Even the best rheumatologists of the city find it difficult to manage a case of knee osteoarthritis since, it’s more of a damage or degeneration rather than a disease.
As you go through the FAQ’s , you would get the best of the informations on osteoarthritis and latest updates in the management of the same.
What is Knee Osteoarthritis?
Knee is a very important weight bearing joint of the body that does two important functions of the body. It bears the weight of the body and at the same time it carries the same weight in all directions both against and towards the gravity. With age, excess load, poor posture and trauma, it is prudent that such a joint will go through loss of integrity, altered lubrication, damage to the supporting structures and reduction in Shock absorption property. X-rays of Knees show reduction of joint space, loose bodies near the knee joint, hooking and irregularity of the bones near the knee joints.
Thus, Osteoarthritis is just a mechanical damage of a joint and to fix this issue, one has to ensure that no more than optimal weight is put on the joints within a normal range of motion.
Is it curable?
No oral medicine can change the damage accrued to the knee joint by any possible mechanism. The treatment is directed to reduce weight on the joints (dedicated Weight loss Programmed), Strengthening the muscles and ligaments around the knee joints (Dedicated Physical therapy), By Passing the weight of the knees to the sheen bones (Knee Braces), alleviation of pain (Painkillers and Paracetamol), Increase Lubrication of the Knee joint (Synovial Fluid Replacement Therapy) and changing the joint (Prosthetic Knee Replacement Surgery).
Amongst all these, only Total Knee Prosthetic replacement can solve the problem permanently and the solution can last for around more than 25 years.
I have been prescribed chondroitin and Glucosamine. Some are taking calcium too and some are having diacerin. Are these of any help?
No. they are not of any help. You must be wondering that even if they do not work, then why the doctors keep prescribe the same. The international guidelines have commented that this group of medicines has shown some benefit in a particular group of patients but some other studies have shown that they actually do not work. Since, the medical therapy is very limited in osteoarthritis, doctors go for a trial of these drugs and in case the patients respond well to them, the doctors suggest continuing the therapy. In my opinion, if these drugs work in some, they work as placebo.
People have a common disbelief that Calcium is mandatory for any disease of bones. This notion is a completely wrong one. Calcium is not necessary in treatment of osteoarthritis at least. Even if someone goes for a blood calcium test, the reports are going to come normal in nearly 99% of the persons. Hence, calcium actually does not help in this disease. So reduce your pill burden by deleting calcium from your daily medicine consumption list.
Do collagen peptide powders have any role?
No, they do not have any role in the treatment of Osteoarthritis. The recommendation for these medicines as per the international guidelines is in neutral status. Hence, I would suggest not to waste money in these medicines.
I have been prescribed paracetamol at a dose of 650mg thrice daily. Is it safe to have this drug for long?
For a painkiller to be very effective, it must have three important properties.
It should be Antipyretic (can reduce fever), Anti-inflammatory (can reduce inflammation i.e. redness, heat, swelling and pain) and its should be Analgesic (should reduce pain). Of these three properties, anti-inflammatory property is most important. But, it should be kept in note that higher the anti-inflammatory property of the drug, better the pain resolution but at the same time, higher the side effects (Stomach Ulcers, renal Damage, and Rise in BP etc). Since, osteoarthritis affects the elderly mostly; immense caution should be exercised in using anti-inflammatory drugs. Most NSAIDs have excellent anti-inflammatory properties.
Paracetamol has no anti-inflammatory property. It is antipyretic and at higher doses it can act as analgesic. Thus, at a dose of 4gms /day in divided dose, paracetamol can give some relief to pain. However, it should be kept in mind, that paracetamol actually does not help in recovery of the damage. It can be taken for as long as One year. A periodic check up for Liver function might be necessary. Caution must be exercised in persons who are alcohol consumers and who have hepatic damage.
What else can be as safe as paracetamol?
One can use Tramadol. It is a centrally acting analgesic with no anti-inflammatory action and vomiting is the notable adverse effect. It can be taken at a dose of 100mg four times a day if tolerated.
What physical therapies are needed for Knee Osteoarthritis?
Please cheek the physiotherapy section. It has detailed description with photographs and is downloadable as well as printable.
When do I need a Knee Replacement? Should I wait until I am 60?
