Category

Knee Replacement

Category

Overview

A condition that is characterized by pain in the front part of the knee and surrounding the patella (kneecap) is called patellofemoral pain syndrome (PFPS). Doctors also refer to this condition as “jumper’s knee” or “runner’s knee.”

The condition is not serious, despite leading to symptoms ranging from sore to very painful kneecap. Just rest and conservative treatment measures can also lead to pain reduction in patients affected by this disorder.

Causes of Patellofemoral Pain Syndrome

  • Knee Overuse: In many cases, PFPS is caused by vigorous physical activities that put repeated stress on the knee —such as jogging, squatting, and climbing stairs. It can also be caused by a sudden change in physical activity. This change can be in the frequency of activity—such as increasing the number of days you exercise each week. It can also be in the duration or intensity of activity—such as running longer distances.

Other factors that may contribute to patellofemoral pain include:

  • Use of wrong sports training techniques or equipment
  • Altered sizing in footwear or playing surface
  • Wrong Alignment of the Kneecap: Patellofemoral pain syndrome can also be triggered by irregular tracking of the kneecap in the trochlear groove. In this condition, the patella is protruded to one side of the groove upon knee bending. This deviation may lead to elevated pressure between the rear of the patella and the trochlea, irritating the soft tissues.

Factors that add to poor kneecap tracking include:

  • Malalignment of the legs between the hips and the ankles. Malalignment may lead to shifting of kneecap which is very far to the outside or inside of the leg, or it may ride very high in the groove of the trochlea—leading to patella Alta.
  • Muscular disparities or weaknesses, particularly in the front thigh muscles (quadriceps). During knee bending and straightening, the quadriceps muscles and tendon aid in keeping the kneecap inside the trochlear groove. Weak or imbalanced front thigh muscles can lead to poor kneecap tracking inside the groove.

Any individual can be affected by this condition, however, athletes more frequently encounter this problem.

Symptoms of Patellofemoral Pain Syndrome

The sure sign symptom of patellofemoral syndrome is a dull, aching pain usually occurring on the front portion of the knee or around the kneecap. The pain may be felt in one or both knees and often deteriorates with movement.

Other painful symptoms are:

  • Pain during exercise
  • Pain during knee bending, including navigation through stairs, jumping or sitting on your heels
  • Pain after sitting for a prolonged period with bent knees
  • Cracking or popping sounds in the knee during stair navigation or post sitting for a prolonged duration

Diagnosis of Patellofemoral Pain Syndrome

Your doctor will inquire about your knee history and apply pressure on your knee areas. He/she will also move your leg in various positions to help exclude other conditions, having similar signs and symptoms.

To determine the exact cause of your knee pain, your doctor may prescribe imaging tests like:

  • X-rays: A small quantity of radiation enters your body to create X-ray images of your body on a screen. Though this tool sees bone well, it is less effective at enabling soft tissue visualization.
  • CT scans. This technique combines images of X-ray from different angles to form thorough images of internal structures. Though CT scans can envisage both bone as well as soft tissues, the procedure carries a much higher radiation dose as compared to plain X-rays.
  • MRI: MRIs create thorough images of bones and soft tissues, such as the knee ligaments and cartilage using a combination of radio waves and a strong magnetic field. However, they are much more costly as compared to the above diagnostic tools.

Treatment of Patellofemoral Pain Syndrome

In many patients, simple home remedies can improve pain in patients affected by this condition.

1) Treatments at home

Changes in daily routine

Discontinue performing activities that hurt your knee, till your pain is sorted out, including alterations in your exercise routine or moving to low-impact exercises. Latter activities may apply less stress on your knee joint. If your body weight is above normal, dropping weight also helps in reducing pressure on your knee.

RICE Method

Opting for the RICE method may go a long way in improving your state. RICE is an acronym for Rest, Ice, Compression and Elevation.

  • Rest: Avoid applying weight on the knee which is paining.
  • Ice: Apply ice packs for 20 minutes at a single time, multiple times in a single day.
  • Compression: Cover the knee lightly with an elastic bandage, leaving a cavity in the kneecap area, to avoid extra swelling. Ensure that the bandage is loose enough to not cause any pain.
  • Elevation: Rest with your knee elevated to a height above your heart, as frequently as possible.

Medicines

Taking certain NSAIDs like ibuprofen or naproxen can aid in the reduction of swelling and pain. If your pain continues or worsens, preventing knee motion, kindly contact your doctor. Medical treatment for patellofemoral pain syndrome is meant to relieve pain and re-establish the range of knee motion and its strength. In the majority of cases, this pain can be treated by non-surgical means.

