Knee Pain and Arthritis

Knee pain is common symptom in the middle age and older people. Most of the time it is due to wear and tear as we progress through life in work, activities of daily living and sports. It affects us by limiting our ability to walk, run, climb stairs, squat or kneel. It can be accompanied by knee swelling, loss of motion and stiffness. Sometimes it may cause our legs to buckle and give way resulting in falls and severe injuries.

Treatment requires an accurate history, clinical examination and investigations such as X-rays, MRI scans and blood tests.

Common causes are

1. Osteoarhritis or degenerative arthritis
2. Inflammatory arthritis such as Rheumatoid Arthritis (RA)
3. Meniscus and ligaments injuries, stress or insufficiency fractures in the elderly osteoporotic patients

A careful history taking and clinical examination would reveal the cause of the pain which can be confirmed by xrays and MRIs and blood tests in special cases.

Treatment is directed at the aetiology of the pain. In most cases of arthritis, treatment consist of

1. Medications
2. Physiotherapy
3. Surgery

Medications include

1. Anti-inflammatory medications such as celebrex, arcoxia, Synflex. However these medicines can have side effects on the stomach, heart and kidneys especially if they are taken over long periods. They shoulde be avoided in patients with chronic kidney disease, heart problems or severe gastric problems.
2. Supplements such as glucosamine, collagen, piascledine can be helpful in patients with ear and tear osteoarthritis.
3. Injections such as intra-articular steroids and hyaluronate gel injections are used when oral medications failed.
4. Physiotherapy to improve knee movements and muscle strength is helpful for pateints with stiff painful knees

Surgery is useful for torn meniscus and ligaments, or where conservative treatment have failed

Surgery include

1. Arthroscopic or keyhole surgery
2. Corrective osteotomy
3. Joint replacements

 

Arthroscopic Surgery

The knee joint is very amenable to arthroscopic or keyhole surgery. Loose bodies, torn meniscus, cartilage defects and ulcerations can be treated arthroscopically with low risks and morbidity 

 

Corrective osteotomy

patients with knee deformities loke bow legs or knock knees can have their legs straighten out with bony cuts ( osteotomy surgery ) in the femur or tibia especially for younger patients less than 50 years to delay need for joint replacement surgery

 

Knee replacements

Knee replacement are indicated for patients with severe osteoarthritis who had failed to respond to medical treatment and continued to have pain and loss of function affecting daily living. Depending on the severity and type of joint involvement , partial or total knee replacement can be done providing good pain releif and function for 20 years or more in most patients.