The term ‘Arthritis’ is pretty familiar to most of us, yet a very few understand the disease.Although arthritis is seen in both genders, women are more commonly affected. Unlike the popular belief that arthritis affects the elderly people, in reality, it can affect people of all age groups. In joints affected by arthritis the cushions at the ends of the bones wear out. This results in pain and in course of time leads to deformity of the legs. Knee joint is the most common joint affected by arthritis because of its crucial role in day to day activities.
The most common types of arthritis are the Osteo-arthritis (age related wear and tear) and Rheumatoid-arthritis (seen in middle aged patients caused by malfunction in one’s immune system).
Other less common types of arthritis include a) Gouty arthritis (caused by increased uric acid in blood), b) post-traumatic arthritis (due to old fracture), c) septic arthritis (because of infection) etc…
Worn out area(Arthritis)
Some of the earliest symptoms of knee arthritis are a) pain while climbing up and coming down the stairs and b) pain while getting up from sitting position. Other symptoms of arthritis include the following.
1) Stiffness in one or both knees usually felt early morning or after prolonged rest.
2) Swelling in one or both knees
3) Restriction in knee bending making it difficult to sit cross-legged or squat.
4) Patients can sometimes hear crackling sound when they move their knees.
5) In severe arthritis the legs bend leading to bowlegs or knock knees.
Arthritis can affect people of all age groups
Obesity is one of the known risk factors for arthritis
In most cases examination of the patient’s knees and X-rays of the knee (AP standing & Lateral) is all it requires to clinch the diagnosis. In special cases the following additional x-rays would be useful to plan the treatment. X-ray helps to confirm the diagnosis and to grade the severity of arthritis.
Knee x ray showing various grades of arthritis. As you can witness the space between the two bones (arrow) is maintained in early stages (grade 1 & 2).In late stages (grade 3 & 4) the joint space has decreased considerably.
Normal Knee X-ray in standing position: Space between the thigh and the leg bone is maintained
While grade 1 and 2 (early stage) arthritis are managed by medical (non-surgical) treatment, grade 3 and 4 (late stage) arthritis are manages by one of the advanced surgical treatment options.
Non-Surgical Treatments for Early Stage Arthritis:
The basic treatments to get relief from the knee arthritis are:
Swimming is the best exercise for patients with knee pain.
Although biological treatments such as Platelet Rich Plasma (PRP) have shown promising results, the current studies are based on patients followed for short term (18 to 24 months) and long term results are yet to come. We recommend such therapy for patients who are actually not candidates for surgery for various reasons and in patients who want to post pone surgery for one or two years.
It is a form of biological treatment but done through Key-Hole technique. Similar to PRP, the current studies are based on patients followed for short term (18 to 24 months) and long term results are yet to available. We recommend such therapy for patients who are actually not candidates for knee replacement for various reasons and in patients who want to post pone knee replacement for one or two years.
Deformed legs before surgery because of long standing arthritis and precise error free surgical
correction of deformities using computer navigation.
(We are one of the very few centres in Asia to use Cutting edge Technology such as computer assisted surgery for total and partial knee replacement, which helps us in delivering unmatched results ) Surgical treatment for arthritis includes one of the following depending on the extent of arthritis.
Computer Assisted Knee Replacement
1) Total knee Replacement is done a) when the arthritis involves more than one third of the joint surface, b) when the knee is deformed severely or c) in cases like rheumatoid arthritis. Performing Total Knee Replacement with Computer Navigation has various established advantages.
2) Partial Knee Replacement is done when the arthritis involves less than one third of the joint surface and when the ligaments are preserved well. When the inner compartment alone is wornout we replace only that compartment which is called Uni-compartmental Knee Replacement. Sometimes when the knee cap alone gets affected then we recommend knee cap replacement which is called as Patello-Femoral Replacement. We are one amongst very few centres globally to do Computer Assisted Partial knee Replacement surgery.
X-ray showing severe arthritis (before surgery) and well placed new joint using computer navigation(after surgery).
Inner Compartment Replacement
Authored By Dr. Raj Kanna - Orthopaedic and Knee surgeon, Chennai