Knee Arthritis Treatment in India

For most of us, knee replacement surgery used to be a fancy procedure for rich old people. Not anymore. Did you know total knee replacements have some of the highest success rates in medicine? When the knee joint is severely damaged by injury or arthritis, simple activities like walking or climbing stairs become difficult. There could be knee pain even while sitting or lying down.

When medications don’t help, knee joint replacement surgery could be considered to provide relief from pain or to correct deformities of the leg. From the time arthritis knee replacement surgery was first performed in 1968, vast changes in surgical techniques and materials have improved the effectiveness of this procedure.

Can A Knee Replacement Cure Arthritis?

There is no permanent cure for arthritis currently, but a joint replacement can help manage most of the symptoms. Taking medicines as prescribed, regular reviews, and avoiding strenuous activity increases the life of the prosthesis. Post-surgery, many people can perform regular activities without help. Pain is the main reason for a person with arthritis to consider knee replacement surgery.

An artificial knee is never as good as a natural one. It works at about 75% as efficiently as a normal knee. Most people are happy with knee replacement procedures. Post-surgical persistence of pain is one of the main reasons for dissatisfaction. The prosthetic knee cannot bend as far as the natural knee. An artificial joint also experiences wear and tear and may require replacement in the future.

What is Knee Arthritis?

The knee is the largest and strongest joint in the human body. When there is inflammation, pain, swelling, and stiffness in one or both knees it is called knee arthritis.

Which Part of the Knee is Affected by Arthritis?

There can be cartilage loss between the thigh bone and the shinbone on the inner side, outer side, or under the kneecap. When all three areas are affected it is called tri-compartmental arthritis.

Different Types of Arthritis of Knee

The knee is made of the lower end of the thigh bone, the upper end of the shinbone, and the kneecap. The ends are covered with cartilage to protect the bones and act as a cushion. Two rubbery cartilage pieces act as shock absorbers between the thigh and shin bones. Synovial fluid released from a thin lining called synovial membrane helps to lubricate the cartilage and reduce friction.

3 Major types of Arthritis can affect the Knee:

Osteoarthritis of the Knee

It is a degenerative form of arthritis and refers to the wear and tear of the knee. The cartilage of the joint becomes frayed and rough and fails to act as the cushion between the bones. Soon, the bones rub against one another, and painful bone spurs are formed.

Rheumatoid Arthritis of the Knee

It is a chronic condition that can affect the knee joint. The effect is usually bilateral or symmetrical. Pain and stiffness arise when the synovial membrane covering the knee joint starts to swell. Rheumatoid arthritis is an autoimmune condition.

Post-Traumatic Arthritis of the Knee

This form of arthritis develops as a result of injury to the knee. The injury could be a broken bone that damages the joint surface. It could also be instability and accelerated wear and tear due to a meniscus tear or any ligament injury.

Arthritis Treatment

Currently, there is no cure for arthritis, but treatment options can help relieve pain and any disability. Treatment usually starts with a few lifestyle adjustments:

• Losing weight if needed
• Exercising just enough to remain active, like swimming and cycling.
• Avoiding or reducing activities like climbing stairs. These could aggravate the pain.

Supervised physical therapy can help to strengthen the leg muscles. These exercises are customized for individual needs and lifestyles. Devices such as canes or knee braces can be used to assist while walking.

Medications

• NSAIDs like ibuprofen or simple pain relievers like paracetamol are the mainstay of pain relief and are quite effective in osteoarthritis. Most people tolerate oral NSAIDs well, but there are a few side effects when they are taken for prolonged periods.
• Special NSAIDs like celecoxib are more helpful for pain and improving function. These tablets should not be used along with regular NSAIDs.
• Topical NSAIDs (creams and gels) can also be used when oral drugs are not tolerated well.
• Corticosteroid injections may be given to provide relief from pain and inflammation. They are used judiciously because they could cause more damage than good in the long run.
• Newer medicines like disease-modifying anti-rheumatic drugs like methotrexate and hydroxychloroquine are prescribed commonly.

Surgery for Arthritis

When non-surgical knee treatment provides no relief, there are different types of surgery that could be tried:

1. Knee Arthroscopy

Knee arthroscopy is a minimally invasive procedure often used for early stages of arthritis. A small camera called an arthroscope is inserted into the knee joint, allowing the surgeon to view and treat the affected area.

