Osteoarthritis is the second most common rheumatologic problem with a prevalence of 22% to 39% in the country. Dr Akhilesh Yadav tells you more
The condition
Osteoarthritis is the second most common rheumatologic problem and is the most frequent joint disease with a prevalence of around 40% in India. It is the form of arthritis which features the breakdown and eventual loss of cartilage of one or more joints. Cartilage is protein like substance which acts as cushion in between the joints. Although osteoarthritis can affect any joint, this disorder commonly affects hands, knees, hips and spine.
It’s a condition that give rise to joint inflammation, it happens when the wear and tear of cartilage, the tissue which protects from the ends of both bones and joints. It’s most common type of arthritis and is degenerative and it gets worsen with age. It causes damage to your joints, including: Hand and fingers, knees, hips, lower back and neck. It can also lead to problems with anxiety and depression.
The disease is associated with modifiable and non-modifiable risk factors such as obesity, lack of exercise, bone density, occupational injury. The physical ability arising from pain and loss of functional capacity reduces the quality of life and increases the risk of further morbidity. This condition is three times more prevalent in women as compared to men, which ultimately leads to joint replacements.
Incidences of joint replacement surgeries have seen an upsurge in the past 5 years. According to the recent data provided by Joint registry (ISHKS), over 35,000 total knee replacements (TKR) and over 3500 total hip replacement surgeries (THR) have been performed in India in the last 5 years. It is evident from the data that more than 75% of the TKR were performed on women ranging in the age bracket of 45-70 years. More than 33000 cases (over 97 per cent) of TKR were attributed to osteoarthritis, and more than 60% of women above the age of 60 years suffering from osteoarthritis have undergone total hip replacement surgeries.
Progession and what it means
The most common Symptoms of Osteoarthritis (OA) includes pain, tenderness, and stiffness in joints, loss of flexibility, bone spurs, grating and cracking sensation of bones rubbing together, swelling around the joint that gradually degrades the joint causing several complications.
The progressive degenerative nature has been classified into five categories. Therefore there is need to take precautions before it reach stage 4.
Stage 0: Normal: At this stage the knee joints do not show any signs of joint impairment or damage.
Stage 1: Minor: In this stage minor wear and tear and bone spur growth can be seen. At this stage you won’t experience any kind of pain or discomfort.
Stage 2: Mild: Diagnosis through X-rays of the knee joint will reveal increased bone spur growth, with healthy cartilage size. At this stage many people start experiencing the symptoms like pain after a long day of walking or running and tenderness.
Stage 3: Moderate: In this stage, the cartilage between bones shows obvious damage, and the space between the bones begins to narrow. People with stage 3 OA are likely to experience frequent pain when walking, running, bending, or kneeling. They also may experience joint stiffness after sitting for long periods of time or when waking up in the morning. Joint swelling may be present after extended periods of motion, as well.
Stage 4: Severe: People in stage 4 OA experience great pain and discomfort when they walk or move the joint. That’s because the joint space between bones is dramatically reduced—the cartilage is almost completely gone, leaving the joint stiff and possibly immobile. The synovial fluid is decreased dramatically, and it no longer helps reduce the friction among the moving parts of a joint.
To-do list
If the condition is detected in the earlier stages (stage 0 to stage 2), no specific treatment module is needed. The condition can be controlled through exercise and physical therapy to relieve pain and discomfort. Such therapies are non-pharmacologic (do not require any medication).
Medication: While the pain doesn’t subside with exercise the next option is to reduce the discomfort through medicines. If you experience a predisposition to Osteoarthritis (OA) or are at an increased risk, your doctor may recommend you take supplements, and doctors may prescribe for OTC pain killers and pain relief therapies. Usually the stage 3 condition can be controlled through medications.
Surgical intervention: In stage 4, if you experience severe OA of the knee, the last resort is surgical intervention. In most of the cases only the medial or lateral compartment is affected, unlike arthritis where it affects all the three of them.
If diagnosed at early stage, it can be treated with medications, but when the symptoms have crossed the extreme stage, surgery is the only option left. Full knee replacement has been the most common and the conventional method for treating arthritic knee. This is useful and necessary only when all the three compartments are involved, and can prove to be a disadvantage in case of unicompartmental arthritis. This is where unicompartmental knee surgeries are helpful.
Minimally invasive total knee replacement: Timely detection and advancements made in the field of total knee replacements with minimally invasive techniques making use of computer assistance has been providing an enhanced pathway for better recovery and improving the quality of life. Surgeries are now performed under highly specialised and advanced environment, ensuring shorter discharge time and negligible pain. This also enables a shorter hospital stay, speedy recovery and greater patient satisfaction.
Partial knee replacement: The latest techniques like partial knee replacement and new alloy implants are proving much better than previous ones, ensuring a long-lasting positive effect on knees. Earlier knee replacement was considered a necessity for the elderly suffering from the persistent keen pain. But today with improved implant technology and technique, the young generation is positive towards opting for surgery at an earlier age. The main advantage of the partial knee replacement is that it preserves the ACL which is a crucial ligament for movement and knee stability unlike in the case of total knee replacement where it is sacrificed. As this follows the minimal incision approach, a faster recovery, rehabilitation and quick return to full fledged activities is seen in all patients. Because the ligaments are kept intact, the patient feels the replaced portion of the knee as a natural part itself.
The writer is senior transplant Head Joint Replacement (Hip & Knee), Centre for knee and Hip Care, Vaishali
