Stop pain before it stops you - arthroscopy as an option?

Painful joints can greatly affect one's quality of life. Fortunately modern medical advances can help one live a normal and active life.

Loss of mobility can be devastating: Osteoarthritis of the knee is a common disorder. Due to modern medical advances, more than 25 per cent of the population is older than 60 years but still looks forward to many decades of active life. Painful joints as a result of wear and tear or inflammatory arthritis can be a serious impediment to normal life. Osteoarthritis of the knee is one of the most common disorders mostly affecting those above 40. It affects more women than men and risk factors include obesity, heredity, knee injury and occupational loading. Symptoms include pain, restricted movement, impaired function, and even total disability in severe cases. Pain may be experienced not only during movement but also while resting.

Many people experience aching in and around the knee, persistent pain or attacks of acute stabbing sensation, morning stiffness and stiffness associated with pain. The disease is also associated with swollen knee joints, buckling or giving way due to weak knee muscles and tenderness in the knee area. In severe cases, the pain may confine a person to the house. Loss of mobility and dependence on others can be psychologically devastating. This is especially so in elderly people. Fortunately, recent advances in joint replacement surgery can help.

What is arthritis?

Any joint has two or more bones articulating with one another. The ends of the bones have a smooth covering called the articular cartilage. The joint also produces a thick viscous fluid called synovial fluid, which helps in smooth and painless movement. Any condition that damages the articular cartilage or reduces or alters the quality of the synovial fluid can lead to increased friction and stiffness of the joint. With extensive loss of the cartilage, bone rubs against bone leading to severe pain and cracking noises on movement. In advanced stages, there is severe weakness of the muscles around the joint along with instability. The joint ultimately becomes deformed and is unable to perform its normal actions. Broadly, arthritis of the knee can be of two types. Osteoarthritis, which is due to wear and tear, is more common in the elderly and in the lower limbs that bear the body's weight.

The other is inflammatory arthritis. Rheumatoid arthritis is the most common example and can affect younger people also. Inflammatory arthritis may also be associated with serious cardio-vascular, gastro intestinal and eye disorders. The symptoms depend on the severity of the disease. In mild cases, pain may be felt only at the end of the day or during strenuous activities. With increasing severity, the walking distance gradually decreases and it may be associated with swelling and warmth over the joint even during moderate activities.

In advanced cases, walking without support becomes impossible and pain may be present even during rest. Many patients spend sleepless nights for fear of pain even with the slight movement. Early diagnosis and treatment is important in restoring normalcy and patient education is important to increase awareness. Medical personnel must reassure their patients and provide adequate advice about lifestyle, diet, and the need to reduce weight. Specific exercises can be recommended in mild to moderate cases to maintain muscular strength, while simple knee sleeves, shock absorbing heel insoles, canes and hot/cold foam application can also ease the pain. Patients must avoid using the stairs often if pain persists.

Physiotherapy can also be considered. Patients must be initiated into simple exercises such as walking. If one experiences pain while exercising, rest the joint for a couple of days and restart gently. Medication can also produce partial relief. Local application of gel or cream, oral painkillers, cortico-steroid injection can be used under a doctor's supervision. However, long-term use may result in side effects such as acidity, gastritis and even kidney failure. Moreover, analgesics give only partial relief and cannot be considered a suitable intervention.

Surgical intervention may become necessary in the event of severe disability. Arthroscopy, osteotomy and knee replacement are some forms of surgery.

Surgical options

Knee replacement may be unicompartmental or involving total replacement of the knee. The surgeon will decide what is best after studying the severity of the pain, the degree of functional impairment and evidence of structural joint damage. Arthroscopy is the simplest surgery. Carried out under local anaesthesia, the patient can be discharged in a day or two. It is minimally invasive and involves cleaning/debridement of joint, repair of damaged cartilage, removal of damaged bone and loose fragments of cartilage. It helps preserve the remaining healthy part and stimulates the regeneration of a new cartilaginous load-bearing surface. However, this is useful only in very early stages and is not applicable for patients who have very severe pain, instability or deformity of the joint.

Osteotomy or "bone cutting" helps prevent deterioration of joints with arthritis. It helps realign the loading axis of the knee to redistribute the static and dynamic loads on articular surfaces. This reduces pain and delays progression of the disease, but is rarely performed, as it is useful only in a few cases and does not eliminate the symptoms totally.

When pain is very severe, joint replacements can offer a dramatic cure with restoration of normal activities. Here, the superficial layers of the bone are removed and replaced with new gliding and load-bearing surfaces made of plastic, metal or ceramic. Deformities can be corrected and the joint becomes stable allowing the patient to regain mobility.

Unicompartmental knee replacement is recommended for patients with partial knee damage. It involves insertion of small implants in place of the damaged tissue of the knee joint. It helps relieve pain and preserves function for as long as possible. It is usually recommended for patients less than 60 years of age.

Total knee replacement is recommended for patients with moderate to severe symptomatic knee arthritis affecting both the medial and lateral compartments. It involves resurfacing the worn out parts of the knee surface with implants made of metal and plastic, placed on the joint surface of each bone.

Latest advance

Computer Navigation is the latest advance in orthopaedic surgery. The anatomy of the operating area is assessed and displayed accurately and three-dimensionally. As the surgeon uses an instrument during surgery, the IGS camera calculates its position and transfers the data to a computer. The whole system offers the surgeon a virtual 3D navigation support system. It allows very precise, safe and perfect surgeries. Computer Navigation enables knee replacement surgery to be performed with greater precision and control. Surgical instruments are continuously tracked by the navigation system, enabling the surgeon to judge the precise position and alignment of the bone cuts. The benefits to the patient are better alignment, early mobilisation and most importantly decreased wear and tear of the prosthesis. As a result, the longevity of the joint replacements may be extended up to 25 years, which means that many patients may never need a revision surgery in their life.

Source: RefillPill.com Editors' Choice