2) Non-surgical Treatment

Physical Therapy

Dedicated exercises for improving range of motion, strength, and knee joint endurance can contribute to providing relief in this condition. It is particularly vital to concentrate on strengthening and stretching your front knee muscles as these muscles are the key stabilizers of your kneecap. Experts may also recommend core muscle exercises to build up the muscles in your abdomen and lower back.

Using Orthotics

Orthotics/shoe inserts can contribute to alignment and stabilization of your foot and ankles, withdrawing stress from your lower leg. These devices can either be customized or bought directly.

3) Surgical Treatment

Surgery is very rarely required to treat patellofemoral pain syndrome, only in extreme cases, which are not responding to non-surgical modes of treatment.

Arthroscopy

During this procedure, your surgeon inserts a small camera, referred to as an arthroscope, into your knee joint. The camera shows images of the knee joint on a screen, which your surgeon uses to guide small surgical instruments in the area to be operated on.

  • Debridement: In some cases, removal of damaged smooth, white tissue covering the ends of bones at the joints (articular cartilage) from the kneecap’s surface can give relief from pain.
  • Lateral release: If the affected muscle is very tight to pull the kneecap out of the trochlear groove, this procedure can relax the tissue and resolve the improper alignment of the kneecap.
  • Tibial tubercle transfer: In some cases, kneecap realignment by shifting the patellar tendon along with a portion of the bony prominence on the shinbone may be essential.

A conventional open surgical cut is needed in this procedure. The surgeon detaches the tibial tubercle, partially or completely, to enable shifting the bone and the tendon to the knee’s inner side. The piece of bone is then reattached to the shinbone using screws. In the majority of cases, this transfer permits better kneecap tracking in the groove of the trochlea.

Realignment

In more extreme cases, a surgeon may require operating your knee for re-alignment of your kneecap’s angle or to reduce pressure on the cartilage.

To conclude, Patellofemoral pain syndrome is one of the most common causes of anterior knee pain today. And, while there are several treatment options available to treat the syndrome, it is crucial to accept the fact that your knees are absorbing a huge amount of pressure since the time you have started walking. Plus, with regular wear and tear, knee pain is bound to happen and take a toll over a while as even the knee’s two shock absorbers — pads of cartilage called menisci — start to deteriorate with age. But certain steps like regular stretching and mobility drills, wearing good footwear, and practicing correct form while exercising should be paramount if you are looking to age-proof your knees. 

The knee is the human body’s largest joint and its healthy maintenance is required to perform most of the everyday activities, easily. The knee joint is formed by the thighbone’s (femur’s) lower portion, the shinbone’s (tibia’s) upper portion, and the cap of the knee referred to as the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges present between the thighbone and the shinbone are known as menisci. They function as the natural “shock absorbers” protecting the joint. The thigh and shinbones are held together by large ligaments, lending stability to the joint whereas the long thigh muscles make the knee strong. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane secretes a liquid that moistens the cartilage, minimizing friction to almost zero in the case of a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Although there are more than 100 types of Arthritis, the three most common types are Osteoarthritis, Rheumatoid arthritis and Post-traumatic arthritis. In this article, we will majorly focus on Osteoarthritis.

What is Osteoarthritis (OA)?

Osteoarthritis is an age-related “wear and tear” type of arthritis. It generally affects persons aged 50 years or more, but may also affect younger individuals. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Osteoarthritis (OA) of the knee happens when the cartilage, the cushion between the knee joints deteriorates. This can cause pain, stiffness and swelling. Appropriate treatment can help relieve discomfort and slow the damage. It can also improve your quality of life facilitating you to better keep up with your day-to-day activities.

Osteoarthritis

What are the causes of  Osteoarthritis?

  • Age: The risk of developing OA increases as someone gets older because bones, muscles and joints are also aging. 
  • Joint injury
  • Using the same joints over and over in a job or sport can result in OA.
  • Obesity: Extra weight puts more stress on joint and fats cells to promote inflammation.
  • Weak muscles: Joints can get out of the right position when there’s not enough support.
  • Hereditary: People with family members having OA can also suffer from OA.
  • Women are more likely to develop OA than men.

What are the signs &  symptoms of OA?

  • Joint stiffness and soreness
  • Grating sensation
  • Bone spurs
  •  Loss of flexibility
  • Pain or aching in the joint during activity
  • Limited range of motion that may go away after movement
  • Clicking or cracking sound when a joint bends
  • Swelling around a joint.

How to Diagnose Osteoarthritis?

Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A physician can diagnose most of the cases but in some cases, he may refer you to an Orthopedic surgeon, physiatrist for further evaluation.

Medical History

Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. The doctor will look for a family history of the disease as well as the presence of various risk factors to indicate the need for further testing.

Physical Examination

A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include signs like swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate the range of motion and general joint mobility.

