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In osteoarthritis, the cushioning (cartilage) between the bones wears away in the joints. As osteoarthritis gets worse, the cartilage disappears and bone rubs on bone. Bony spurs or growths usually form around the joint. The ligaments and muscles around the joint loosen and become weaker.Deterioration of articular cartilage is the main problem associated with knee osteoarthritis. The condition can be caused by:

1.Problems with subchondral bone (the bone layer underneath cartilage)
2.Obesity
3.Genetics which make some people more likely to develop knee osteoarthritis
4.Fractures, ligament tear, and meniscal injury which can affect alignment and promote wear and tear
5.Repetitive strain on the knee
6.Previous knee injury

Primary osteoarthritis is mostly related to aging. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition.

Secondary osteoarthritis is caused by another disease or condition. Conditions that can lead to secondary osteoarthritis include obesity, repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes, and other hormone disorders.

Obesity causes osteoarthritis by increasing the mechanical stress on the cartilage. In fact, next to aging, obesity is the most powerful risk factor for osteoarthritis of the knees. The early development of osteoarthritis of the knees among weight lifters is believed to be in part due to their high body weight. Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead to early osteoarthritis of the knees in soccer players. Interestingly, recent studies have not found an increased risk of osteoarthritis in long-distance runners.Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis. Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause arthritis in pseudogout.

Some people are born with abnormally formed joints (congenital abnormalities) that are vulnerable to mechanical wear, causing early degeneration and loss of joint cartilage. Osteoarthritis of the hip joints is commonly related to structural abnormalities of these joints that had been present since birth.Hormone disturbances, such as diabetes and growth hormone disorders, are also associated with early cartilage wear and secondary osteoarthritis.

Doctors don’t know what causes joint cartilage to wear away. But they do know that osteoarthritis is more common as you get older or if you are very overweight. Sometimes a serious knee injury can bring on arthritis after a few years.

About half the population has one leg shorter than the other, a trait that, while common, is often not diagnosed or corrected. Researchers at Queen’s University believe uneven leg length may be a cause of knee osteoarthritis which, if recognized, could be prevented.

The study in which the leg length discrepancy figure was offered was published more than 25 years ago. In it, the author was evaluating the difference in 798 patients who had chronic and treatment-resistant low back and hip problems. He found that when the leg length inequality was corrected using a simple shoe lift, the majority of patients achieved permanent and nearly complete elimination of their symptoms.