At 80 years, an average person would have walked 177000 kms. Knee pain due to arthritis (wear & tear) is a significant cause of disability in the elderly. Although older age is the greatest risk factor for arthritis, Arthritis is not an inevitable consequence of growing old.

Radiographic changes of arthritis, particularly osteophytes, are common in the aged population but symptoms of joint pain may be independent of radiographic severity in many older adults. Aging changes in the musculoskeletal system increase the propensity arthritis but the joints affected, and the severity of disease are most closely related to other arthritis risk factors such as joint injury, obesity, genetics, and anatomical factors that affect joint mechanics

Knee replacement surgery is quite successful for end-stage arthritis. Since it is a major surgical procedure, efforts are now being made to identify and treat the risk factors of arthritis at an early stage – like Cartilage damage and Shock absorber tears so as to prevent or postpone knee replacement.

Knee joint is protected by two resilient shock absorbing discs called meniscus and the fate of the joint is decided by the integrity of these discs. A injury called “ROOT TEAR” in which the attachment of the meniscus gets torn and is extruded from the joint. Since this is often missed in MRI it is called the hidden lesion of the knee. Once the shock absorber is extruded from the joint, the joint compartment is fully exposed to the impacts and loading resulting in accelerated wear and tear. Patients will typically have sudden knee pain or worsening of knee pain, a popping sensation, pain on lying down and turning positions during sleep.  The good news is these tears can be repaired successfully with Key-hole procedure with good results and thus preventing the knee damage and postponing the need for total knee replacement.

Joint Preservation as a treatment concept is gaining traction, where a proper diagnosis along with addressing the lesions causing pain and joint damage, aims to postpone the knee replacement says.

This speciality offers scientifically proven methods like meniscus repairs, osteotomy to correct bent knees, cartilage repair, subchondroplasty and unloading braces.  Exercise therapy and weight loss is very important. Patients can expect good relief but some amount of residual pain due to the pre-existing damage. 

Patients should also be aware of spurious treatments like blood product injections and stem cells injections which are ineffective in advanced stages of disease and should remember the adage “if it is too good to be true. it is always too good to be true.”

With the aim of preserving the joints, the Joint Preservation Clinic provides new methods of treatment and joint conserving surgeries by exclusively trained orthopaedic professionals. Arthroscopy, Meniscus repairs and Root tear repairs, Cartilage repair, joint unloading surgery and subchondroplasty are the procedures provided at the clinic. Identification of source of pain and assessing the status of the patient in the disease continuum, weight reduction and exercises are the important factors for the successful joint preservation.

 

Dr Clement Joseph, MBBS, MS – Orthopaedics is Head – Institute of Orthopaedics, Gleneagles Global Health City, Chennai