OSTEOARTHRITIS
Osteoarthritis is the destruction of the smooth cartilage covering the ends of the bones. This destruction is similar to the wear and tear of moving machines. It usually starts in middle age without any specific cause. You may have seen elderly persons walking like a duck or using a stick. Most of these people suffer from Osteoarthritis.
STAGES
In the early stages, there is a pain in the knee while :
• Getting up from a sitting position.
• Changing the knee position after a period of rest in one position.
In later stages, pain is almost constant and becomes worse on exertion. At this stage, the pain is relieved by :
• Rest.
• Pain killer medicines.
• Oil massage.
In the advanced stage, walking is difficult and often requires much effort. Going up and down the stairs is incredibly, very difficult. The knee may appear ‘swollen’, and the thigh may appear thin. The shape of the legs changes, and the knee bows outwards. At this stage, the gait changes, and there may be a sideways lurch at every step.
CAUSES
Common causes of Osteoarthritis are:
• Wear and tear due to prolonged joint use (This is the commonest cause of Osteoarthritis).
• Defect in cartilage quality, such as in a disease called pseudogout.
• Defect in the alignment of the articulating surfaces.
• Loose structures inside the joint, such as a loose cover of the meniscus.
• Old injury.
• Previous infection.
RISK GROUPS
Osteoarthritis may run in families. It is more common in obese people and those who use the knee excessively, such as for sports, standing for a long time or working long hours with the knee in extreme positions. Osteoarthritis is ten times more common in females than in males. People with bowed legs develop Osteoarthritis much earlier.
SYMPTOMS
Knee osteoarthritis is more common among people above fifty, significantly obese. Most people with Osteoarthritis complain of pain and creaking sound in the knee. Many people who believe that knee pain means the beginning of old age do not always consult with a doctor. It is important to remember that knee pain can occur at all ages, and some causes are curable. Also, some diseases may start as mild pain but rapidly progress to destroy the knee joint. Early diagnosis and timely management can prevent the progress of an otherwise progressive disease.
When to consult with a doctor?
You should consult with a doctor, especially an orthopaedic surgeon if you have:
• Pain or stiffness in one joint only or if one joint is affected more than the other.
• Repeated swelling of the knee with pain.
• Symptoms suggestive of a mechanical fault as sudden clicking, something either moving or loose inside the joint.
• Recent bowing of the legs with pain on the inner side of the knee.
• Walking about within the house is difficult due to pain.
TREATMENT
Osteoarthritis is not curable. Once it starts, it remains for the rest of your life. However, you can relieve the symptoms and minimise disability with timely treatment. Treatment of Osteoarthritis is through:
• Non-surgical methods in early stages.
• Surgical methods in advanced stages.
NON-SURGICAL TREATMENT
The patient has to do the following for non-surgical management of Osteoarthritis.
Patient education: You may start worrying about being crippled because of arthritis. Your doctor will, therefore, give you a very accurate picture of your condition, which will help lessen your fears and anxiety.
Weight reduction: Regular and adequate exercise may be problematic if you have difficulty walking. You may, however, go cycling or swimming regularly. It is, therefore, essential to modify your diet and avoid high-calorie foods such as sugar, sweets, rice, potato, oil or ghee.
Avoid the following, which put excessive stress on the knee:
• Sitting on the floor, in low chairs, sofas or beds.
• Squatting, sitting cross-legged and using Indian-style toilets.
• Exercises in which you must stand or walk for a long time.
You may get relief by:
• Doing exercises where you can sit on a chair or stool.
• Doing specific exercises to build up the muscles around the knee to support the ‘weak’ knee.
• Occasional use of medicines to relieve pain. Paracetamol is a safer medicine.
SURGICAL TREATMENT
Three types of surgeries are recommended for the treatment of
Osteoarthritis. These include:
• Arthroscopy.
• Correction of the alignment of the knee.
• Changing the knee joint.
None of these surgeries cures Osteoarthritis. Your doctor may recommend any of these options depending on the condition of your knee.
Arthroscopy: Your doctor may recommend it if you either have…
• Mechanical problems such as something stuck or loose inside the joint.
• Repeated swelling of the knee joint. Although the relief may be partial or temporary, it is often recommended because it is a safe and ‘minor’ procedure.
As mentioned earlier, your doctor can view the inside of the knee directly through an arthroscope and assess the condition of the cartilage covering the bone ends and the semi-lunar cartilage. Your doctor will also be able to remove the following:
• Any loose or torn pieces of semi-lunar or articular cartilage.
• Loose or overgrown tissue lining the knee. The joint will then be washed thoroughly with saline water to remove damaged pieces completely.
Correction of alignment of the knee: Your doctor may suggest a surgery called High Tibial Osteotomy (HTO) to correct the alignment of the knee. This surgery is usually recommended if you have painful Osteoarthritis of the knee with bowing of the legs. When your legs are bowed, more body weight passes through the inner side than the outer side of the knee. During the surgery, the bone just below the knee is cut and realigned so that more body weight passes through the outer side of the knee. After this surgery, more than 70% of patients have had relief from pain for almost 8-10 years. It is effective for mild to moderate arthritis and people who are either young or not obese.
HTO is major surgery and requires a plaster cast for a month after the operation. You can, however, start walking to the toilet with the plaster about one week after the surgery. Your doctor will also recommend physiotherapy for a few weeks after removing the cast.
Changing the knee joint: This is a relatively new technique in which the damaged ends of the bones of the knee joint are removed and replaced with artificial parts. A cup-like part is fixed on the end of the thigh bone, and a plate-like part is fixed on the end of the leg bone with a special glue called bone cement. The new parts of the knee are smooth; therefore, there is no pain during regular joint movements. Although this surgery relieves pain, it is not always practical. You may have to observe several movement restrictions so that the new joint may last for five to eight years. Also, the artificial knee joint is very expensive. This surgery is usually recommended for people who cannot walk within the house also.