Osteoarthritis is age related wear and tear of joints resulting in symptoms of joint pain and stiffness and soreness in the surrounding muscles. In general 80-90% of people older than 65 years have x-ray proven osteoarthritis. In the USA, more than 20 million people are affected with chronic disability, in people older than 70 years.
Knee is the weight-bearing joint of the body and is therefore most commonly affected. Knee arthritis is disturbing for basic daily activities, such as sitting, standing, walking and stair climbing. The prevalence and severity of knee arthritis vary depending on Age, sex, body weight, activity level, and genetic and environmental factors. Longstanding and persistent pain leads to frustration and depression and there is a real risk of obesity, falls and hip fractures. As aging population is increasing, Knee Arthritis is emerging as a leading cause of financial burden on healthcare.
If you are suffering from Knee pain and arthritis, you need to be in touch with a joint replacement surgeon for assessment of your knee and long-term treatment plan. The surgeons can guide you towards activity modification, physical therapy, and muscle strengthening exercises and prescribing some pain medications. You can also help your symptoms by dietary modifications and weight loss. For each kilogram of body weight lost, knee experiences 4 kg reduction in load per step and 4800 kg reduction in compressive load for each kilometer walked. People with BMI (Body mass index) of greater than 30 have 4 times increases risk of knee arthritis. Weight loss is therefore also an important preventive measure.
Using Olive oil, Fish and Vegetables reduces pain by 40% in people with inflammatory arthritis. Avoiding high heat cooked foods reduces acutely painful episodes in osteoarthritis and diets rich in Vitamin C also slows the progression of osteoarthritis.
Your knee needs to be strong enough to take your weight and withstand extreme stresses, twists and turns, so that you can stand upright, walk and run without difficulty. In osteoarthritis, moving surface of the joint, the cartilage, becomes rough and thin and the bone underneath reacts by growing thicker and broader. All the tissues in the knee become more active, as it is trying to repair the damage. Your body’s repair may be successful and the changes inside the joint won’t cause much pain. It is possible to manage your pain with diet, weight loss, activity modification and exercise without requiring any active medical treatment.
However, if the repair doesn’t work, it may mean that your knee is severely damaged. You will have progressive pain and stiffness despite use of different pain medications and injections. Steroid injections can help improve your symptoms for weeks or months but not permanently. Hyaluronic acid injections are also used for lubrication and reduction in pain but their usefulness for long-term pain relief is not very convincing.
Persistent pain requires Knee replacement surgery as the standard of care for knee arthritis. There are three compartments of knee joint – the inner (medial), the outer (lateral) and the kneecap (patellofemoral) compartment. If arthritis affects only one side of your knee – usually the inner side – it is possible to have a half-knee replacement (sometimes called unicompartmental or partial knee replacement). Because this involves less interference with the knee joint than total knee replacement it usually means a quicker recovery and better function (Fig 1). Partial knee replacements can be carried out through a smaller cut (incision) than a total knee replacement, using techniques called minimally invasive surgery. A smaller incision further reduces the recovery time.
It’s also possible to replace just the under-surface of your kneecap and its groove (the trochlea) if these are the only parts affected by arthritis. This is called patellofemoral replacement or patellofemoral joint arthroplasty. This operation is only suitable for about 1 in 40 people with osteoarthritis. The outcome of kneecap replacement can be good if the arthritis doesn’t progress and it’s a less major operation offering speedier recovery times.
Total Knee replacement operation involves replacement of all three compartments of your knee joint (Fig 2). Orthopedic surgeon with specialize training in joint replacement surgery can recommend one of these operations based on detailed assessment your knee. Because of increasing elderly population, the need for Knee replacement surgery is increasing. Successful results of knee replacement surgery in experienced hands is increasing its popularity. Knee replacement implants, surgical technique, and recovery from the operation has improved tremendously over the last few years. Partial knee replacements and even total knee replacement surgeries are approaching only “48 hours hospital stay” targets in experienced hands.
Surgeons trained in “Computer guided Hip and knee replacement” surgery are adding further accuracy to the operation and therefore increasing the chances of survival of artificial knee Joint. Approximately 70000 knee replacements are performed in UK and 700000 in USA annually. The current survival of knee replacement is 95% at 15 years and 85% at 20 years.
In Summary, Knee pain from age related wear tear (Osteoarthritis) can be seriously disabling. Early referral to Arthroplasty trained orthopedic surgeon is helpful. Knee replacement surgery is a well-known operation with good results in experienced hands. It helps to alleviate pain and return to normal function with good health. Individuals with persistent pain despite continuous use of pain medications should be considered for Knee replacement. Unnecessary delay in surgery can lead to depression and progressive weakness of muscles compromising the recovery and rehabilitation after surgery.
Dr Mujahid Jamil Khattak is a British trained Orthopaedic Surgeon with Fellowship experience in Joint Replacement surgery from Oxford, London and Bristol, United Kingdom. He currently works as consultant Hip & Knee Arthroplasty Surgeon at The Aga Khan University Hospital Karachi. (Email: [email protected]