KNEE JOINT is the most common joint of all the joints in our body to be affected by osteoarthritis. Millions of patients worldwide are being affected by this disabling condition every year. This makes it very necessary for everyone suffering from this painful problem to know something about the normal knee joint, knee arthritis and knee replacement surgery!
Femur (Thighbone), Tibia (Shinbone) & Patella (Knee Cap) that along with tendons forms covering of the tibiofemoral joint
Very grossly, joint between the femur and tibia (Tibiofemoral Joint) is used more in walking purpose and joint between patella and femur (Patellofemoral Joint) is used more in sit-to-stand and stair activities. All these bones form three compartments in the joint Medial, Lateral & Patellofemoral.
Ends of these bones are covered with a soft & resilient lining called as Cartilage, which gives smoothness to the movement and also acts as shock absorber during movement of the joint and in all sorts of activities like walking, running, jumping etc.
Furthermore, all these bones are held together by Four Ligaments (2 Collaterals and 2 Cruciates), which are elastic but tough band like structures that help to keep the bones in proper alignment and help in proper functioning of the joint.
In between the femur and tibia, there are Two Menisci, which are the disc-like structures protecting the cartilage from overloading and also to facilitate smoothness of joint motion providing more congruence of the bony ends.
Entire joint is enveloped in Capsule along with the Inner lining of Synovial Membrane, which forms lubricating fluid or Synovial Fluid necessary for the joint smoothness.
So, what Is Arthritis of Knee Joint?
Arthritis of the Knee Joint literally means Wear & Tear of the cartilage or covering over the bone ends resulting in a Painful & Inflamed joint. Arthritis starts with cracking of the brittle-aged cartilage and wearing of the menisci protecting it. As the stage advances, entire meniscal and cartilage buffer between the bones is lost and the opposing bony ends start rubbing with each other causing lot of pain and change in walking pattern. At very advanced stages of arthritis, the knees become grossly bent resulting in significant disability in walking and performing Activities of Daily Living (ADL).
X-ray of a Normal Knee has a clear space between the bones suggesting healthy cartilage & menisci, whereas X-ray of Arthritic knee shows loss of joint space between the bones and bony spurs around it.
(X-rays of Normal and Arthritic Knee Joints)
Various Causes or Reasons of Arthritis
- Age Related Osteoarthritis – One of the commonest reasons for arthritis is AGE. Due to increasing age, the health of cartilage and menisci gets deteriorated resulting in wear and tear of the joint
- Weight – A very well-known and proven reason of Early Age Of Arthritis; nowadays, evident hugely due to overweight or obesity across the glob
- Rheumatoid Arthritis – Another factor causing arthritis at an early age
- Post-traumatic or Post-Injury – Injury/damage either to bone or joint structures can result in arthritis of the joint
- Osteoporosis – Quality of the bones is very important factor for development of arthritis and also after knee replacement
- Other factors, less important like blood disorders, connective tissue disorders can also result in arthritis of the joint
Various Treatments can be offered in Early Stages of Knee Osteoarthritis
- Analgesics & Chondro protective Medicines have some role in symptomatic relief from pain due to osteoarthritis in early stages but NO MEDICINE can be an alternative to DEFINITIVE Measures like surgery in late stages of arthritis.
- Physical Therapy is an integral part in the treatment of osteoarthritis of the knee joint in for of Ultrasound, Interferrential Current, Short Wave Diathermy, Non Contact LASER Therapy and the most important is Muscle Strengthening Programmes under the care of an expert physical therapist.
- Intra-Articular Injections – Various types of Injections have been described but mainly two types are in routine use in the treatment of early knee arthritis; like Steroid Injection & Articular Viscous Supplementation like Synvisc One. Effect of these injections is mostly short lasting, whereas they carry an inherent risk of infections in the joint.
- Braces – Various types of knee caps and braces can be prescribed in various stages of knee osteoarthritis. In early stages of arthritis, braces can be useful in providing stable support as well as opening up a reduced joint space to a certain degree with Valgus OA knee brace. But in later stages, these braces are only psychological support rather than a real help or remedy.
- Joint Preservation Surgeries (Osteotomy & Arthroscopy) – In Early and Mid Stages of osteoarthritis and particularly in younger age patients(where sometimes knee replacement is too early!), Osteotomy Surgery for changing the Mechanical axis of the damaged and angled joint gives a good pain relief for few years. BUT, well performed osteotomy surgery can last for long time. Otherwise, it may end up in enhanced arthritis or marked shift in mechanical axis of the leg so much, so that it may hamper the results of even knee replacement!
- Arthroscopy, for cleaning up the arthritic joint and removing damaged menisci as well as bony loose bodies is also a treatment option for Osteoarthritic Joint. Though it gives good pain relief in very selective number of patients. Long term or permanent pain relief should never be expected out of this surgery in cases of advanced stages of osteoarthritis!
When all these aforementioned treatments fail to give pain relief to a patient with Knee Arthritis, THEN Only remedy to offer a lasting relief from pain and to regain mobility in life remains!!
And that is TOTAL KNEE REPLACEMENT!!
