Rajesh Bhalla

Knee Arthritis

Knee Arthritis is a condition in which the articular cartilages of knee joints wear away with age. It is a degenerative knee condition affecting thousands of people every day and with growing age.

Knee arthritis can also be defined as any injury causing damage to the cartilage on the end of the bones near the joints. Cartilage is a semi-rigid, flexible tissue connecting tissue surrounding joints providing cushion-like support to joint bones. Once the cartilage of the knee gets damaged there is limited but every day new treatment for restoring them are evolving. The injury in knee cartilage cannot be healed naturally. Attempts for cartilage resurfacing technique can restore it to a near normal healthy state.

Knee Arthritis

Symptoms of knee arthritis:

  • Swelling or Inflammation near Knee Joints with or without performing any physical activity.
  • Knee pain while performing any physical activity.
  • Knee Joint stiffness after sitting for a long time.
  • Creaking or Cracking sound while knee movement.
  • Deformity of Knees.

The most common form of knee arthritis is Knee Osteoarthritis. It is a slow yet progressive degenerative disease in which the knee joint cartilage gradually wears away due to age related degeneration. Mostly this condition is seen in middle-aged and older people. Sometimes even young patients can get affected. Young individuals, those who have there the meniscus or cartilage removed due to previous injury to the same are most likely affected by osteoarthritis. Even in Athletes, this is a common condition.

There is a major misconception about knee osteoarthritis is that; the end stage of this condition is knee replacement. The vast majority of knee arthritis today is due to impactful injuries. This kind of knee arthritis is called Traumatic arthritis. This type of arthritis is very similar to knee osteoarthritis which can also develop even after many years of injuries caused due to fracture, ligament injury or meniscus injury. Some of the injuries are at localized areas of the knee which makes it potentially easy to treat and are more successful than arthritis which is at the larger area of the knee.

Common Types of Knee Arthritis

  1. Osteoarthritis: It occurs due to age related wearing away of cartilage replaced by fibro cartilage, which acts as a protective layer for bone joints.
  2. Post-traumatic arthritis: This is a type of arthritis caused due to the previous injury in joints and areas surrounding the joints.
  3. Rheumatoid Arthritis: This is a condition in which the body’s immune system destroys healthy tissue like knee joint cartilage leading to swelling at joints and even softening of knee bones.
  4. Gouty Arthritis: It is a condition caused to Uric acid getting accumulated near knee joints leading to pain and swelling of knee joints. Some common causes of Gouty Arthritis previous family history, Obesity due to excess weight which can lead to excess Uric acid.

Treatment of Knee Arthritis

Early signs of knee arthritis can be treated at home to lessen the pain and prevent the symptoms to get worse. Stopping physical activity can lead to stiffness and weakness of the muscles which can lead to a reduction of motion in knee joints. If the patient is suffering from obesity then losing weight can be appropriate in reducing pain in the early stages of arthritis. Eat food which can increase cartilage growth. In the case of inflammation of the knee use of heating pads and ice packs can be helpful in reducing the inflammation and pain. Patients can also use knee braces around the affected area in the knee. Light Physical exercises can be done in place of rigorous exercises and in need physical therapists can be consulted for exercises that can be helpful in strengthening the joint muscles.

The flow chart in the treatment for knee arthritis comprises a physical examination of symptoms of the which are clearly visible like swelling and certain deformation in the knee and then further examination extends to tests imaging of affected body parts by X-Ray, CT scan or MRI scan to study the exact status of knee arthritis. The most important aspect which needs to be determined while treating any kind of arthritis is the location at which the symptoms are shown.

Knee osteoarthritis on the femoral condyles (the two prominences at the lowest extreme of the thigh bones) are easier to treat in comparison to the one at the trochlear groove (groove at the top of the femur or thigh bone where the knee cap rests), patella (Knee Cap), tibial plateaue (upper extremity of the tibia which are the bones present at the front portion of the legs below the knees). Apart from the location the size of the lesion or the region which has suffered damage is also important when it comes to the treatment of arthritis as the smaller regions or lesions are easier to operate than the larger ones.

 In cases where a patient is required to go for Cartilage Replacement Surgery, these cases should visit best orthopaedic doctor in Delhi or doctor in your vicinity. Certain assessments and evaluations are done some listed below: –  

  • Analysis of the affected lesion/region size whether there is a kissing lesion comprising of formation of cartilage surface on the opposite side of the defect.
  • The presence of bone contusion or bone bruise often referred to as damage to the bone present beneath the soft tissues due to ligamentous injury.
  • The patient’s structural knee alignment.

If the patient has the previous history of meniscus removal from the sizable portion then the success rate of the Cartilage Replacement surgery becomes very low. The role of Meniscus is very important as it forms cushioning support for the knee. It acts as a shock absorber and protects the tibia and femur from sudden impact. In such a situation of knee arthritis, a concurrent Meniscal transplant can be performed for restoring the cushioning effect of the knee joints.

In addition to this, it is also important to check and examine the patient’s knee alignment. Patients who are bowlegged (a condition in which legs curve outwards at the knees) and have affected region inside the knees have much lower chances of the Cartilage Replacement surgery success.

Knee Arthritis treatment provided by us include

  • Microfracture for smaller affected regions.
  • Cartilage grafting (OATS, osteoarticular transplant system): Taking cartilage from other areas of the body i.e. non weight bearing area of knee bones and grafting it back around the defected weight bearing area of the affected knee bones.
  • ACI (Autologous chondrocytes Implantation): Here the cartilage cells from patient’s knee (healthy cartilage area) are harvested in first stage of surgery. Once they are grown in culture media outside. In second stage they are implanted back over treated damaged weight bearing area
  • Fresh osteoarticular allograft : for a large affected area and failed microfracture surgery.
  • Food Supplements : High quality collagen Peptides, Vitamin C , Calcium and anti inflammatory natural supplements have shown good results in all early as well as in some advanced arthritis. Apart from the surgical procedures, it is important for the patients to have a regular and thorough assessment of some factors comprising of monitoring of overall health of the patient, relative age of the patient, alignment for the knees, the overall amount of narrowing between joint space, size of the defect, checkup of the remaining portion of meniscus, regular monitoring of diabetes are required for choosing the best treatment for some of the specific treatment of Knee arthritis. With complete evaluation and proper treatment at the right stage of the disease, the chances of having an improved and performing knee last longer.

Post Operation

The most essential part of treating knee arthritis is the post-operative rehabilitation program. When Patients undergoing microfracture treatment and immediately begins weight-bearing program they get the less successful result as compared to patients who are no on a weight-bearing program at least for three to six weeks and also for those who continuously use passive motion machine for 6-8 hours as an everyday routine. The patient must work diligently with their physical therapist for optimizing their post-operative results.

Patient education and awareness is incredible to catch their symptoms early and consult doctor in proper than adventuring over peer’s home remedies. Learned patients enjoy healthy knees for a long time when follow a doctor who is specialized for knee joint preserving surgeries and cartilage surgeries.

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