UNDERSTANDING OSTEOARTHRITIS OF THE KNEE

Osteoarthritis is characterized by degeneration of the joint cartilage (cap covering the ends of long bones) with destruction of the bones at the joint and weakening of its supporting tissues.

Our Knee Joint Is Made Of:

• Lower end of the femur (the thigh bone)
• Upper end of tibia (the leg bone)
• Patella (the knee cap bone)
• A strong capsule that covers these bones ends
• The tendons, that with the help of muscles, moves the knee joint
• And the ligaments that stabilize the knee joint, and allow movement of the knees in only one axis just like the hinge of the door
• The undersurface of the capsule is lined with thin tissue called synovium which is studded by blood vessels and lots of nerve endings.

The ends of the tibia and fibula and the undersurface of the patella are covered with cartilage.

These cartilages are of thickness of 2 mm to 3 mm in a healthy adult.

There is small amount of fluid also present in the knee joint.

The joint cartilage is one of the smoothest surfaces known. It along with the synovial fluid makes the knee join 10 thousand times more slime than the two surfaces of ice rub together.

Osteoarthritis is not only destruction and rough bone ends it’s beyond that……

It’s characterized by:

·        Destruction of the joint cartilage

·        Roughening of the ends of the bone and their destruction

·        Swelling in the synovial lining of the capsule

·        Destruction of the joint capsule and loss of its elasticity

·        Loss of alignment of the joint

·        Destruction of the ligaments that stabilize the joint

·        Weakening of the muscle and the tendon those move the joint

These changes don’t occur all together and sometimes it takes years for this gradual degenerative destruction. The cartilage and the bones don’t have nerves so there destruction is painless. The pain starts when the synovium swells or the knee become stiff or the knees become instable. More the severe are these changes more is the discomfort and the pain.

SYMPTOMS OF OSTEOARTHRITIS KNEE

–       Steady or intermittent pain in knee joint

–       Stiffness that tends to follow periods of inactivity, such as sleep or sitting

–       Crunching feeling or sound of bone rubbing on bone (called crepitus) when the joint is used

–       Inability to walk long, squat or sit cross leg

–       hard swellings (caused by osteophytes)

–       soft swellings (caused by extra fluid in the joint)

Other symptoms can include: 

• your knee giving way because your muscles have become weak or the joint structure is less stable
• your knee not moving as freely or as far as normal
• your knees becoming bent and bowed
• the muscles around your joint looking thin or wasted.

PREVENTION OF OSTEOARTHRITIS

Osteoarthritis (the above changes of the knee) is age related and is inevitable. What we intend is to delay it as late as possible and to reduce its severity. But not everyone develop osteoarthritis, and if they do their severity is different. So there are some risk factors that predispose a person for osteoarthritis of the knee. Understanding the risk factors may provide some help to check osteoarthritis.

RISK FACTORS FOR KNEE OSTEOARTHRITIS

• Modifiable
• Excess body mass
• Joint injury (sports, work, trauma).
• Occupation (due to excessive mechanical stress: hard labor, heavy lifting, knee bending, repetitive motion).
• Men—often due to work that includes construction/mechanics, agriculture, blue collar laborers, and engineers.
• Women—often due to work that includes cleaning, construction, agriculture, and small business and retail.
• Structural malalignment, muscle weakness.
• Non-modifiable.
• Gender (women higher risk).
• Age (increases with age and levels around age 75).
• Race (our Asian populations have lower risk as compared to western world).
• Genetic predisposition.

Lifestyle modifications:

• Weight reduction
• low-impact activity, such as walking, aerobic aquatics, and biking, for all patients, including those with mild to moderate arthritis.
• physical therapy with patients who have functional limitations.
• In Indian setup :

• we have to promote western commode for defecation
• Avoid  squatting or cross leg on the ground
• Look for chair while in mosque, temple or gurudwara
• warm saline (water with salt) fomentation
• local ointment applicatiion
• Avoid sitting on ground for prayers or namaj and prefer chair for that

My mantra for prevention of osteoarthritis is to repeatedly chant in yourself that I have to prevent myself from puttin my body's weight on my bent knees

Treatment of osteoarthritis

Osteoarthritis is like aging, the changes that has occurred can’t be reverted. What we can target is to reduce its progress and decrease the discomfort and the pain. If the preventive and medicines fail to give comfort to the patient than we can think of surgical treatment. The surgical treatment includes arthroscopic debridement, high tibial osteotomy and unicondylar or total knee replacement.

But always make it clear it in your mind that treatment options are totally decision of your doctor and one has to consult an orthopedician for initiation of treatment

A)     Lifestyle modification and prevention as already explained

B)      Pharmacological treatment (medicines)

      a)      Analgesics :

•  Both NSAID group as  well as Opiods are used for the treatment of pain in osteoarthritis. Oral NSAIDs are used with caution in patients with cardiovascular disease, peptic ulcer disease, or renal disease.
• NSAIDs should be used at the lowest effective dose and for the shortest duration necessary to control symptoms
• Topical NSAIDs may also be used in patients at risk for gastrointestinal adverse events and are recommended for treating osteoarthritis of the knee in patients aged ≥75 years.
• With the exception of diclofenac, topical agents have not been proven to be as effective in controlling osteoarthritis pain as oral NSAIDs.
• Topical NSAIDs should not be administered with oral NSAIDs due to increased risk of gastrointestinal adverse events, Antaacids are often prescribed along twith NSAIDs
•  Dietary supplements such as glucosamine, chondroitin, fish oil, and vitamin D/calcium have not proven effective against osteoarthritis pain, but few reseach say that they hep in regeneration of the bone and thus help in longstanding survival of the joints

OPIOIDS IN OSTEOARTHRIS: Opiates are prescription medicines and are usually reserved for treatment of moderate to severe pain in people for whom acetamino acetaminophen, NSAIDs, exercise, and physical therapy have not worked.