Deformity, limping: The knee appears visibly deformed. During walking, there is a limp or an asymmetrical gait.

Here is an article that provides more information on the different causes of knee pain and swelling, or painful knees that are difficult to bend.

Medical Diagnosis

When these symptoms become too troublesome, you may consult a doctor for the problem. The doctor will ask you questions about your symptoms and will examine you.

If you show clinical signs of arthritis, additional tests may be performed, especially X-rays. This helps rule out other causes that would require specific treatment.

Tibiofemoral Knee Arthritis: Primary vs. Secondary

Primary Tibiofemoral Knee Arthritis

Primary arthritis occurs when the cartilage is damaged without an identifiable reason or cause. It is attributed to age and normal wear and tear. Some individuals have genetic predispositions that cause their cartilage to wear out faster than average.

Secondary Tibiofemoral Knee Arthritis

Secondary arthritis happens when there is an identifiable cause for the cartilage wear. This can be due to:

Trauma to the knee such as:
Anterior cruciate ligament (ACL) tear
Meniscal injury
Intra-articular tibiofemoral fracture (fracture of the tibial plateaus)
Patellar dislocation associated with cartilage damage

Other conditions such as rheumatoid arthritis can also lead to secondary arthritis.

What Are the Consequences of Tibiofemoral Knee Arthritis?

Do you necessarily experience pain and discomfort if you have tibiofemoral knee arthritis visible on an X-ray?

This is not always the case. The severity of symptoms can vary widely among individuals. Some may have significant radiographic changes with minimal symptoms, while others with less severe radiographic findings may experience substantial pain and functional limitations.

How Many People Have Knee Arthritis Without Symptoms?

A significant number of people experience knee pain (or other symptoms indicative of arthritis) without actually having arthritis. Conversely, a roughly equivalent number show all the signs of arthritis on X-rays but have no symptoms at all!

Several studies have explored this phenomenon, and the results vary widely:

15% to 76% of people with knee pain have knee arthritis visible on X-rays.
15% to 81% of people with knee arthritis visible on X-rays experience pain.

This means that, depending on the study, 1.5 out of 10 to 8 out of 10 people have tibiofemoral knee arthritis without pain or other symptoms!

Several factors explain this, including the stage of arthritis. The more advanced the arthritis (stage 3 or 4), the higher the risk of pain or other symptoms.

Conclusion. These numbers suggest that symptoms are more important than X-ray results. If I don’t have significant symptoms, I shouldn’t focus too much on my knee X-rays.

Source: Bedson 2008

What Is the Typical Progression of Tibiofemoral Knee Arthritis?

For some individuals, knee arthritis can remain asymptomatic: despite cartilage deterioration, they may never experience pain or discomfort, even as the cartilage continues to deteriorate over time.

For those who already have symptoms, does it necessarily get worse over time without specific treatment? Not necessarily.

prognosis of knee arthritis: These graphs show that the symptoms of knee arthritis can sometimes decrease over time (blue curve): whether it's pain (left), functional abilities (middle), or knee stiffness (right). Image: Altamarino 2023 — These graphs show that the symptoms of knee arthritis can sometimes decrease over time (blue curve): whether it’s pain (left), functional abilities (middle), or knee stiffness (right). Image: Altamarino 2023

Research teams have tried to determine:

If symptoms remained stable in some people followed for 5, 10 years (answer: yes; for some, symptoms even become less severe over time without specific treatment (Altamirano 2023)!);
Which factors increased the risk of symptoms evolving into more pain or discomfort.

Here are the identified factors:

On the left, the factors that can explain the progression or worsening of arthritis. On the right, the quality of the evidence we have: high, moderate, limited, contradictory, or inconclusive.

This table explains that in the presence of one or more of these factors, you are more likely to experience worsening symptoms (although it’s a prognosis, with some degree of uncertainty). The factors with the most evidence are:

Your age at the onset of arthritis (the younger you are, the higher the risk of worsening)
If you are “non-white” compared to those categorized as “white”
Your body mass index (BMI; the higher it is, the more likely your knee arthritis will worsen)
Your other associated illnesses
Presence of infra-patellar synovitis detected via MRI
Joint effusion (knee swelling, fluid present in the joint)
Already advanced arthritis at the time of diagnosis (radiologically or symptomatically)

Source: Bastick 2015

How to treat tibiofemoral knee arthritis?

First, we need to clarify what we mean by “treating arthritis”:

Are we talking about relieving pain, addressing the symptoms of knee arthritis? In this case, we have many different action plans, which I will discuss later in the article.
Are we talking about curing arthritis: regrowing lost cartilage, removing osteophytes, and preventing them from ever coming back? In this case, although research teams are working on it, no treatment currently allows for this. Osteophytes can potentially be removed surgically, but there’s no guarantee they won’t return. And nothing allows for regrowing lost cartilage.

We treat the symptoms of arthritis, not the arthritis itself, which remains without a specific cure.

How to Prevent the Worsening of Tibiofemoral Knee Arthritis?

While it is not possible to reverse and “regrow cartilage,” it is possible to limit the worsening of wear and tear by addressing what are called “modifiable risk factors for arthritis.”

These are factors more commonly found in people with symptomatic knee arthritis (causing pain or other problems) compared to those who do not have it.

