Knee pain in middle and older aged people is a very common and disabling problem. To some, it causes mild discomfort while to others it affects their lifestyle. Osteoarthritis (OA), also known as wear and tear arthritis, is the most common condition causing knee pain in this age group.
In the knee, the top of tibia (shin bone), bottom of femur (thigh bone) and patella (knee cap) are covered by articular cartilage. The characteristic feature of OA is the breakdown and loss of this articular cartilage. This cartilage does not contain nerves so damaged cartilage does not cause pain. Instead the damaged/missing cartilage causes friction between the bones which causes the pain. The cartilage attempts to heal but is irregular and not enough. As the disease progress it starts damaging the bones and the tissues surrounding them.
What is Knee Osteoarthritis? How to prevent Knee Osteoarthritis?
Symptoms
Patients almost always complain of pain which may come and go or it may persist throughout the day. The pain usually gets worse during activities such as climbing stairs and sitting cross legged. Some patients also develop swelling of the knee. As the disease progresses, patients develop stiffness and are not able to completely bend or straighten the knee.
X-rays
X-rays show a loss of joint space between the femur and tibia indicating a loss of cartilage in that area. Initially the loss is localized to one area but gradually it involves the whole joint. They also show bony changes such as spurs and cysts which appear in advanced stages.
Treatment
The earlier the arthritis is treated, more likely pain will decrease. Initially the treatment includes medications, physical therapy and injections. Surgery is indicated only in advances cases.
Physical Therapy
It combines stretching and strengthening of muscles around the knee (Quadriceps and hamstrings). (Refer pic below) Light aerobic exercises such as walking, cycling and swimming are also helpful.
Medications
Anti-inflammatory medicines are used to reduce inflammation that contributes to pain. Both oral and topical ointment and sprays are helpful. Chondro-protective drugs such as diacerin, glucosamine are used to preserve the knee.
Injections
They are recommended if physical therapy and medicines are not effective.
- Viscosupplement – It mimics the fluid inside the knee and lubricates the knee. It has very few side effects and provides long term relief.
- PRP - Platelets from the patient’s blood are separated and injected in the knee. They reduce inflammation thus reducing pain and improving function. It has cartilage preserving action also and provides long term relief.
- Steroid – Only used for acute flare up of pain and in swollen joint. Only used for short term relief.
Surgery
Reserved for patients with advanced disease. Surgical options include Arthroscopic debridement, deformity correcting surgery (HTO), partial and Total knee replacement.
Prevention
Changing lifestyle today will reduce your chances of developing arthritis in future.
- Control weight - If you are at a healthy weight, maintaining the weight may be the most important thing you can do to prevent arthritis. If you have a few extra kilos then you need to lose them. 1 kg of body weight puts around 2.2 kg of stress on the knee! So losing as little as 1 kg of weight is useful. If you have started developing arthritis, losing weight reduces the progression of the disease.
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Exercise - You should be active in your daily life. You should regularly do aerobic exercises such as walking, cycling and swimming. You can also start muscle strengthening exercises as described earlier.
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Avoid injuries/Get them treated - Suffering an injury when you’re young predisposes you to arthritis when you’re older. The risk can be 3-5 times higher than a normal individual. Before playing sports/exercise, always do adequate warm up, wear proper fitting shoes and cool down after the work out.
If unfortunately, you sustain an injury then it is essential to consult a doctor and get the injury treated and prevent further damage. A stitch in time saves nine!
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Eat right - You are what you eat. It cannot be more true than for bones and joints. A healthy diet makes your muscles and bones strong and less prone for wear and tear. The diet should consist of high amount of proteins with green leafy vegetables and fruits. Eggs and meat in moderate quantity are beneficial. Individuals above the age of 50 years should increase their calcium intake as the body needs more calcium to keep the bones strong.
Dr. Abhishek Jain
Arthroscopy, Joint Replacement and Trauma surgeon
Jain Hospital, Gurgaon
