In osteoarthritis, the slick surface of the cartilage at the end of the bones that form the knee joint becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone. It is like what happens to the tyres of your vehicle after many months of use. When bone rubs on bone this way, the joint becomes painful. The damage is not reversible, which makes it a disease without a cure. This is in the sense of the inability of modern medicine to make the knee joint recover to what it was before the disease. However, through Total Joint Replacement, we can reverse the crippling effect of end-stage knee arthritis.
Osteoarthritis affects millions of people all over the world. It affects people who are middle-aged or older. Other risk factors for osteoarthritis include obesity, previous injury to the affected joint and family history of osteoarthritis. At the age of 70, almost all of us would have the disease, but it may vary in severity. When a young person suffers from osteoarthritis, it is usually due to previous injury to the knee.
Pain is the first symptom you will notice. Your joint may hurt during or after movements. There may be joint stiffness, most noticeable when you wake up in the morning or after a period of inactivity. There may also be loss of flexibility. You may not be able to move your joint through its full range of motion. You may hear or feel a grating sensation or noise when you use the joint. Your joint may swell due to effusion (water) collection in the knee. A swelling at the back of the knee, known as Baker’s Cyst, may be noticed. Knee deformity like bowing or a K-leg may be present. Talk to your doctor if you present any of these symptoms.
When you see your doctor, he will ask you questions relating to your knee pain. Do not forget to tell him about all your past and on-going treatments and medications. It may not be safe to combine prescriptions of different doctors. Your doctor will then examine the knee and may request an X-ray. He may possibly request other laboratory tests. If he suspects your knee pain could be caused by something else, other than osteoarthritis, extended blood tests may be requested. In any case, the diagnosis of osteoarthritis is usually straight for the doctor who has some bone and joint experience
How is osteoarthritis treated?
Pain relief to improve your activity level is the goal. The doctor will control the pain and inflammation with medications. He may also advise on lifestyle modification and physiotherapy. Rest or a change in activities to avoid provoking osteoarthritis pain may be recommended. For those who wish to remain active, switching from high-impact activities (such as aerobics, running, jumping, or competitive sports) to low-impact exercises (such as stretching, walking, swimming, or cycling) may be required. A weight loss programme may also be recommended.
Total Joint Replacement
Osteoarthritis will eventually get worse. At a point, all the measures known to the doctor to relieve your pain would no longer work to your satisfaction. It is also possible for the medications you are taking to cause side effects like irritation of the stomach, such that you would no longer tolerate them. When you get to this point, surgery would be recommended. There are various options like arthroscopy, osteotomy, joint fusion and finally, total joint replacement.
Total Joint Replacement has been described as one of the most successful surgeries of all times. It takes away the knee pain and can allow you to return to the active life. You would be able to do exercises and play with your grandchildren or do your shopping. The techniques of Total Knee Replacement have evolved over the years and it is relatively safe these days. Before he performs the surgery, the orthopaedic surgeon will do a health evaluation to be sure you can withstand the surgery. He may seek advice from your primary care doctor or cardiologist (heart doctor) before he goes ahead. He should tell you the benefits and what could go wrong after the surgery.
The surgery involves removing the damaged parts of the joint, the top bone called femur and the leg bone called the tibia, and replacing them with metal implants. In-between the metal pieces, the surgeon puts a plastic. Sometimes, part of the knee cap is also replaced. The purpose of the operation is to take away the pain. It could make your knee alignment better and could correct your bow or K leg.
Total knee replacement is designed to last. Its duration depends on your level of activity. Consider two cars of the same brand; one you drive from Lagos to Abuja every day, and the other you drive only on Sundays. You can guess which will last longer, all things being equal. In general, most total joint replacement will last over 20 years.
The good news is that the surgery can now be safely performed in a few centres in Nigeria. Talk to your doctor about your knee pain and the possibility of having joint replacement, unless you are happy to live with the pain and disability.
Next week, we will discuss knee arthroscopy, the most commonly performed orthopaedic surgery in advanced countries, which can now be safely performed in Nigeria.