Dr. Kaiwan M. Randeria

 

Dr. Kaiwan M. Randeria is an Orthopedic Surgeon, holding a Fellowship in Joint Replacement Surgery. He aims to increase awareness about bone health, which has been adversely affected in keeping with today’s unhealthy lifestyle and nutritional issues. [Connect with him at: drkaiwan94@gmail.com ]

 

It was a routine Monday morning and while I was brooding over my Monday blues, a tense male in his mid-50s came to the OPD with a palpable tension in his voice. He asked, “Doctor, my right knee has been hurting since the past 10 months whenever I exercise or jog.. and no matter what I do, it just doesn’t seem to resolve!”

An examination of his knee revealed a ‘crepitus’, which is a clinical sign of a grating sensation noticed when the osteoarthritic process starts. There was also an outward bowing of his knee joint, known as a ‘varus’ deformity. This diagnosis was confirmed by an X-ray.

Let’s try and understand some facts about Arthritis…

What Is Arthritis?

“Arthros” means joint in Latin, while “itis” stands for inflammation. Simply put, it means an inflammation of a joint. Arthritis can occur in the knee, hip, spine, shoulder, elbow, phalanges (fingers & toes) and ankle joints depending on the type of causative mechanism. The cause of arthritis can be manifold such as degenerative (wear and tear), autoimmune (e.g.- Rheumatoid and Ankylosing spondylitis), post infectious, post traumatic (i.e. after any injury) and hemophilic (due to repeated bleeding into the joint in blood clotting disorders) to name a few.  The most pre-dominant amongst these is primary degenerative arthritis of the knee joint, which I shall elucidate further.

 

What Is Primary Degenerative Arthritis Of The Knee?

Osteoarthritis has a prevalence of 22% to 39% in India. The knee joint is formed at the juncture of the femur and tibia (lower end of the thigh bone with upper end of the shin bone) with two intervening menisci (cartilages). The menisci act as a cushion between these bones. The wear and tear of these cushions results in direct friction between the two bony surfaces. This is accompanied by irregularities in the form of outgrowths (spurs), and loose bodies in the joint. There is also inflammation and irritation of the joint capsule leading to pain in joint movements.

 

Who Is At Risk For Osteoarthritis?

While the exact cause of primary osteoarthritis is yet to be ascertained, the following are a few predisposing risk factors:

Age: 55-65 years’ age group; although recent trends have shown an occurrence in the lower age groups too.

Gender: Higher predisposition and disease severity in women.

Obesity / Lifestyle: Almost twice the incidence is seen in obese individuals with a sedentary life.

Hereditary: Osteoarthritis is passed through generations in families, but the inheritance pattern remains unknown.

 

Symptoms of Knee Osteoarthritis

The most frequent complaint is that of a mild to severe aching pain in the knee joint during activity, with stiffness especially after periods of inactivity. The pain is aggravated on performing strenuous activities, sitting up from a squatting position and climbing stairs. These symptoms may be accompanied with a creaking or grating sensation in the joint. There may be a change of alignment which is visible as an outward or inwards bowing of the knee joint. This discomfort eventually results in decreased activity levels leading to further weight gain which in turn exacerbates the tendency for increase in cholesterol levels, diabetes and other health issues, leading to a vicious cycle.

Managing Primary Osteoarthritis Of The Knee

Always consult your orthopaedist – never self-diagnose any sort of joint pain. A simple way of managing this disease is depicted by the ‘Dieppe and Lohmander Pyramid’. (Note: The treatment is dictated based on your existing disease severity and should be followed strictly as per your orthopaedist’s advice)

 

Step 1 – Holistic Approach: Proper education regarding the disease, weight loss by diet modifications, changing to appropriate footwear and general exercises.

Step 2 – Core Treatments: Specific exercises to strengthen muscles around the knee joint, warm fomentation and providing simple analgesics (as prescribed by the doctor only)

Step 3 – Simple Non-Surgical Interventions: Walking aids such as sticks / crutches, electrotherapy techniques, walking braces, use of non-steroidal anti-inflammatory medicines, topical liniments.

Step 4 – Advanced Non-Surgical Interventions: Injections into the joint space. (This management has several contrasting opinions with some doctors some avoiding this step.)

Step 5 – Surgery: in the form of total or partial knee replacement, high tibial osteotomy (in younger patients wherein the bony alignment is restored), arthroscopic debridement (i.e. extraction of loose debris from the knee joint) and synovectomy (i.e. a partial removal of the synovium; a thin membrane that lines the joint) to name a few, as deemed fit by the orthopaedist, depending on the severity of the disease.

 

Can We Reverse This Process Or Cure This Issue Without Any Surgical Intervention?

Unfortunately, the answer to this is largely no. When the human body walks, there is a continual wear and tear of the knee joint which over a period of time tends to get worn out especially when the load acting on the joint i.e. your body weight is on the upper limit. The progression of arthritis can be delayed, and the severity can definitely be managed by weight loss and physiotherapy but it cannot be totally reversed.

 

In conclusion, Primary Osteoarthritis has become a prevalent issue in our population and has a lifestyle component also influencing it. One should try and maintain a normal BMI (Body Mass Index), have a healthy and balanced diet and exercise frequently. If detected early, the disease can be controlled well with weight loss (if overweight), correct exercises and physiotherapy. Severe osteoarthritis mostly requires surgical management as decided by the orthopaedist.

 

Our Parsi community has an inclination to consume fatty foods and red meats in excess which leads to raised uric acid and weight gain. Yes, we all have heard the story of the stereotyped Parsi octogenarian amongst us who would have spent his entire life eating ‘Salli-boti’ and ‘Dal-ni-poris’ but has ‘never had to visit a doctor in his life’. However, my advice would be not to risk your health striving for such an achievement. A good healthy balanced diet with regular exercise can keep your joint health in good condition.

 

[Disclaimer: The contents of this article should not be considered as formal medical advice. Kindly visit your orthopaedist for any related treatment.]