KNEE PAIN

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.

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.

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

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

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

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.

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.

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.

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.

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.

• 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.

• 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.

• 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 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.