Mumbai Knee Foot Ankle Clinic : Dr. Pradeep Moonot, Arthritis, Knee Replacement, UKR

Arthritis

Knee osteoarthritis, also known as “wear and tear” arthritis is a common condition particularly in the middle and older aged patient. The joint becomes roughened and this leads to pain, stiffness and swelling of the knee. Some patients may also notice that they become increasingly more bow-legged or knock-kneed.
Other causes of arthritis are inflammatory arthritis (rheumatoid arthritis) and post-traumatic arthritis (after a fracture, ligament injury, or meniscus tear).

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Symptoms

  • Generally, the pain associated with arthritis develops gradually, although sudden onset is also possible.
  • The joint may become stiff and swollen, making it difficult to bend or straighten the knee.
  • Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing, or kneeling. The pain may often cause a feeling of weakness in the knee, resulting in a "locking" or "buckling." Many people report that changes in the weather also affect the degree of pain from arthritis.
  • When severe, pain can be felt at rest and at night, disturbing sleep. As the condition worsens, it may become difficult to fully straighten the knee or to kneel.
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Investigations

After the examination the doctor/surgeon will ask for a weight bearing AP and lateral xrays of the knee. It is important that the xrays are done standing, otherwise the diagnosis of arthritis can be missed. The doctor may also ask for other special xrays like tunnel –views or a MRI scan depending on the symptoms (like locking or clicking sensation)

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Treatment

The purpose of treatment is to reduce pain, increase function and generally reduce your symptoms. Patient satisfaction is a fundamental goal in treating osteoarthritis of the knee
In almost all cases conservative or non –surgical treatment should be tried initially. The effectiveness of different treatments varies from person to person. The choice of treatment should be a joint decision between you and your physician.
In its early stages, arthritis of the knee is treated with nonsurgical measures. Nonsurgical treatments fall into four major groups: lifestyle modifications; exercise; supportive devices; other methods

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Lifestyle Modification

Lifestyle modifications can include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities that aggravate the condition, such as climbing stairs. Many, but not all, people with osteoarthritis of the knee are overweight. Simple weight loss can reduce stress on weight bearing joints, such as the knee. Losing weight can result in reduced pain and increased function, particularly in walking.

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Exercise

Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Your physician or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

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Supportive Devices

Using supportive devices, such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. Some research studies have focused on the use of knee braces for treatment of osteoarthritis of the knee. They may be especially helpful if the arthritis is centered on one side of the knee. A brace can assist with stability and function. There are two types of braces that are often used. An "unloader" brace shifts load away from the affected portion of the knee. A "support" brace helps support the entire knee load. In most studies, the knee symptoms improved, with a decrease in pain on weightbearing and a general ability to walk longer distances.

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Other Methods

  • Other measures may include applications of heat or ice, water exercises, liniments or elastic bandages.
  • Drug treatment
  • Like anti-inflammatory medications (NSAIDs), Glucosamine and Chondroitin sulphate, steroid and viscosupplementation with Hyaluronic acid injections in the knee may also help (see attached link)
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Surgical Treatment

Each patient is unique but generally the indications for knee replacement are:

  1. Pain interfering with day to day activities and routine work and recreational habits
  2. Pain not controlled by conservative (non-operative) methods like pain-killers and physiotherapy
  3. Loss of mobility, stiffness and swelling of the joint
  4. Xrays confirms arthritis

The main aim of knee replacement is to alleviate pain and thereby improve mobility. This is achieved by replacing the worn out part or parts of the joint with artificial components made of metal and plastic. Whenever possible a partial knee replacement may be performed, replacing only the worn out parts, either the inner part or outer part (unicondylar knee replacement) or the joint between the kneecap and thigh-bone (patello-femoral replacement). If the arthritis is widespread then a total knee replacement should be considered.
In very few cases arthroscopic (key-hole) surgery and osteotomy (cutting the bone) may help improve the symptoms of arthritis.

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