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.
In fact, 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 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 best mode of treatment for early 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.