Is your knee joint troubling you with weight-bearing activities? Do you feel that it is inevitable with aging comes the joint related issues such as pain, stiffness, and restricted range of motion? It affects around 10 percent of men and 13 percent of women aged over 60 years. Osteoarthritis is a progressive disease. Symptoms worsen over time. There is no complete cure, but treatment can help the individual control pain and swelling and stay mobile and active. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips, and spine. The probability of developing osteoarthritis increases with the age of the person. Over the age of 60, most of the people suffer from osteoarthritis to some degree, but the severity varies. Even people between the ages of 20 and 30 can suffer from osteoarthritis, although there are often causes such as: As a joint injury or repeated stress on the knee joint. In people over 50 age, more then men women suffer from osteoarthritis. If you believe that growing old brings upon joint related issues that hamper you from performing day-to-day- activities, then we insist that you read this blog provided just for you by Dr. P Gopal Reddy gives information about what is osteoarthritis, causes, symptoms, and treatment options available. What is Osteoarthritis? Simply means Inflammation of the joint. This happens when the protective cartilage, which cushions the edges of your bones, depletes with time. The connection between both bones is called a joint. The ends of these bones are covered with a protective tissue called cartilage. With OA, the cartilage is destroyed and the bones in the joint rub against each other. This can cause pain, stiffness, and other symptoms. It’s a slow process, and that develops over many years. If not treated in time, it causes osteoarthritis. In knee cartilage in between the tibia (shinbone) and femur bone (thighbone) gets destroyed and bone joint rub against each other, which causes pain and stiffness during movement of the knee. Generally Disease of Advancing Years:
- Can develop in younger people
- Common in women than men
- In India, people, the knee is most commonly affected, hip, spine, and joints of the hand are affected less.
Osteoarthritis Causes: Factors that can cause osteoarthritis include:
- Advancing Age
- Joint Diseases and Infection
- Fracture in around the knee joint
- Genetic Predisposition
- Patterns of joint usage
- Metabolic disorders
- Local mechanical stress on the joint
- Bone deformities
Osteoarthritis Symptoms in Knee Joint: Osteoarthritis symptoms often develop slowly and get worse over time. Signs and symptoms of osteoarthritis include:
- Continuous or intermittent pain in a joint
- Stiffness in a joint while sitting for a long time or getting out of bed
- Swelling of the joint
- A crunching feeling at the round of bone rubbing on bone (crepitus)
- Loss of Flexibility in knee
- Bone Spurs
- Grating Sensation
When OA becomes advanced, the associated pain can get worse. Over time, swelling of the joints and surrounding space can also occur. Recognizing the initial symptoms of OA can help you to treat the condition better. How to Suspect Osteoarthritis in Knee:
- Stiffness, Swollen, Painful knee joint
- Difficulty while working, climbing, and getting out of chair and bed.
- Need support while walking, holding, railings, walls, stick, Etc.
- Exacerbation and remission of symptoms.
- Loss of movements and deformity at the joint indicates an advanced stage of the disease.
What Tests Are Used to Diagnose Osteoarthritis?
- Currently, no blood test for Osteoarthritis, although blood tests are sometimes used to rule out other types of arthritis.
- X-ray: Most useful test to confirm Osteoarthritis in the knee.
- MRI: Can be helpful, shows soft tissue (Cartilage, tendons, muscles) which can’t be seen in X-rays.
Treatment Approaches to Osteoarthritis for Knee At Dr. P Gopal Reddy:
- Weight Control
- Rest and Joint care
- Pain relief techniques
- Finally, if all fails surgery (Joint replacement surgery)
- Discuss exercise plans with your physical therapist provided by a surgeon
- Start exercise under the supervision of a physical therapist
- Stretch and warm up with ROM exercise
- Start strengthening exercise slowly with lifting small weights
- Improvement can be seen slowly
- Stop if the joint becomes painful, inflamed
Go to the doctor immediately if you feel pain and discomfort and he will suggest you with some other exercise or treatment. “Inexpensive and has no side effects” and exercise helps knee joint in the following:
- Decrease pain
- Increase flexibility
- Improve mood and outlook
- Maintain weight
- Promote general physical fitness
Some of the exercises are given below
Straight leg raising – sitting
Straight leg raising – lying
Range of motion
- Obesity increases stress along the joint
- Weight reduction limits destruction by decreasing stress
- Healthy eating habits
- A healthy diet and regular exercises
Rest and Joint care: Do’s
- Regularly scheduled rest.
