What we treat

knee Pain

Knee Pain

Knee Osteoarthritis (KOA)

Osteoarthritis, a degenerative joint disease, is the most prevalent form of arthritis and the leading cause of disability in India affecting about 15 million Indians every year. About 20 years ago, osteoarthritis was known as a disease of the elderly affecting those above the age of 65. However, today, an increasing number of younger people in the age group of 35-55 are being diagnosed with Osteoarthritis.


What is Osteoarthritis of the Knee?

Knee Osteoarthritis is caused when cartilage in the knee-joint wears away. Cartilage is a firm tissue in the human body, which is softer than bone and much more flexible. Cartilage helps in the smooth functioning of the joints.


What are the Symptoms of Osteoarthritis of the Knee?

Symptoms for Knee Osteoarthritis vary, depending on the age of the patient and severity of the problem. Here are some of the commonly found symptoms:

  • Pain and stiffness of the knee
  • Difficulty in movement
  • Swelling in the knees
  • Creaking/Grating sound or sensation during the moment of knees
  • Stiffness in knees in the mornings or after a period of inactivity or during cold weather
  • Extreme pain in the knee joints after being exerted
  • Some patients may have alternating painful and pain-free intervals
  • Formation of bone spurs around the knee – extra bits of bone which feel like hard lumps

What are the Causes of Osteoarthritis of the Knee?

There are a number of factors that could cause osteoarthritis. Below are a few common factors that increase the risk of developing this condition:

  • Genetics
  • Obesity
  • Older Age
  • Athletics and sports such as football, hockey, etc.
  • Illnesses like diabetes
  • Weak bones or low Vitamin-D levels
  • Formation of bone spurs around the knee – extra bits of bone which feel like hard lumps

How is Osteoarthritis of the Knee diagnosed?

The patients’ medical and family history as well as a physical exam is the foundation of diagnosing Osteoarthritis. In order to confirm the diagnosis, patients may be asked to undergo:

  • X-ray: For an idea about the abnormality in the shape of the bone and damage caused by the lack of Cartilage
  • Blood test: To confirm if there are any other reasons for the complication

Treatment for Osteoarthritis of Knee

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful in easing acute pain. Doctors are very careful while prescribing NSAIDs considering the risks of side effects usually suggest the lowest effective dose for a short period of time. Non-steroidal anti-inflammatory creams and gels are often prescribed as well.


Exercise and Weight Loss

Nonsurgical management of Knee Osteoarthritis starts with weight loss and muscle strengthening. Muscle strength is also vital in combating osteoarthritis. The muscles surrounding the knee joint act as shock absorbers for the pressure that daily activities and sports place on the joint. The stronger the muscles are that surround the knee joint are, the more stress they can absorb for the knee joint. Increasing muscle strength will decrease pressure otherwise placed on the joint, thus decreasing symptoms. Knee braces may also help in reducing the stress on the knees.


Transcutaneous electrical nerve stimulation (TENS)

A TENS is an electronic device having pads which are placed on the skin and pulse signals are sent to the nerve endings. This helps modify the pain sensation in the brain with tingling sensation. The results for this method vary from person to person.


Steroid Injections

These injections are mostly given directly to the particular painful knee. They take effect in a day and help in relieving pain for weeks or even months. Steroid Injections are used in extreme scenarios only.


Hyaluronic Acid Injections (Viscosupplementation)

Viscosupplementation is a procedure in which a thick fluid called hyaluronate is injected into the knee joint. Hyaluronic Acid is present in the body naturally and is found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for exertions on the joints. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints.

Viscosupplementation was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997.


1) The Procedure

  • Hyaluronic acid, a gel like fluid, is injected in the knee joint to help lubricate it.
  • There may be a single or multiple shots of Hyaluronic Acid given to the patient, depending on the case.
  • The procedure is advised when steroid injections fail to show progress.

2) Results

  • This procedure is best for patients with mild to moderate OA of the knee.
  • Not all patients are helped by the injections. Most patients report the greatest pain relief 8-12 weeks after beginning treatment, though some fee a difference within the first 3-5 weeks as well.
  • The length of pain relief varies; some patients have reported benefits for more than 6 months following the injections.

3) Side Effects

  • The most commonly reported side effects associated with the hyaluronate injections are temporary injection-site pain; swelling, heat, or redness; rash and itching; bruising around the joint; and fluid accumulation in the injected knee.
  • These reactions are usually mild and don't last long. Similar to steroid injections, rare complications include infection and bleeding.

Knee-Replacement Surgery

Knee-replacement Surgery is advised when the pain becomes severe enough to make daily tasks extremely painful and difficult. Majority of patients with Knee Osteoarthritis do not need Knee-replacement surgery.

Stem Cell Therapy

Stem Cell Therapy is a non-surgical procedure which utilizes the stem cells from the patients’ own body reserves to help heal the injured area. This procedure has gained popularity in recent years due to its success ratio.

What are stem cells?

Every organ in the human body is made up of cells. These cells help in the smooth functioning of each particular organ. Every day, millions of these cells die and new cells are produced within the body. This process is called degeneration and regeneration of cells. These new cells are generated from a specific cell in the body, known as the 'Stem Cell". The Stem Cell is in essence a parent cell which functions just to replace the new cells with old ones. Stem cells are primitive blood-forming cells that normally live in the bone marrow. They divide and mature into all the different types of blood cells (red cells, white cells and platelets), including the cells of our immune system.

When a number of cells come together, they form a tissue. When the tissue itself is damaged, the degeneration rate of cells goes higher than the regeneration. As a result, there is complication in the functioning of that organ, with pain and weakness.


The Procedure – Stem Cell Therapy and Knee Osteoarthritis

When the body is unable to regenerate cells as fast as the rate of degeneration, new stem cells need to be introduced to the part of the body where the complication is faced, in this case, the knee. This procedure is well tolerated by patients and not considered difficult.

  • A special needle is inserted into the bone to withdraw marrow blood, which contains the stem cells. This need also extracts concentrated platelets, which are introduced into the injured area after the stem cells.
  • The harvested bone marrow blood is then concentrated through a lab process, where the stem cells are separated from the marrow blood; and is re-injected exactly into the injured tissue.
  • Once the stem cells are injected into the injured area, the platelets are again injected to keep the stem cells active for a long time. If stem cells are the seed in a lawn, then the platelet rich plasma can be considered as fertilizer.
  • When the stem cells are re-injected, they improve the natural repair process of degenerated and injured tendons, ligaments, and arthritic joints.

There are two major types of stem cell transplants: Autologous and Allogenic. Autologous is the type when the stem cells are withdrawn from one's own blood (Mesenchymal Stem Cells) while in Allogenic procedure, the stem cells are withdrawn from a donor's blood.


Advantages of Stem Cell therapy

The fact that Stem Cell therapy is relatively pain-free makes it a viable alternative to knee-replacement surgery. Most patients return to normal activity following the procedure and are able to avoid the painful and lengthy rehabilitation periods that are usually required to help restore strength, mobility and range-of-motion following invasive joint surgeries. Furthermore, patients are far less vulnerable to the risks of surgeries, such as infection and blood clots.

The major difference between any other treatment and stem cell therapy is that it doesn't just suppress the pain and other symptoms but works on actually recreating the new cells in the damaged body. It is a healing process for the knee. Many believe that Stem Cell therapy is the best substitute for knee replacement.

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