KNEE OSTEOARTHRITIS (OA OF KNEE JOINT)
Aging, injuries, wear-and-tear of cartilage in knee joint results in development of knee osteoarthritis. Symptoms vary depending on knee OA stages. Knee osteoarthritis treatment may include conservative and surgical measures, starting from medications, physiotherapy, MAKOplasty and total knee replacement, at the end. How to find your way in all the information? What steps shall you take if you are diagnosed with knee arthritis? Let us get all this straightened out.
WHAT HAPPENS WHEN CARTILAGE WEAKENS?
The thinning of cartilage will eventually transform into Osteoarthritis or wear-and-tear arthritis. When this happens, the bones from the joints cause more friction against one another which will eventually lead to pain, irritation, inflammation, rigidity, reduced mobility and, sometimes, the formation of bone spurs, which is a bony growth on the bone.
HOW COMMON IS OSTEOARTHRITIS OF THE KNEE JOINT?
Osteoarthritis is the most usual type of arthritis that is usually detected in as much as 40 percent of the adult population. Meanwhile, of these, only 10 percent proactively pursued medical attention. Unfortunately, out of the affected population, one percent of the affected adults are severely handicapped by osteoarthritis.
SYMPTOMS OF OSTEOARTHRITIS OF THE KNEE JOINT
- Discomfort will increase as you progress through the day
- Irritating ache
- Inflammation of the affected joints
- Changes in nearby joints
- Throbbing warmth on the arthritic joint
- Crackling noises and feeling of the affected joints
- Small cysts may grow in the affected hand
- Reduced mobility in the knee
KNEE OA stages
Staging of osteoarthritis is based on the degree of the joint cartilage wear off. Detailed and illustrated explanation of OA stages is presented on the picture below.
KNEE OSTEOARTHRITIS TREATMENT OPTIONS
The treatment for Osteoarthritis aims to:
- Relieve pain
- Maintain joint function
- Prevent related deformities
- The extent of deterioration of Osteoarthritis and patients’ expectation on future lifestyle will set the course of how it will be treated.
All available knee arthritis treatment options can be grouped into two main categories:
NON-SURGICAL KNEE OSTEOARTHRITIS TREATMENTS OPTIONS
Every patient is unique and will present different reactions to medications. Therefore, doctors will often prescribe medications to meet individual needs.
Specially designed set of routines and exercises to help improve your mobility, reduce tenderness, increase your muscle function in your leg and your level of fitness.
Assistive devices such as knee braces or knee sleeve, shock-absorbing shoes or sole inserts, cane, crutches. Two of the most common types of braces for knee arthritis are “unloader” brace and “support” brace. An “unloader” brace reduces the stress and weight that your affected knee is supporting. On the other hand, a “support” brace can help to support the weight load on your whole knee.
CORTICOSTEROIDS OR HYALURONIC ACID INJECTIONS
Hyaluronic acid acts as a type of lubricating fluid in the joints, reducing friction when joints are moving and rubbing against each other. People who have osteoarthritis will have less hyaluronic acid to safeguard the joint. Steroids are powerful anti-inflammatory drugs. The type of steroids commonly used in knee arthritis treatment is corticosteroids or cortisone.
Before the procedure starts, your doctor will first make sure that the area around your joint is numb so that you can feel more comfortable during the injection. Your doctor will then insert needle in between your joint and inject cortisone into the space. Cortisone injections may help to reduce pain in your affected joint. However, the medication used in the injections can speed up the joint damages over time.Therefore, your doctor will limit the number of cortisone injections you can have every year to three or four injections maximum. Compared to oral medicines, hyaluronic acid injections may be more effective in relieving the joint paint as a result of OA. For some people, hyaluronic acid can help reduce pain level for as long as six months to a year. Sometimes there are some that managed to keep the pain away for even longer. Unfortunately, everyone respond differently to these injections so it may not be the definite treatment for everyone.
Although hyaluronic acid injections are expensive treatments, many health insurance programs provide coverage to support these treatments. Therefore, hyaluronic acid injections could be an option for you. Before proceeding to choosing hyaluronic acid or corticosteroids injections, your doctor will discuss the pros and cons of the treatments with you. Through this consultation, your doctor will determine whether if and which of these injections is the suitable course of treatment for you. Usually, non-surgical treatment only provides a temporary relief for most people and may extend to longer-term effect for some people. Therefore, one cannot be cured through non-surgical treatments and should not expect such outcome.
SURGICAL KNEE OSTEOARTHRITIS TREATMENT OPTIONS
A surgeon inserts a small camera through small surgical incision made in your knee. Through the camera, the surgeon will be able to see the extent of damage in your knee as a result of osteoarthritis. After identifying the state of the damage, the surgeon will use other small surgical instruments to remove damaged tissues in the knee joint. The surgeon can also clean the joint thoroughly by removing any loose parts in the knee joint that may be the root cause of your pain. Arthroscopy may not be suitable for everyone and it only temporarily reduces pain or delays the need for other more permanent treatment such as osteotomy or arthroplasty.
