Dr Vikas Padha
As the life expectancy of human beings has increased in modern times , the population of the elderly is increasing all over the world including in our country . And with the increase in the aged population, certain problems related to the human body are becoming more common. Problem related to Knee joints is one such issue that is drawing everyone’s attention and has become talk of town everywhere. Let’s decode this enigma today .
Anatomy
Knee joint is one of the most important joints of lower limb and plays an important role in our walking. ‘Joint’ is the junction where ends of two or more bones meet together and along with other structures like ligaments and meniscus, covered by synovial membrane and nourished by synovial fluid , they form a mobile unit that ensures the mobility of body because they allow the flexibility . Knee joint consists of ends of bones called femur (thigh bone) and tibia (leg bone) along with Patella (knee cap). Nature has developed a protective layer at the ends of bones in the joint that come in contact with each other that is known as articular cartilage.
What is Osteoarthritis?
Our joints function well till this articular cartilage is intact but problem starts when this articular cartilage starts degenerating because of various reasons including aging. And this degeneration of articular cartilage marks the beginning of what is known as Osteoarthritis (OA)
What predisposes to Knee Osteoarthritis ?
Men and women are equally likely to develop OA but more joints are affected in women than in men. Certain occupations which cause repetitive stress like workers engaged in knee-bending activities have association with OA Knees. Fractures involving joint surfaces of bones can result in OA. Obesity causes increased joint loading and predisposes to OA of Knees. And there is family history too as it has been found that women whose mothers had generalized OA are more likely to develop the same condition. Osteoarthritis of Knees is often bilateral.
Patients usually present after middle age (over 50 years old). Many are overweight and may have longstanding bow-leg deformity.
Symptoms of Knee Osteoarthritis
Knee pain is the usual presenting symptom that becomes worse after the use of stairs. Stiffness is common especially after periods of inactivity but with time it becomes constant and progressive. Swelling is also common and sometimes giving way or locking is present.
Deformity may also be present but in advanced stages of OA. Bending of knee joint is terminally decreased. Loss of function is the most distressing symptom. A limp, difficulty in climbing stairs, restriction of walking distance, or progressive inability to perform everyday tasks or enjoy recreation may eventually drive the patient to seek medical help.
Treatment of Knee OA
The treatment of OA Knee depends upon whether this is diagnosed in early stage before any structural damage to the knee joint or in late stage after the irreversible structural damage has happened in the Knee joint.
Treatment of Early Osteoarthritis of Knees
In Early OA , the principles of treatment are :
* Maintain movement and muscle strength.
* Protect the Knees from ‘overload’.
* Relieve pain.
* Modify daily activities.
The mainstay of treatment in the early stages is physical therapy which should be directed at maintaining joint mobility and improving muscle strength. The Physiotherapy can include aerobic exercises but care should be taken to avoid activities/exercises that increase impact loading. Heat therapy and local application of analgesics may reduce pain as well but their effect is short lived and needs repetition.
Protecting the knees from excessive load may slow down the rate of cartilage loss. It is also effective in relieving pain. Weight reduction for obese patients, wearing shock absorbing shoes, avoiding activities like climbing stairs and using a walking stick can also be helpful.
Pain relief is very important but all patients don’t need drug therapy and those who do may not need it all the time. If other measures don’t relieve pain, simple analgesic like paracetamol can be useful and if this fails to control pain, a non-steroidal anti inflammatory medicines can be added or opioids too can be supplemented in case of very severe pain . Certain supplements known as Natriceuticals have also been used with the aim to regenerate the cartilage but their efficacy is not proven yet.
Treatment of End Stage Osteoarthritis of Knees and Total Knee Replacement Surgery
In late stage of OA Knees, Total knee Replacement (TKR) is an excellent surgery for end-stage arthritis of the knee joint (final stage of osteoarthritis). In this late stage of Osteoarthritis , the knee joint gets damaged irreversibly . This causes severe disability resulting from pain, deformity and limited function. Total knee replacement relieves pain, corrects deformity and improves walking ability. This excellent surgery has changed the lives of millions worldwide including Indians. With more than 90% reported survival rates at 15 years, total knee replacement is one of the most successful surgeries being done worldwide in today’s world .
What is Total Knee Replacement Surgery?
This surgery is also called the knee transplant surgery . But this terminology creates a lot of confusion as layman thinks that total knee replacement is also a very complex surgery like organ transplant surgeries. For example: heart transplant , kidney transplant or lung transplant. But in reality , total knee replacement is a very different surgery when compared to organ transplant surgeries. In organ transplant surgeries, the organ of the donor is transplanted to the recipient which is a very complex surgery but in total knee replacement surgery , no such transplant of knee is done from the donor to the recipient. Here, only the damaged surfaces of ends of bones articulating with each other in the knee joint, (namely femur or thigh bone, tibia or leg bone and patella) are removed and are covered with artificial components made of materials like stainless steel, titanium and ultra-high molecular weight polyethylene. In a nutshell, only resurfacing of knee joint is done instead of transplantation and this is much simpler procedure and safer also when compared to kidney transplant or heart transplant. Here, the knee joint of the patient is retained and only the damaged portion of articulating surfaces of bones is covered by artificial components as already described . In reality, this is Knee RESURFACING surgery as only articulating surfaces of Knee Joint are replaced .
This confusion between knee replacement surgery and organ transplant Surgery has resulted in knee replacement hesitancy amongst the vast population who don’t agree to undergo knee replacement surgery readily just because of this confusion. Hence, this reality needs to be propagated to the masses so that the patients who need this surgery agree to undergo this excellent surgery without any further delay .
Advantages :
* Permanent relief of pain.
* Deformity is fully corrected.
* Range of motion of Knee Joint is fully regained.
* Well done Total Knee Replacement surgery transforms the life of patient from a painful sedentary life to a comfortable painfree dynamic life.
To conclude with , Total knee Replacement surgery is needed only and only in cases of End Stage ( Advanced ) Osteoarthritis of Knees and has an excellent outcome if done in proper indication .
(The author is Senior Joint Replacement Surgeon Narayana Hospital Katra)
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