Age does not guide the timing of surgery. The amount of damage is the most important decisive factor. In early stages, one can definitely try all physiotherapeutic maneuvers and weight loss planning. In most of the cases, these two techniques can give relief from pain and discomfort. If these two does not work, one should definitely think of knee replacement.
What is all about Synovial Fluid Replacement Therapy?
Synovial Fluid Replacement therapy is never an alternative to Knee Prosthesis. As mentioned previously, misuse and excess weight bearing on the knee joints cause reduction in the quality of the synovial fluid. It is a highly dense fluid that works as a cushion or shock absorber between the thigh bone and the leg bone. With wear and tear the viscosity of Synovial Fluid deteriorates so does its important properties of joint lubrication and protection.
HYLAN GF 40 is a high molecular weight artificial compound that is available in sterile gel from at 6ml and 2ml strength. The 6ml strength is sued for Knee osteoarthritis and the 2ml ones are sued for Shoulder and Hip arthritis. It is administered in an extremely sterile condition under USG guidance and has shown good results in patients with mild to moderate knee osteoarthritis. The actions last for 6 months and often they may provide relief up to One year and after that he/she may require a second injection.
Some doctor has been injecting Hyaluronic Acid injections repeated in my knee. How long does it take to act?
Hyaluronic Acid is an important component of Synovial Fluid and t6he knee cartilage. It is thought that if Hyluronic Acid is injected inside the knee joint, then the cartilage overlying the bones may grow back causing healing of the damage. But, The FACT is, cartilages never grow. Neither do they have any blood circulation. It is an avascular structure and both oral and intra articular supplementation of chemicals of the cartilage do not do any good. Hence, it is not recommended to get Hyaluronate Injections in the knee joint ever.
Use of repeated Hyaluronate has been a significant malpractice among low qualified doctors and sometimes done by Physical medicine and rehabilitation Specialists too. It is never recommended.
How successful is the surgery of Total Knee Replacement?
Total Knee Replacement or Popularly called TKR is one of the most successful surgeries. By the term success we mean, that the patient after the surgery will be able to walk free with minimal limitations, will remain pain free and can have an excellent quality of life without any surgical complications. And this success depends on various parameters.
- Skill of a Surgeon: A skilled and experienced surgeon has better success rates. Always choose surgeons who are experienced for more than 5 years and have done more than 20 to 25 surgeries. Try to talk to at least 10 people who have done surgeries under a surgeon.
- The patient who is supposed to get operated should not be bed ridden prior to surgery. There should be a good motivation for physical therapy both before and after surgery. Sticking to the physical therapies and exercises after the surgery is a strict requisite for a successful surgery.
- Surgeries are always difficult in very obese patients. The load on the knees needs to be curtailed at any cost. The life of the prosthesis depends a lot on the amount of weight that is put up on the artificial knees.
- Young patients fare better with surgical success. The quality of bones is good and so is the muscle power. Recovery is quicker and the duration of quality life is more with younger patients. However, if the quality of bones are good and the patient is physically very active, he or she can get the surgery done even at the age of 70 without any issues.
Total Knee Replacement is a very costly procedure. Is it covered by Medical Insurance?
Yes, these surgeries are covered by most of the medical insurance companies. However, these companies must have some waiting period for the surgeries to be done. That means you cannot go for the surgery that year you start paying premium for the insurance. Most companies have a waiting period of 4 years.
What is the approximate cost of the surgery?
The approximate cost varies and is dependent on Hospitals, Surgeons and Prosthetic Companies. Most of the prostheses are made outside India and hence the cost is escalated due to customs duties, taxes etc. Usually the average cost of Single Knee replacement is around 170000INR to 220000INR depending on hospitals and the implant. In government hospital, the cost of the surgery can be as low as 70000INR to 100000INR per knee. We are trying to give the exact figures as per different hospitals soon.
How long does it take to recover from the surgery?
The hospital stay is approximately 5 days. Complete recovery takes approximately 10 to 12 weeks. Till then one has to follow the guidelines of the orthopedecian and Physical therapist.
What is revision knee arthroplasty?
Revision knee is arthroplasty is a surgery that is done when an already implanted prosthetic knee joint starts malfunctioning. The revision is carried out by an experienced surgeon and this surgery ensures that the knee remains fully functional after the surgery.