A surgeon will reposition the bones in the affected knee joint that have been damaged by Osteoarthritis. This procedure is only suitable for people with knee damaged limited to one area or side of the knee. During this procedure, the surgeon will realign the knee so that the patient’s weight is removed from the damaged area. As a result of this procedure, the patient may restore mobility and movement in the affected knee and experience reduced level of pain in the knee. However, people who have gone through osteotomy may require knee replacement surgery in the future.
This procedure is also generally referred to as joint or knee replacement surgery. During this procedure, a surgeon will remove the part of the knee affected and destroyed by osteoarthritis. An artificial joint made of metals and plastic materials will be installed in the original position of this removed part. In certain instances, some people may have all or part of their knee joint replaced during arthroplasty surgery. After this procedure, the length of your recovery time depends largely on the extent of your surgery. However, arthroplasty often successfully results in the complete relief of your pain and significant improvement in the mobility of your knee.
WHAT ARE THE 2 TYPES OF ARTHROPLASTY?
This procedure is suitable for people that are not eligible for a total knee replacement. MAKOplasty is a minimally invasive surgical procedure assisted by robot. By leveraging the robotic precision, this procedure is also able to target the specific root cause area in your knee compartment and spare other parts of your knee that are in good condition. MAKOplasty is a lot less invasive in comparison to other procedures.
During this procedure, a surgeon will make a four to six inches incision over your knee. Then, several small incisions will be made on both of your thighbone and shin. In this partial knee resurfacing procedure, a surgeon will use a robotic arm and treat only the targeted area in the knee that are damaged and arthritic. This procedure allows the surgeon to be very precise during the treatment. Therefore, surgeons will be able to preserve healthy bones and tissues around the damaged area. The level of precision in this procedure allows a surgeon to accurately resurface the affected tissues in the knee within 0.5mm of accuracy. So the healthy bone and surrounding tissues will remain untouched after the procedure. The surgeon will then install an implant in the joint so that your knee can function normally again. Due to the effectiveness and minimal invasion of this procedure, patients will experience a rapid recovery with ability to be mobile during the next day after surgery.
MAKOplasty will allow you to preserve your own natural bone and tissue. During surgery, the robotic arm will assist your surgeon by providing the surgeon with real-time visual, tactile and auditory feedback. The additional feedback from the robot arm will support the surgeon to optimally resurface the joints and accurately position the implant. As a result, your knee will move naturally following the surgery. Together with the natural tissues and bones that are properly preserved during the surgery, a surgeon will be able to provide the specific implant positioning that is ideal for you. Therefore you will regain a more natural feeling of your knee after the surgery. Especially having the healthy bone spared from any surgical impact, people who go through. MAKOplasty partial knee procedures may still stand a chance to be eligible for a total knee replacement procedure in the future if the need arises.
TOTAL KNEE REPLACEMENT
A surgeon replaces the damaged joint surface with an artificial joint during joint replacement surgery. With the OA symptoms deteriorate; this procedure becomes necessary for people with advanced cases of OA. An artificial joint combines a well-polished metallic roller, pivoting against a smooth plastic block to reduce the friction of the movement that is similar with joint movement. A surgeon will use special polymer to attach these implants to the ends of your knee joint. During the procedure, in case of the previous baker-leg defect (valgus knee), the surgeon will realign the leg so that the leg bone structure will appear as natural as possible after the surgery. Total knee replacement surgery can be a lengthy process taking as long as one to two hours per knee. In this surgery, your surgeon will remove the deformed bone and tissue, and put the new implants properly in place so that the function of your knee can be restored. Several recommendations for you to protect your newly replaced knee after the surgery: Visit your orthopedic surgeon on annual basis for a periodic follow-up examinations and x-rays.
- Regularly partake in light physical exercises so that you can gradually regain strength and keep your new knee moving so that it will get used to operating at a higher level.
- Be cautious and alert with your movements so that you do not fall and get injured. Any injuries involving broken bone in your leg will require more surgery to restore the bone damages afterwards.
- Inform your dentist about your knee joint replacement surgery prior to any dental procedures. If you need any dental procedures, you will need to inform and consult your orthopedic surgeon to determine if you need to take antibiotics prior to your dental procedures.
- Visit your orthopedic surgeon on annual basis for a periodic follow-up examinations and x-rays.
DIAGNOSING OSTEOARTHRITIS OF THE KNEE JOINT
- History taking and physical exam: Your doctor will go through your symptoms and medical history with you during your appointment. Your doctor will need to perform a physical examination around your knee to better understand your condition. During this physical examination, your doctor will look for symptoms such as:
- Inflammation or redness around your affected knee
- Tenderness of the knee
- Range of assisted and self-directed joint motion
- Level of instability of the joint
- Crackling sensation inside the joint during knee movement
- Level of pain when additional weight is felt on your knee
- Issues with your walk and movements
- Any possible injury surrounding the affected joint
- Any signs of rheumatoid arthritis
- X-ray: This examination can reveal any damage to your bone and detect any presence of bone spurs.
- Magnetic Resonance Imaging (MRI) scans: When X-rays do not produce a clear cause of joint pain or present further damages to other joints, your doctor will order MRI scans to further investigate possible root cause of your condition.
- Blood tests: A blood test may be ordered when there is a need to exclude other conditions that might be causing your joint pain. One of these conditions could be rheumatoid arthritis, which is an immune system condition and a totally different type of arthritis causing inflammation of the lining of your joints.