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  Dr. Harsh Shah
 
• Knee
• Hip
 
:: Faq - Knee

• What is knee arthritis ?
• Symptoms
• What does knee arthritis feel like ?
• Diagnosis
• How do we look into this problem ?
• Treatment
• What can be done for your knee pain ?
• Non-operative treatment
• Arthroscopy
• Tibial Osteotomy
• Total Knee Replacement
 
What is osteoarthritis?

Osteoarthritis is a common problem for many people after middle age. Osteoarthritis is sometimes referred to as degenerative, or wear and tear arthritis. Osteoarthritis may result from an injury to the knee earlier in life. Fractures involving the joint surfaces, instability from ligament tears, and meniscal injuries can all cause abnormal wear and tear of the knee joint. Not all cases of osteoarthritis are related to prior injury, however. Research has shown that some people are prone to develop osteoarthritis, and this tendency may be genetic.

The main problem in osteoarthritis is degeneration of the articular cartilage that covers the joint. This results in areas of the joint where bone rubs against bone. Bone spurs may form around the joint as the body's response.

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Symptoms
What does osteoarthritis feel like?

Osteoarthritis develops slowly over several years. The symptoms of osteoarthritis are mainly pain, swelling, and stiffening of the knee. The pain of osteoarthritis is usually worse after activity. Early in the course of the disease, you may notice that your knee does fairly well while walking, then after sitting for several minutes the knee becomes stiff and painful. As the condition progresses, pain can interfere with even simple daily activities. In the late stages, the pain can be continuous and even affect sleep patterns.

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Diagnosis
How do we look into this problem?

The diagnosis of osteoarthritis can usually be made on the basis of the initial history and examination. X-Rays are very helpful in the diagnosis and will be the only special test required in the majority of cases.

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Treatment
What can be done for your knee pain?
Non-Operative Treatment

Osteoarthritis is a condition, which progresses slowly over a period of many years. Osteoarthritis cannot be cured. Treatment is directed at decreasing the symptoms of the condition, and slowing the progress of the condition.

The treatment of osteoarthritis depends on how far advanced the condition is. In the early stages, treatment for osteoarthritis is usually directed at decreasing the inflammation in the joint. Anti-inflammatory medications, such as aspirin and ibuprofen, are useful in decreasing the pain and swelling from the inflammation. If the symptoms continue, a cortisone injection may be used to bring the inflammation under better control and ease your pain. Cortisone is a very powerful anti-inflammatory medication, but does have secondary effects that limit its usefulness in the treatment of osteoarthritis. The major drawback in use of intra-articular injection of cortisone is the fact that it may actually speed the process of degeneration when used repeatedly. Most physicians use cortisone sparingly, and avoid multiple injections unless the joint is already in the end stages of degeneration.

There are also braces on the market now that can reduce the pressure on the side of the knee that is most involved. These braces have been designed mainly for the more common condition of early wear and tear in the medial compartment (inner half) of the knee. A brace may help with your pain and is worth experimenting with. Various kinds of elastic supports do little to improve the pain.

Physiotherapy also has a little role to play in this condition. Its role is like painkiller, while you are on it, it does give you some degree of pain relief but does not necessarily change the course of the condition. Exercises may be helpful to prevent stiffness in a painful joint, but it has no role in improving the condition of the joint.

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Arthroscopy

Arthroscopy is sometimes useful in the treatment of osteoarthritis of the knee. Looking directly at the articular cartilage surfaces of the knee is the most accurate way of determining how advanced the osteoarthritis is. Arthroscopy also allows the surgeon to debride the knee joint. Debridement essentially consists of cleaning out the joint of all debris and loose fragments. During the debridment any loose fragments of cartilage are removed and the knee is washed with a saline solution. The areas of the knee joint which are badly worn may be roughened with a burr to promote the growth of new cartilage - a fibrocartilage material that is similar scar tissue. Debridement of the knee using the arthroscope is not 100% successful. If successful, it usually affords temporary relief of symptoms for somewhere between 6 months to 2 years.

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Proximal Tibial Osteotomy

Osteoarthritis usually affects the inside half (medial compartment) of the knee more often than the outside (lateral compartment). This can lead to the lower extremity becoming slightly bowl egged, or in medical terms, a genu varum deformity. The result is that the of the lower extremity moves more medially (towards the medial compartment of the knee). (It's really all in the physics/biomechanics of the situation.) The end result is that there is even more pressure on the medial joint surfaces, which leads to more pain and faster degeneration.

In some cases, re-aligning the angles in the lower extremity can result in shifting the weight-bearing line to the more normal and relatively unaffected lateral compartment of the knee. This, presumably, places the majority of the weight-bearing force into a healthier compartment. The result is to reduce the pain and delay the progression of the degeneration of the medial compartment.

The procedure to realign the angles of the lower extremity is called a Proximal Tibial Osteotomy. In this procedure a wedge of bone is removed from the lateral (outer) side of the upper tibia. This converts the extremity from being bow-legged to knock-kneed. This procedure is cannot be expected to be always successful, and generally will reduce your pain, but not eliminate it altogether. The advantage to this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions to activity level. It is thought that this operation buys some time before ultimately needing to perform a total knee replacement. The advantages of the operation generally lasts for 6-8 years.

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Total Knee Replacement

The ultimate solution for osteoarthritis of the knee is to replace the joint surfaces with an artificial knee joint. The decision to proceed with a total knee replacement is usually considered in people around the age of 60, (although younger patients sometimes require the surgery simply because no other acceptable solution is available to treat their condition). The main reason that orthopaedic surgeons are reluctant to perform the surgery on younger individuals, is that the younger the patient, the more likely the artificial joint will fail. Replacing the knee the second and third time is much harder and the relative advantages seem to get less with each surgery.

Artificial knee joints can last between 12 and 15 years in an elderly population. Younger patients are more active and place more stress on the artificial joint, that can lead to loosening and failure earlier. Obviously, younger patients are also more likely to outlive their artificial joint, and will almost surely require a revision at some point down the road.

Now let's look at what happens during a total knee arthroplasty. The end of the femur is shaped so that the artificial implant will fit snugly. The tibial surface is then cut flat to accept the bottom portion of the artificial joint. The patella is also cut flat to accept the artificial patellar surface. The femoral surface is placed on the end of the femur. The tibial artificial surface is placed on the top of the cut tibia. The patellar button is then placed on the cut surface of the patella. The end result is that all moving surfaces of the knee are metal against plastic. Now let's view the arthroplasty from the and .

 
 
 
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Dr. Harsh Shah - Joint Replacement Specialist
Appointments No. : 0960 181 8844
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