What are the treatment options for Osteoarthritis?

General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

Medical Management

  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
  • Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
  • Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is the human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage over time leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Depending on the severity of the disease your doctor will suggest the best line of treatment to treat Osteoarthritis.

The Knee and its Structure

The knee is human body’s largest joint and its healthy maintenance is required to perform most of everyday activities, easily. The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The menisci are C-shaped wedges located between the femur and tibia. These act as “shock absorbers” that cushion the joint. Large ligaments hold the femur and tibia together and provide stability whereas, the long thigh muscles provide strength to the knee. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

What is Arthritis and different types of arthritis?

The most common disease responsible for disrupting the harmony and causing chronic knee pain and disability is arthritis. Swelling and tenderness in any of the joints of our body, including the knees is referred as arthritis.

Although there are many types of arthritis, mostly knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Rheumatoid arthritis is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
  • Post-traumatic arthritis is a type of arthritis that can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, leading to knee pain and limiting knee function.

Treatment of Arthritis

Treatment of arthritis concentrates on providing relief from symptoms and improving function of the joint/knee. You may need to try multiple treatments or combine several treatments from the following to help you in getting relief from your arthritis.

  • Lose some weight (in case of overweight or obese patients)
  • Exercise: Muscle strengthening around the knees through exercise restores stability of the knee joint and reduces pain. Stretching of muscles through exercise aids in maintaining the mobility and flexibility of the knee joint
  • Pain-killers: These include over-the-counter paracetamol, naproxen, diclofenac, etc. However, these should not be continued for more than 10 days without your doctor’s consultation.
  • Corticosteroid or hyaluronic acid injections directly in the knee: Corticosteroids act as powerful anti-inflammatory agents whereas hyaluronic acid is a kind of lubricant in the knee.
  • Alternative therapies such as topical counter-irritant creams containing capsaicin, acupuncture therapy or supplementation with glucosamine and others can sometimes help to improve arthritis symptoms.
  • Physical or Occupational Therapy can also aid in teaching you ways of performing routine activity through exercises or alternate ways of performing routine work.
  • Using braces: Devices such as braces can either transfer the weight from the sides of the knee affected by arthritis or even support the entire knee.
  • Surgery: When every treatment from the above options fail to provide relief from arthritis of the knee, your doctor can recommend surgical options such as arthroscopy (removing the debris in the joint through a tiny telescope and other small equipments), osteotomy (altering the alignment of the knee by changing the knee’s shape) or total knee replacement (where the natural worn out knee joint is replaced by an artificial knee joint made of metals or plastic).

Usually, the treatment of arthritis is dependent on the specific type of arthritis present. But, sometimes the patients may need to try several different treatments, or combination of treatments before they determine what works best for them. However, in most cases, an exact diagnosis increases the chances for successful treatment of arthritis. After undergoing treatment, the doctor may recommend some physical therapy to help the patient regain strength in the knee and to restore range of motion making it possible to perform daily activities more effortlessly.

The word ‘arthritis’ is used to describe pain, swelling, and stiffness in one or more joints. However, it is not a single condition and there more than 100 types of arthritis and related conditions. The underlying cause varies with specific types of arthritis. It can cause everlasting joint changes and the common joint symptoms may include swelling, pain, stiffness, and decreased range of motion gradually.

These differences may be noticeable, such as lumpy finger joints, but usually, the damage can only be detected on X-ray. Apart from joints, some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin. Although there are numerous types of arthritis, the two most common ones are Osteoarthritis and Rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is a chronic (long-lasting) joint condition, affecting millions of people globally. In this case, the cartilage (protective tissues covering the ends of bones forming a joint) breaks down, causing the bones within the joint to rub together. Other causes may include dislocated joints and ligament injuries.

Signs that you may have Osteoarthritis:

  • Joint stiffness and soreness
  • Grating sensation
  • Bone spurs
  •  Loss of flexibility

Treatment of Osteoarthritis

A) General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

B) Medical Management

  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
  • Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
  • Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

C) Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease; a condition in which your immune system mistakenly attacks your body. It happens when your immune system targets your joints lining. While RA affects joints on both sides of the body such as both hands or both knees, it can also affect your whole body.

Signs that you may have Rheumatoid arthritis:

  • Joint pain, swelling, and tenderness
  • Morning stiffness for at least 30 minutes after waking up
  • More than one joint affected (hands or wrists)
  • Fever

Treatment of Rheumatoid arthritis

The primary objectives in treating rheumatoid arthritis are reduction of inflammation and pain, preservation of function, and prevention of deformity. Success requires early and effective medication. Disease-modifying anti-rheumatic drugs (DMARDs) should be started as soon as the diagnosis of rheumatoid disease is certain and then adjusted with the aim of suppressing disease activity. NSAID drugs are members of a drug class that reduces pain, decreases fever, prevents blood clots, and in higher doses, decreases inflammation and provides some symptomatic relief in rheumatoid arthritis but do not prevent erosions or alter disease progression. They are not appropriate for monotherapy (therapy that uses one type of treatment) and should only be used in conjunction with DMARDs, if at all.

