Osteoarthritis, also known as degenerative joint disease (DJD) or “wear and tear” arthritis is the most common type of arthritis. It mostly affects the hands, hips, and knees.
The ends of the bones are covered by a smooth surface that provides a cushioning effect to the joints, known as cartilage. The wear and tear of this structure leads to arthritis. When this degenerative process happens with advancing age it is called Osteoarthritis (OA). Osteoarthritis has become a major health burden on society with a prevalence rate of 22% to 39% mainly affecting women more frequently than men. In the global burden of disease, in 2000, osteoarthritis was the 4th leading cause of years lived with disability (YLD) leading to 3% YLD. Knee osteoarthritis accounts for a fourth-fifth of the entire burden of osteoarthritis which clearly reflects that the knee is the most common joint affected by osteoarthritis.
When osteoarthritis happens with age as a degenerative process it is known as Primary Osteoarthritis and if it is due to some associated disease like Rheumatoid Arthritis, Ankylosing Spondylitis, injury to the joint and any previous joint infection etc. then it is called as Secondary Osteoarthritis.
Osteoarthritis has become one of the most common reasons for disability in the population more than 60 years of age. Inappropriate lifestyle of today’s world has further added to the early onset of arthritis.
Although multifactorial the main etiological factors are increased Body Mass Index (BMI) or obesity, lack of exercise, sedentary lifestyle and any activity putting an increased amount of force across the knee joint like kneeling, squatting, deep knee bending etc.
Osteoarthritis can affect any joint with a maximum propensity to affect the knee joint. Any injury sustained across the joint specifically fracture and infection puts the joint at risk of early arthritis.
Typical signs and symptoms of knee osteoarthritis include pain and stiffness affecting a range of motion after prolonged use, which goes away with resuming activities, difficulty in walking and climbing stairs, and difficulty sitting on the floor with cross legs. If neglected osteoarthritis can lead to severe muscle weakness and wasting along with deformity where an individual cannot straighten the knee joint and develop curving or bowing of legs.
A combination of preventive measures can be taken to avoid the early development of osteoarthritis or slow down the progression. Early diagnosis and timely treatment is the key to controlling osteoarthritis. Your doctor uses three tools to check osteoarthritis- medical history, clinical examination and X-rays to determine the stage and severity of arthritis. Treatment of osteoarthritis depends on the stage or degree to which the joint has been affected.
Initial management is physiotherapy, avoidance of certain postures, anti-inflammatory medicines glucosamine, diacerein and sometimes injections in the knee joint to subside pain, and inflammation and provide lubrication (viscosupplementation) & stem cell therapy. One must make sure of dietary intake of vitamin D, calcium and other minerals. All females over 60, males over 65 years and post-menopausal females should get their bone DEXA scan done to check if they have osteoporosis and required treatment must be taken to ensure adequate bone strength.
The end-stage disease is treated by resurfacing the joints which is commonly known as joint replacement surgery. Timely considering the surgical options and not delaying when it’s needed also provides the benefit of replacing only the affected part (partial knee replacement) which is less invasive and includes cutting less of the bone while retaining almost two-thirds of the native joint surface. Partial knee replacement which is scientifically called Unicondylar Knee Arthroplasty enables a person to have a rapid and early recovery and also saves from a major revision surgery like in case of revision of total knee replacement.
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Surgery adds to the financial burden on an individual and society. Therefore our focus should be on preventive measures and treatment in the early stage of osteoarthritis. One must follow a multimodal approach like a healthy lifestyle including a healthy diet, daily exercises (mainly resistance exercises) and avoiding harmful substances like smoking and alcohol. Strengthening of the thigh muscle (Quadriceps) has the most important role in preventing arthritis. Nevertheless having said that strengthening of the calf and hamstring is also equally important, as all muscles work together in taking away the stress on the cartilage.
Anyone suffering from joint pains must see their family physician or an orthopaedic surgeon if the pain doesn’t subside after a few days of basic treatment as timely reporting can provide better guidance thus preventing pain and disability. Family and community support must be ensured to the senior citizens to encourage them to do outdoor activities safely and under guidance as sitting inside the house the entire day cultivates negative sentiments and hence the low motivation towards being healthy.
