Knee pain can be defined as acute pain or long term (chronic) knee pain. Acute knee pain can be caused by meniscal injuries, tendon ruptures, ligament tear or fracture of any of the bones of the knee. Causes of long term knee pain (chronic) are osteoarthritis, rheumatoid arthritis, gout, tendonitis, bursitis or infectious arthritis.
Arthritis pain can begin suddenly, but it is more likely to develop slowly. You may feel a grinding sensation in your knee as you move. You might even hear cracking or popping sounds coming from your knees. You are most likely to notice a restricted range of motion when you climb stairs or in other daily activities. Arthritis can make it challenging for your knee to perform previously simple movements difficult or impossible. As arthritis progresses you may notice changes in your knee’s appearance. Your knees can start to point toward each other or bend outward.
There are more than 100 different types of arthritis and related disease. The most common types are osteoarthritis, Rheumatoid arthritis (RA) and Gout. In osteoarthritis the protective cartilage inside the joint wears away. This makes movement of affected joints difficult and painful. The intensity of osteoarthritis pain may vary from person to person and can range from mild to severe. In Rheumatoid arthritis the joints and other organs are attacked by the body’s own immune system. Normally the immune system protects human body from invaders like viruses, bacteria. In rheumatoid arthritis it becomes overactive and attacks healthy tissues. In people with autoimmune disease like RA, the persistent inflammation breaks down the joint and damages it permanently. Gout is a form of inflammatory arthritis but it does not cause body-wide inflammation like RA. In Gout, uric acid crystals are the roots of problem. Excess uric acid can form crystals in joints. This results in painful joint inflammation. Gout usually strikes in the large joint of the big toe, but can also affect other joints.
Osteoarthritis also known as wear and tear disease of the joints, is the most common type of arthritis. In osteoarthritis the protective cartilage inside your joints wears away, causing your bones to rub together and your joints to swell. osteoarthritis affects mainly weight bearing joints like knee, hip. Common symptoms of osteoarthritis include joint soreness, morning stiffness, pain and inability to move through a full range of motion. Age, genetics, excess body weight, injury or overuse of the joint are the main causes of osteoarthritis.
Osteoarthritis commonly occurs in weight bearing joints of the knees, hips and spine. It may also affect the fingers, thumb, neck. Osteoarthritis usually does not affect other joints unless previous injury, excessive stress or an underlying disorder of cartilage is involved.
Our knee is divided into three major compartments, the medial compartment (the inside part of knee), the lateral compartment (the outside part of knee) and patello femoral compartment (the front of knee between knee cap and thigh bone). Normally osteoarthritis starts from medial compartment and gradually affects other compartments of knee.
Osteoarthritis is perceived as a disease associated with ageing but in actual fact. It can affect anyone at any age. Overweight and obese individuals are at high risk of developing osteoarthritis, losing weight can help preventing osteoarthritis. Maintaining a healthy life style with low-impact exercise, getting plenty of rest and sleep, and maintaining healthy diet and body weight can help you improve your joint health and prevent osteoarthritis.
Bone to bone contact knee pain indicates severe osteoarthiritic knee. When the cartilage in the knee wears away to the point of causing bone to bone contact knee pain, diagnosis will involve moving your knee to check range of motion and signs of degeneration and injury. Your doctor will also ask you question about your medical history. This can include details of your symptoms and how long you have been experiencing them. Imaging test like x-ray, MRI, will be used to confirm a diagnosis of bone to bone contact osteoarthritis. The initial treatments of osteoarthritis are weight reduction, physiotherapy and life style modification. When the conservative treatments for advanced stage of osteoarthritis have been exhausted, then knee-replacement surgery is the procedure of choice. Knee-replacement surgery or knee arthoplasty, is a surgical procedure to replace the damaged surfaces of the knee-joint to relieve pain and disability, correct mal-alignment of knee joint.
Knee replacement / resurfacing surgery can be performed as a partial knee replacement or total knee replacement surgery. When there is a severely damaged osteoarthritic knee, the joint is completely degenerated then total knee replacement surgery is the preferred procedure, but when patient with osteoarthritis that is limited to just one part of the knee, he/she may be candidate for partial knee replacement.
In partial knee replacement only the damaged part or compartment of knee is replaced with metal and plastic. The healthy parts of the knee are left alone. By using ligament preservation technique both the ligaments ACL and PCL can be kept intact. Thus this technique makes partial knee replacement beneficial for young active patients, who want to do sporting activities and lead a very active life style by achieving normal function in knee.
Use of advanced technology in knee replacement surgery has made this procedure more accurate and long lasting. The availability of advanced prosthetic materials provide orthopedic surgeons with options that helps increase the longevity of the prosthesis. Studies have shown well-aligned knee replacement may last longer and be more functional. This can be achieved by the use of computer navigation for knee replacement surgery. Computer assisted surgery can help the surgeon to align the patient’s bone and implants accurately which is not possible with the naked eye. It can also help in ligament balancing that insures better range of motion.
With CAS technology surgeons are able to make accurate adjustments to ensure the optimal implant fit, which reduces joint wear and extends the life of the implant. Other benefits of CAS are:-
- reduces the size of incision
- less blood loss during surgery
- prevent damages to muscles and ligaments
shorten time to recovery
There are some risks associated with this surgery like DVT and infection, but in the hands of well-trained, dedicated joint replacement surgeon, the risks should be quite low. So one should be very careful, while choosing joint replacement surgeon for knee replacement surgery.
Knee replacement surgery is a safe, effective option to relieve the pain. This surgery allows for the correction of deformity and the restoration of normal knee function. Most patients begin basic movements like standing, walking with support the day or next day after surgery. The patient can walk without support after 3 weeks of surgery. Most surgeons allow patients to drive at 4 to 6 weeks after surgery. Patients feel nearly normal at 6-8 weeks.
Dr. Anoop Jhurani is one of the most experienced joint replacement surgeons of India, having experience of performing more than 6000 successful joint replacement surgeries. He has been trained in a fellowship programme by Dr. C.S. Ranawat at Hospital of Special Surgery New York (USA). He has special expertise in performing partial knee replacement and revision joint replacement. He has performed simultaneous bilateral hip replacement and four joint replacement in severe cases. He is performing computer navigated joint replacements since 2007 in Rajasthan. Dr. Anoop Jhurani, often invited speaker in major conference in India and overseas, has performed live joint replacement surgeries in India and other countries like Bangladesh, Vietnam and Niegeria.