Possible causes of arthritis may include injury, abnormal metabolism, inheritance, infections, or immune system dysfunction. Seek immediate medical care if you have swelling or stiffness that doesn’t go away in a few days or if it becomes too painful to touch your joints. If joint pain isn’t connected to any recent injury, you must immediately consult your doctor.

It’s normal to have joint pain occasionally, but when the pain starts interfering with your daily movements, it’s time to seek medical help. The initial move is to get an accurate diagnosis of what’s causing your joint pain.  You may be later referred to a rheumatologist or orthopedist (Doctors who specialize in arthritis and related conditions). During the medical examination, your doctor may ask questions related to your symptoms and medical history to assess your situation.

Although there’s no particular cure for arthritis, treatments have developed gradually. The treatment for arthritis aims at controlling pain, lessen joint damage, and enhance the quality of life. A variety of medicines and lifestyle changes can help accomplish this and protect joints from additional damage.

Mr. Gonsalves was leading a normal and active life till arthritis crept up and set his life in turmoil. From being an active 60+ grandpa, he soon became confined to his bed and dependent on his walker. After years of physical therapy, medication and non-invasive procedures, the pain simply did not subside. Faced with debilitating pain that prevented the senior citizen from even getting a good night’s sleep, his family doctor and orthopedic surgeon recommended a Total Knee Replacement as the solution to the problem at hand. Six months post-surgery,
Mr. Gonsalves is now a changed man who has gained a new lease at life. Here is his side of the story.

What made you choose to undergo a Total Knee Replacement?

Unfortunately, all the initial efforts at managing my condition like physical therapy, medicine and more, failed and I was left battling the pain and restricted movement. As someone who previously led a very active life, picking up my grandchildren from the bus stop, going for a walk with my friends every morning, this condition started affecting me mentally and emotionally. Lastly, my family doctor and orthopedic surgeon recommended Total Knee Replacement as the solution to my condition.

Was it an easy decision to make?

To be honest, I was a little apprehensive about undergoing the surgery as would anyone who is in this situation. Fortunately, both my family doctor and orthopedic surgeon were very helpful when it came to assuaging my doubts and fears. They told me that this procedure is one of the most common orthopedic surgeries in the world with a vast majority of people experiencing significant improvement in pain and mobility after the procedure. The final decision to undergo the surgery was made cooperatively by me, my family, my family physician, and my orthopedic surgeon. Here I must add that my family physician first referred me to an orthopedic surgeon for a thorough evaluation to determine whether I might benefit from this surgery.

Would you recommend a knee replacement surgery to lakhs of people suffering from knee pain?

Only if your condition is unmanageable through non-invasive means like mine was, will they recommend the surgery.  In fact, your orthopedic or family doctor won’t recommend you undergo one without due cause. In most cases, the patient’s family doctor will recommend the patient to an orthopedic surgeon who will evaluate if the patient is the right candidate for Total Knee Replacement. This was the process that I myself underwent before undergoing the surgery. From what I realized after having spoken at length with my orthopedic surgeon is that they only recommend surgery if:

  • The patient has severe knee pain that restricts their movements. These include regular movements like walking, climbing stairs and sitting in and getting off chairs. The knee pain in such cases is usually so severe that one cannot walk too far without significant pain or the use of a cane or walker.
  • The pain interferes with the patient’s resting or sleeping both during day and night.
  • The inflammation and swelling are severe and do not improve with rest and medications.
  • The knee starts showing signs of a deformity like bowing in and out.
  • Lastly, when everything from anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries have failed.

How is your life post-surgery?

To say that it is incredible is an understatement! I feel as if I have got a new lease in life. The reduction in stiffness was almost immediate after the surgery. The pain took some time to go, but that was because of the surgery itself. Now I can confidently state that I am pain-free and happy! I was able to walk with the help of a walker almost 24 hours after surgery and was driving within 6 weeks. I am back to my old routine and my grandchildren are thrilled to have their grandpa back at school pick-up duty! Going for walks and socializing with my friends is also something I really enjoyed getting back to. All those years of pain and discomfort seem like a bad memory now. I am so glad to have undergone the surgery and would advise anyone in severe and unmanageable knee pain to undergo the surgery instead of waiting for their condition to worsen. I made my choice and I am truly thankful that it was the best one for me!