How common are knee joint health problems & when is the need for a Specialist?

According to Dr. Raju Vaishya, a leading orthopedic & joint replacement surgeon in New Delhi "Knee pain is a common problem these days, which we see not only in elderly people but also in middle-aged or young people. Any pain in the knee joint which lasts for more than a couple of months, for which you require regular painkillers or some treatment, should alarm you to consult a specialist. Another thing that is very common in knee problems is difficulty in getting up from a chair, difficulty in climbing stairs, coming downstairs, difficulty in using the Indian type of toilet, difficulty in sitting in a cross-legged position, and difficulty in running. If any of such problems are occurring then it shows that you have an onset of arthritis and you must consult a specialist."

 

What are the most common reasons for knee pain?

1. Lack of proper lubrication in the knee joints area, result in chronic knee pain. 

2. Obesity puts the knee under tremendous stress, even in the young population. 

3. Vitamin D deficiency is an important factor which has been found to cause pain in in the knees, especially at an early age. 

4. Osteoarthritis & Rheumatoid arthritis in old age - Something very natural that happens in elderly people. The longer you live the more chances you have of getting arthritis. 

5. Post-traumatic arthritis - some injury to the knee joint, some fracture or ligament injury, which if not properly treated gives rise to arthritis. 

 

Patient education to surgery - knee pain is treated according to its stage & severity, says Dr. Raju vaishya

Patient Education:

So, stage-wise management of any problem, especially of the joint, first starts with patient education. A patient must be educated by the doctor that what are the problems that the patient is having and what is the diagnosis, how the patient can prevent it from getting worse, and how we should manage in order to live comfortably with the problem like arthritis. So, patient education is very important because if the arthritis is of chronic type, and if a person has to live for many years with it, and if he or she knows about it, the patient can manage themselves very well, like in any other chronic condition such as diabetes, blood pressure or heart problem. So, all chronic diseases require patient education and patient cooperation. That is number one, much more important than any other treatment. 

 

Physical Exercise

And the second part of the treatment is physical exercises, to strengthen the joint muscles around the joint. Then physiotherapy, in addition to activities of daily living. There are certain things which put your joint, like knee joint, in distress and those should be avoided, such as jumping, running, sitting in the cross-legged position, using Indian toilet, etc. 

Reducing weight  (in overweight or obese patient) is of tremendous help. If one can reduce a significant amount of weight or even a little, loss of weight can put your knee joint in tremendous comfort, because the stress on the knee is reduced significantly. So, weight reduction is an important thing.

 

Physiotherapy 

After doing all this, if someone still has pain, then the patient may require physiotherapy and some medicines, to strengthen the cartilage of the knee joint. This is now possible with the use of certain nutraceuticals or food supplements like curcumin extract like Boswellia, ginger and all these things are now available commercially in capsule form. This improves nutrition. Vitamin D and calcium are very, very important for bone health and should be taken if required. Painkillers may be required if there is intense pain or inflammation, but these should be avoided as far as possible because they in long-term use produce side effects to the stomach, kidney, heart, and brain. And hence painkillers are not the solution for your knee pain. These may damage the important structure vital organs of the body. And secondly, they do not alter the disease process they can only give you temporary relief. So, painkillers are to be avoided. Those patients who have persistence of pain may require further intervention in the form of injections in the joint using either steroid injection.

Nowadays a viscous gel is available, which improves the internal environment of the knee or lubrication of the joint. This is known as hyaluronic acid This can help the patient for six months to two years and can also be repeated. So that is good. 

Surgery

The operations, that are commonly done in patients who are refractory to the above treatment, is keyhole surgery or arthroscopic surgery. Another one is the partial or total joint replacement, which is reserved for end-stage arthritis, where all the treatments have failed or if the patient has presented late and is unable to walk and stand, specially reserved for older people. But nowadays, since arthritis in some people starts early surgeons may have to do it early.

 

Watch Orthopedist Dr. Raju Vaishya speaking on the safety & efficacy of knee replacement surgery or total knee replacement

"Knee replacement surgery can be a game-changer in the life of a patient who has been bearing severe pain for a long time now. How safe are these procedures and when is the time to get them done, explains Dr. Raju Vaishya

The knee replacement is now pretty safe. And in fact, it is one of the safest and most successful operations in orthopedic surgery, with a success rate of more than 95%, with a longevity of 20 to 30 years. So, there is no doubt that knee replacement, if it is properly operated on the patient, well done by an experienced surgeon in a good center, gives you outstanding results, informs Dr. Raju Vaishya, orthopedic & joint replacement surgeon working at Apollo Hospital (Sarita Vihar) & Healing touch clinic (Sukhdev Vihar - Okhla), New Delhi 

The doctor says that "But it is reserved for end-stage arthritis. Arthritis is divided into four stages- one to four. One being the least of and the four is the most affected joint. So, Knee replacement surgery is usually indicated in stage four arthritis where there is direct bone to bone contact and all the cushioning cartilage of the knee joint is worn out. This can easily be assessed on a standing X-ray of the knee joint and if the patient has a continuous problem, the patient has a deformity, unable to walk properly- Instead of taking painkillers, it is better to go for a knee replacement. Because it not only it will relieve the pain but it improves the quality of life tremendously and if somebody has to live for 10, 20 or 30 years more. Nowadays life expectancy is pretty good, most people go up to 70-75 or 80."

He says "So, if someone has knee pain, due to severe arthritis at the age of 55-60 instead of pulling on with painkillers, etc for the next 10-20 years, it is better to go for knee replacement, so that you can avoid complications related to chronic use of painkillers."