Sedentary Lifestyle: People who are sedentary or engage in little physical activity each week are more likely to develop arthritis. Therefore, adopting a more active (and less sedentary) lifestyle is advisable.
Weight Loss: Women who lose 5 kilograms have half the risk of developing symptomatic arthritis. Hence, losing weight if you are obese or overweight can help reduce the risk of symptomatic arthritis.

Source: Zhang 2009; Bastick 2015; Berteau 2022

Of course, addressing these factors is not an “obligation.” It’s up to you to weigh the potential benefits against the constraints of adopting these behaviors or measures (in addition to the difficulties that can arise, even with the best intentions, such as losing weight).

How to Relieve the Pain of Tibiofemoral Knee Arthritis?

The main treatment approach for tibiofemoral knee arthritis (as well as other forms of knee arthritis) remains the relief of symptoms: reducing pain or swelling, limiting stiffness, increasing walking distance, and regaining the ability to perform more daily activities (household chores, hobbies, sports, work).

Let’s explore this further.

An Almost Endless List of Treatments for Knee Arthritis

In scientific publications, as well as in magazines or public websites, you will find an almost endless list of treatments proposed to relieve the symptoms of knee arthritis. Here is a sample:

Lifestyle Adaptations:

Exercise: Engaging in physical activity at least 3 times a week, for 20 to 50 minutes, involving exercises that make you slightly breathless and engage your legs.
Weight Loss: If you are overweight or obese.

Medications:

Certain Medications: As prescribed by your healthcare provider.

Non-Medication Approaches (Almost Infinite List!):

Antioxidants: Through diet, plants, or supplements.
Various Manual Therapies: Including massage and physical manipulation.
Pelotherapy: Application of mud.
Topical Applications: Creams, balms, ointments, poultices.
Homeopathy: Magnetic bracelets.
Physiotherapy: Cryotherapy, TENS, ultrasound therapy on the knee, shock wave therapy, massage.
Essential Oils: Usage for pain relief.
Tai Chi: For flexibility and strength.
CBD: Cannabidiol for pain management.
Harpagophytum: A plant used for its anti-inflammatory properties.
Braces or Orthotics: To support the knee.

Procedures by Medical Professionals:

Injections: Platelet-rich plasma (PRP) injections into the knee.
Infiltrations: Corticosteroid injections.
Arthroscopic Surgery: Minimally invasive surgery without opening the knee.
Surgical Procedures: Under local or general anesthesia.
Osteotomy: Cutting and reshaping bones.
Unicompartmental Knee Replacement: Partial knee replacement.
Total Knee Replacement: Complete knee replacement.

treatments of knee arthritis: diagam — **Another Way to Represent the Different Treatments Offered for Osteoarthritis. Image: Maqbool 2021**

How to Sort Through All These Treatments?

If you are accustomed to reading articles here on Fonto Media, you know that we like to consider four main criteria when recommending one treatment over another:

☑️ As effective as possible (theoretically/empirically = in studies on real people)
☑️ With the fewest potential side effects
☑️ As low-cost as possible (in terms of time, energy, and money)
☑️ With minimal dependence on a third party or equipment

Depending on the criteria that matter to YOU, you may reach different conclusions than mine. In my opinion, you are the only person who can decide how much weight to give each of these criteria for yourself.

Personally, this leads me to the following conclusion: if I have symptomatic knee osteoarthritis, I should prioritize assessing the amount of physical activity I do each week. Do I follow the recommendations? Am I doing enough?

❌ If I’m not doing enough, to what extent can I increase my amount of physical activity each week? What activities can I do given my current condition?

✅ If I’m doing enough, why not try increasing the amount of physical activity, especially activities that strengthen the muscles in my legs, to see the impact on knee pain?

Physical activity has numerous benefits for physical and mental health, beyond its positive effect on knee osteoarthritis symptoms. Therefore, in my opinion, it is my main lever of action.

What Do the Current International Recommendations Say?

Here are the statements from a research team that reviewed all the knee osteoarthritis recommendations from various countries in 2022:

In the 24 most important and recent international recommendations, the following are the most recommended non-drug solutions for knee osteoarthritis, ranked from most to least recommended:

Aerobic exercises: movements and activities that cause continuous light breathlessness.

Weight loss.

Learning to manage pain.

Using assistive devices for walking.

Practicing tai chi.

Zhang 2022

What to Remember About Femoro-Tibial Gonarthrosis?

Here are the four points that I believe are the most important for patients to keep in mind on this topic:

X-rays and other knee examinations can determine whether there is joint wear. However, some people have joint wear without pain or discomfort! Moreover, regardless of the x-ray results, it doesn’t really provide additional treatment insights.
Some people have knee osteoarthritis and pain, but it doesn’t necessarily worsen. Pain or discomfort can even decrease over time without specific treatment.
There are many medical, surgical, and “natural” treatments for knee osteoarthritis. None can regenerate damaged cartilage. Several can relieve symptoms, but it’s challenging to identify those that are truly effective beyond a simple placebo effect.
Regular physical activity is the treatment most likely to be effective according to international recommendations (along with weight loss). It is also the one that most logically suggests a positive impact on both physical and mental health.

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Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !