M.B.B.S., M.S.(Orth.), DNB (Orth.), F.I.A.S. (Germany)

 Knee pain has been one of the most common problems faced by people after the age of 60. 

Most of the people above 65 years may have faced knee pain at some time in their lives. Most patients today have been seen to have adjusted to their life according to the pain and have been seen avoiding to see a doctor to treat it.

Knee pain in elderly is most commonly due to osteoarthritis, also known as a wear and tear arthritis. This occurs due to degenerative changes taking place in the joints due to ageing. The lining cartilage of the knee joint gets worn out resulting in exposed bone raw surfaces which rub against each other and cause pain. Also along with cartilage problems, pain can be due to meniscal tears.

In a study conducted in Mumbai, India, It has been shown that most patients who assume squatting position and cross legged sitting have maximal chances of having knee pain. Mainly pain is initially felt while climbing down stairs, and later both climbing up and down, sitting cross legged, and even walking. Pain usually settles on rest.

People suffering from such knee pain often don’t seek medical attention, and when they do, their joint is often beyond help. Damage has been done. Orthopaedic Surgeons are usually consulted who would order a set of xrays and conduct some clinical tests.

The most common advice given by orthopaedic doctors to these patients is to avoid Squatting and sitting cross legged, avoid unnecessary stair climbing. But walking is totally permitted and in fact encouraged.

Exercises of the knee are the most important treatment for osteoarthritis of the knee. These are for mobilisation of the joint, treating deformities and strengthening the knee muscles. Hot water or Ice fomentation also help a lot and are encouraged. Medicines for pain may also be given.

If patients do not have relief with this first line therapy then injections for knee joint are advocated. These can be either steroid medicines or viscoelastic gels supplementation.

Patients who do not have relief with these or if their pain keeps recurring and causes debility severe enough to restrict their movement and hampers life, may be advised to undergo knee replacement surgery. This surgery may be a partial knee replacement or a total joint replacement depending upon the amount of joint damage involved.

The results of Knee replacement surgery have been very encouraging with very few complications leading to millions of patients now benefiting from this surgery every year in Mumbai.

Patients who do not wish to undergo a major surgery like knee replacement, but wish to have a relief of pain, these may be advised to have arthroscopic lavage of the knee joint. Though the results of Arthroscopic Surgery are not permanent but are quite good and long lasting.

2. What to do for Knee Arthritis Pain in Elderly: Is Replacement the        only solution?​

1. What to do if you have a Knee Injury?


There are all sorts of ways in which one can have a knee injury. Most get injured while playing sports like football, running, jumping or even in day to day activities like walking down stairs, fall from a bike, getting down from a bus or even a local train like in Mumbai. Thousands of people suffer from bike injuries in Mumbai in any given month. You might feel a sudden jerk or pull in the knee and moderate to severe pain after you injure the knee. And shortly afterwards, you may also see a swelling around the top and sides of the knee.

Two possibilities may arise:

1. Either you are totally unable to walk or have severe limping due to pain in knee and you will be carried to a hospital by someone in which case an Xray of your knee will be seen by a orthopedic doctor. If you have a fracture around the knee, the doctor will advice accordingly.

2. Now the others, who can walk after knee injury with some amount of pain and limp may not visit a doctor immediately. These are the subset of patients likely to have a knee ligament injury.

Generally, if one has a knee any injury and is suffering from pain and/ swelling, the best treatment to do at home is to do RICE (R - Rest, I- Ice fomentations, C- Compression Bandage, E- Elevation). Now we shall explain each in detail.

Rest: Give complete rest to the knee. Avoid walking too much. Avoid bending your knee like in squatting or sitting cross-legged. Taking a few days bed rest may also help.

Ice Fomentation: Apply ice or an ice pack onto the knee and upper thigh, continuously for ten every 2 to 3 hours. This can continue for a few days till pain gets relieved.

Compression Bandage: A crepe bandage can be used for applying compression over the knee to decrease the pain and swelling.

Elevation: The involved leg should be placed in a elevated position on top of pillows for the swelling to subside.

If one has done these for a number of days, say for 3 to 4 days, he or she should feel somewhat better.

After this, one can resume routine activities of feeling better in the knee. But they should at all times avoid running, jumping or activities that stress the knee.

The signs and symptoms that can suggest that you need a specialist opinion are:

1. Pain in the knee on walking, and/or fully bending or straightening the knee.

2. Clicking sounds heard in the knee on moving the knee, especially during walking or bending knee. This can be suggestive of a meniscus injury in the knee.

3. Locking in the knee: feeling that the knee gets locked in a particular positon while walking or bending which again may be suggestive of a Meniscal or a ligament tear.

4. Instability: if on walking, you feel as if the knee is loose or moving inside and you dont have complete confidence of walking and not falling down, then it may be suggestive of a ligament injury in the knee like a anterior cruciate ligament injury (ACL) or a posterior cruciate ligament injury (PCL).

5. Swelling: if the knee remains persistently swollen then there could be possibility of a ligament or a meniscus tear in the knee.

Such signs should be seen as RED FLAGS and be acted upon as soon as possible. One should in these cases see a Orthopedic doctor specialist in Knee injuries and Knee arthroscopic surgery.