Dr Manish Kumar Varshney
Knee pain is a common problem we all see around us, in fact it is so common that around 1/4th of adult population suffers from it. Patients remain puzzled regarding the origin of the same and keep taking pain killers to get symptomatic relief while root cause remains untreated and unfortunately, they accumulate side-effects of medications. Here we will understand the basics of development of arthritic knee pain and its management. Arthritis simply means inflammation of the knee joint that irritates the pain seeking and transmitting nerves. This ‘inflammation’ may be understood as swelling within the knee joint (typically synovium – special membrane in joint responsible for its maintenance) making knee painful. Inflammation within joint may develop due to degenerative and non-degenerative process (or diseases). The non-degenerative diseases within the joint include crystal deposition diseases, inflammatory joint diseases (rheumatoid, psoriatic arthritis etc.), ligament and meniscus problems and trauma (fractures/dislocations). Outside the knee joint soft tissues may get injured in trauma like tendon injuries, injury to fascia and ligaments outside the joint or there may be bursitis which is common in this region due to uneven terrain. Degenerative diseases within the joint typically are grouped under the term ‘arthrosis’ that may arise as end stage to various above-mentioned conditions or may be age-related. Here it is important to understand that pain in arthroses arises from inflammation, so the conditions are interrelated and confusing to a layman. However, it is more important to understand that management of diseases is quite different and should be properly obtained. With respect to arthritic knee pain the pertinent thing to realize is that most of the arthritis are controllable (some are treatable also) in early stages of the disease. This is the most rewarding thing for the doctor and important for patient because it prevents the progression of disease to ‘advanced arthroses’ where the only treatment is knee replacement. Crystal diseases like uric acid deposition can be easily managed by wonderful available medications. Rheumatoid disease and other inflammatory diseases have unique drugs that can be tailored to patients’ severity of involvement in the disease and are now very successful in controlling the disease. The patient must remain compliant in taking the medications. Ligament and meniscus problems can be easily repaired or balanced using key-hole surgery (arthroscopy). Other soft tissue injuries get cured by appropriate management aimed at reducing inflammation and promoting healing. This makes it clear that one should not ignore initial symptom of knee pain while simultaneously taking the treatment religiously. What remains uncontrolled is age-related and post-traumatic osteoarthritis/osteoarthritis. In these situations, the medications fail and will have minimal impact if any. Knee replacement is the successful cure in these patients. Depending on the severity and area of involved joint knee replacement can be done as partial or total knee replacement. The common notion of waiting for undergoing knee replacement until one becomes ‘crippled’ does not hold true and is counter-productive to the results of surgery. I have seen many patients carrying the myth that one should ‘delay surgery’ if possible and keep bearing pain until it is unbearable. Late stages of any disease make surgery or treatment complicated and there is more surgical correction needed making surgery extensive. More cutting during surgery would compromise on the life of surgical success and even pain relief may not be complete. The other inhibition to undergo surgery is financial as knee replacement is considered a costly surgery. Thanks to various state-run and national government health schemes that have subsidised surgery substantially bringing it within the reach of everyone. The expertise to perform surgery is also easily available now with many centers doing surgery. The team at SMVD Narayana super specialty hospital has an experience of performing more than 250 knee replacements at SMVD; including complicated reconstructions and even revision knee replacements that were performed long ago at places outside the state and have now failed due to definite life of the implant. Within the limits of complication considering the remarkable benefits of knee replacement surgery and subsidence of financial constraints, I personally feel patients have no reason to bear pain for so long. It is high time to kill inhibitions and seek treatment and pain relief as soon as possible. Key-hole surgery provides the patient full advantage of preserving his/her knee from further damage so that arthritis does not develop later. I hope this article develops enough awareness amongst the patients to stimulate them towards leading a pain-free functional and productive life.
(The author is Senior Consultant Orthopedic, Spine & Joint Replacement Surgery, author of various books in Orthopedics, including the best-seller ‘Practical Orthopedic examination made easy’).