Arthroscopic Surgery Procedure Highlights:

• Removal of loose cartilage fragments.
• Smoothing of rough joint surfaces.
• Addressing meniscus tears or ligament injuries.

Best For:

• Patients with mild arthritis or mechanical issues in the knee joint.

2. Osteotomy

Osteotomy involves cutting and reshaping the bones around the knee to relieve pressure on the damaged area. This surgery is particularly beneficial for younger, active individuals with arthritis in one part of knee.

Procedure Highlights:

• Shifting weight-bearing load to a healthier portion of the knee.
• Delays the need for total knee replacement.

Best For:

• Patients with localized arthritis in one knee compartment.

3. Partial Knee Replacement (Unicompartmental Knee Arthroplasty)

Partial Knee Replacement surgery replaces only the damaged part of knee joint, leaving the healthy parts intact. It involves smaller incisions and faster recovery compared to total knee replacement.

Procedure Highlights:

• Preservation of ligaments and healthy bone.
• Shorter hospital stay and quicker rehabilitation.

Best For:

• Patients with arthritis confined to one part of knee.

4. Total Knee Replacement (Knee Arthroplasty)

Total knee replacement is a comprehensive procedure where the damaged joint surfaces are replaced with artificial components made of metal and plastic.

Procedure Highlights:

• Replacement of both sides of the knee joint.
• Significant pain relief and improved mobility.

Best For:

• Patients with severe arthritis affecting the entire knee joint.

5. Cartilage Restoration Surgery

Cartilage restoration techniques aim to regenerate or replace the damaged cartilage in the knee, offering relief from pain and improved joint function. Techniques include:

• Osteochondral autograft transplantation (OAT).
• Autologous chondrocyte implantation (ACI).

Best For:

• Younger patients with isolated cartilage damage.

There are 4 steps involved in the Knee surgery:

• Bone Preparation – Damaged cartilage is removed along with a little underlying bone.
• Placing The Metal Implants – Metal components are cemented or pressed into the bone to recreate the joint surface.
• Resurfacing The Patella – The kneecap is cut and resurfaced, if necessary.
• Inserting A Spacer – A spacer between the metal components creates a smooth gliding surface.

It is important to continue physical therapy to regain strength and restore motion. A knee brace or crutches are required till satisfactory recovery is attained.

Recovery and Rehabilitation

Recovery time varies depending on the type of surgery:

• Knee Arthroscopy: 2-6 weeks.
• Osteotomy: 3-6 months.
• Partial Knee Replacement: 6-12 weeks.
• Total Knee Replacement: 3-6 months.

Physical therapy plays a vital role in restoring strength and mobility after surgery. Following your surgeon’s recommendations ensures optimal recovery.

Frequently Asked Questions

1. When does a Knee need Surgery for Arthritis?

Surgery is required when the knee joint is worn out or damaged enough to reduce mobility and in cases where there is pain even during rest. Osteoarthritis is the most common indication for knee surgery.

2. How do they Remove Arthritis from a Knee?

A cut is made to expose the knee cap which is then moved aside to gain access to the joint. Damaged ends of the thigh bone and shin bone are cut away and shaped to fit the prosthesis. A curved metal piece is placed at the end of the thigh bone and a flat metal plate is placed at the end of the shin bone. A plastic spacer is placed between these 2 pieces to reduce friction.

3. What is Stage 4 Arthritis in the Knee?

Level 4 arthritis in the knee is the surgical stage. The person cannot tolerate or manage the symptoms of osteoarthritis and is a suitable candidate for surgery.

4. Is Arthritis in the Knee Serious?

Arthritis in the knee is a serious, debilitating condition that causes pain, stiffness, and swelling in the knee joint. There is no cure for it, but treatment can provide relief from symptoms and slow down the progression of the disease.

5. How do I know which knee surgery is right for me?

Consult with an orthopedic specialist who will assess your condition, lifestyle, and goals to recommend the most suitable procedure.

6. Are there risks associated with knee surgery?

All surgeries carry some risks, including infection, blood clots, or implant issues. However, these risks are minimized with proper care and experienced orthopaedic surgeons.

7. Will I need physical therapy after knee surgery?

Yes, physical therapy is essential for regaining strength, flexibility, and range of motion.