- Learn to recognize any discomfort or body signals and know when to stop or to slow down
- Prevent pain due to overexertion
- Do Relaxation techniques for stress reduction
- Use canes and splints to protect joints
- Use splints only for a limited period
- Need to exercise to keep muscle away from stress
- Wear properly fitted shoes with well-cushioned soles
- Use ramps or elevators.
- Avoid squatting
- Avoid low beds, chairs, toilets, use only elevated
- Avoid continuous, stair climbing, walking, and standing, for a more extended period.
- If you must use stairs rather than ramps or elevators, then take stairs one at a time, and occasionally stop to take a rest.
Pain Relief Techniques(Non-drug) :
- Use warm Towel
- Hot packs
- Hot water bath at a shower
- Cold packs in some cases (acute exacerbation)
- Water therapy in a heated pool at whirlpool
Medicines: Goals for Prescribing Medicine :
- Eliminate and reduce pain
- Improve function
Meet a doctor when you have below effects by using medications:
- Increase in the intensity of pain
- Potential side effects of the medicine
Examples for some medicines:
Should be used cautiously in patients with liver disorder and heavy alcoholics
- E.g., Aspirin, Diclofenac, Nimesulide, etc.
- Take care about stomach irritation and ulcer
- Derangement of kidney function
- Longer the usage of medications, more the side effects
- Topical pain-relieving creams, rubs, and sprays
- Intra Articular steroid injection
Temporary Measure: Not to use more than 2 to 3 times a year. Check Some of the Questions with your Doctor while a Having Medication as a Treatment Option:
- How often should you take this medicine?
- Should take this medicine with food or between meals?
- What side can effects expect?
- Should take medicine with the other prescription medicine?
- Should take this medicine directly at the pharmacy shop?
Finally, if all fails Surgery (Joint Replacement Surgery) New hope in patients suffering from joint pains:
Performed to relieve:
Surgery is Indicated When:
- Pain not responding to medicine
- Severe pain while performing daily activities
- Progressive deformity
Advantages Of having Surgery:
- Absolute relief from pain
- Near normal range of movements
- Deformity correction
What Happens Before the Surgery in Hospital: Preoperative Care
- You are usually admitted to hospital a day before the operation, but this will vary from hospital to hospital and depending on how healthy you are.
- On the day of admission, you will undergo some blood tests, cardiac evaluation, and pre-anesthetic check, written consent will be taken for surgery.
- You will be wheeled on a trolley to the operation room.
- Your doctor will ask for an X-ray, and it will likely do an MRI scan to understand the condition of the knee fully. These photos help your doctor to identify knee details. The results will help you make the right decision for determining the dimensions and placement of your implants in surgery. Images also help determine the best surgical approach.
- Your doctor may change your prescription if you are taking any medication. You can also prescribe new drugs, such as anticoagulants, for smoother surgery.
- Stop Smoking
- A tiny plastic tube will be placed in a vein, usually on the back of your hand. This tube is used to inject drugs for relaxation, sleep, and pain control antibiotics to prevent infection. The Anesthetist will discuss and decide with you, which is the most appropriate anesthetic in which can you will fall asleep. However, there may be medical reasons to use a spinal anesthetic or epidural anesthetic where a needle is inserted in your back to freeze the body from the waist down.
The Operation Itself:
- The surgery procedure usually takes between one and two hours.
- The surgeon will cut the front of the knee.
- Surgeons use a tourniquet (a tight band) above the thigh to stop the flow of blood through a vein or artery, (not in case of total hip replacement) during the operation. This reduces blood flow around the knee and makes the operation easier.
- After performing surgery, the wound is closed either with an absorbable sticker, removal sticker, or clips.
What is the New Joint, and How Does it Work?
- Normally the slippery cartilage on the end of the thigh bone and the shinbone joint allows the knee to move easily against each other. The knee is also held together by ligaments which place the knee bones in the right position.
- In severe arthritis damages the cartilage becomes thin and may wear away completely in between the joint. The bones then rub against each other and become worn.
