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Arthritis and Total Knee Joint Replacement

Dr. Ashutosh P Mavalankar
The knee joint is commonly referred to as a "hinge" joint because it allows the knee to flex and extend The knee joint includes the end of the thigh bone (the femur), the top of the leg bone (the tibia) and the knee cap (the patella). A smooth cushion of articular cartilage covers the end surfaces of both of these bones so that they slide against one another smoothly. The patella, or kneecap, is the moveable bone on the front of the knee.

A painful knee can severely affect your ability to lead a full, active life. Artificial knee replacement surgery (also called knee arthroplasty) is becoming increasingly common as the population of our country begins to age. When pain, stiffness, knee swelling and limitation of motion in your knee keep you from your daily activities, you may need total knee replacement. Total knee replacement is a major surgery, which usually involves a 5-6 day stay in the hospital and a period of rehabilitation, which takes about 2-3 months. A team of health professionals works with the patient to guide his/her recovery, but the patient is the most important member of the team. An informed patient is certainly the best ally in achieving success with total knee replacement surgery.

What is Arthritis?

Arthritis is a generic condition indicating inflammation of a joint. Of the more than 100 types of arthritis, the following three are the most common causes of joint damage: The most common form of arthritis, which necessitates knee replacement, is osteoarthritis or degenerative arthritis. In this condition, the articular cartilage, which is the smooth gliding surface of the joint, has worn away, and the bones grind against each other, creating popping sounds, pain and loss of normal movement. This condition occurs primarily in people over 50. Another common type of arthritis that can affect the knees is Rheumatoid arthritis. It is caused by dysfunction of the immune system. Trauma-related arthritis results when a joint is injured, either by fracture, dislocation or damage to the ligaments surrounding the joint causing Instability or damage to the joint surface.
The thigh bone (femur) is on the top and the leg bone (tibia) is on the bottom. The apparent space between the bones is actually occupied by articular cartilage which is not dense enough to be seen on x-ray and is called the joint space. In advanced arthritis, the articular cartilage has been completely worn away and the bones of the femur and tibia, and the femur and patella, come into direct contact. Wear of articular cartilage can be seen on x-rays as a decrease in the space between the bones.

Treatment for Osteoarthritis
In very early cases of osteoarthritis, or if the patient does not want to undergo surgery, strenuous and painful activities should be avoided. However, gentle exercise such as walking or swimming should be adopted. The patient may benefit from some moist heat, massage or other forms of physical therapy. Weight loss can be very helpful in reducing pain from arthritic knees by reducing the stress, and is good for general health as well. There are a number of medications, both anti-inflammatory and pain medications that can help the patient live with arthritis. There are also medicines that can be injected directly into the knee, such as cortisone and newer products that improve lubrication. Unfortunately, arthritis is progressive in most cases. A cane or a crutch may be required in order to walk. If the pain is not adequately controlled by the above measures, the surgeon considers the following treatment options before advocating total knee replacement to the patient.

Specialized Braces
There are specialized braces that can be helpful in some cases of knee arthritis. These braces are designed to create a force which transfers load from an area of the knee where the cartilage is more worn, to an area of the knee where the cartilage is less worn. These braces are helpful in cases where there is still some cartilage remaining in the knee, and the pressure of the brace causes less discomfort than the knee arthritis.

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