- To replace the knee joint, the surgeon removes the worn out ends of the bones and replaces them with metal and plastic. These materials have been successfully tried and tested for many years.
- A single curved piece of metal replaces the end of the thigh bone (femoral). A flat plate of metal replaces the top end of the shinbone (tibia). Plastic is fixed to this flat plate to act like cartilage and help the bones move easily. With this new joint knee becomes stable and pain-free (near normal).
What Happens After The Surgery?
- During the first 24hrs after surgery, your pain will be controlled by drugs/injections.
- After the first or second day, they remove the plastic tubes used for fluids medications and drainage will be removed.
- Now the Physiotherapist will ask you to get up so that you can start working. You can sit on the bed, and you will be encouraged to keep knee straighten within a day or two after surgery.
- Everyone’s recovery is different, and some people progress faster than others. If you had good muscles before surgery and your knee is not damaged very badly, and you will get up and about to walk with support using Axillary crutches within 2 or 3 days of surgery.
- However, don’t get discouraged if you can’t walk this recovery may vary from person to person because your muscles may be weakened and your knee may be damaged so, in this case, it will take a little longer to gain proper control of your knee.
After the Surgery: Postoperative Care:
- Before going back to the home, you will spend some time in the recovery room.
- You may be given more fluids and drugs such as painkillers through the saline tube in the arm.
- If necessary, a blood transfusion will be given.
- Many surgeons use plastic tube drains from the knee for the first 24 hours to 48 hours to remove blood, which could otherwise cause excess burning around the knee.
- The doctor will cover the surgical site of the knee with a bandage to avoid infections.
- If your anesthetist has used a spinal anesthetic or a nerve block, then you will not feel pain in your legs while resting in the recovery room.
- Pain medications and antibiotics are prescribed by the surgeon, which you should take as prescribed.
- Followup appointments are given by the doctor, which should be adhered to for early post-op recovery.
When To Leave Hospital After Surgery? It depends on how fast you are recovering and other factors. Dr. Chandrasekhar Reddy will observe your condition, and he will discuss with you about your condition, and he will discharge accordingly. After the surgery, you will likely be able to walk along with the carrier without help, just using crutches for support. You will be able to go to the bathroom and able to manage steps and stairs independently. Sutures and staples will be removed between 12-14 days from the day of surgery if they are dissolved by their own. The First Few Weeks At Home:
- It is better to cancel major commitments for the first six weeks after the surgery. Because knee bone requires rest and you most probably need to use crutches or a walker.
- You will also need painkillers because exercise will be painful.
- Every day you will need to carry out exercises to build up the muscle to recover the range of movement.
- Good supportive shoes or slippers are the best worn in the early days to help your walking.
- No need to sleep in a particular position after knee surgery.
Conclusions: We all have to agree with the fact that age, or time in this matter, brings forth many changes to our body. As time moves forward, we tend to grow old. This is an undeniable fact. Our body, at some point in time, gives us an indication that I am done and could only proceed with caution. The human body is similar to that of a machine. The more you make the machine performance, the more are the chances of the machine to undergo repair. As age grows, one has to limit the activities. Surgery is recommended as a last resort to enable you to perform your daily activities and also to reduce the symptoms emanating from degenerative joint disease. Following up with the treating surgeon and the physical therapist after the surgery is very crucial. If you have any answered queries, please pick up your phone and call us at 9949255522 and meet our Dr. Gopal Reddy, Senior Consultant Orthopaedics and Joint Replacement Surgeon. About Gopal Reddy: Dr Gopal Reddy, a skilled and fellowship, trained hip replacement surgeon in Hyderabad possessing valuable experience and expertise in the field of orthopaedics. With the help of continuous education, he attained the best skills that are a must for an orthopaedic doctor to become the best hip replacement surgeon. He can deliver successful outcomes with zero complications.
With 20 years of experience in the field of orthopaedics, Dr Gopal Reddy always strive to provide the world-class orthopaedic treatment to the patients suffering from the joint pain. He is a renowned total knee and hip joint replacement surgeon offering excellent and quality orthopaedic care for all the patients whoever approaches him. Education and Training
- M.S.(Ortho), Fellow-Joint Replacement Surgeon
- Trained from AIIMS, (New Delhi) & Australia
- Senior Consultant Orthopaedics and Joint Replacement Surgeon