Osteoarthritis knee and women’s predisposition

Osteoarthritis (OA) is a condition that affects cartilage, the rubbery cushion covering bones in the joints and keeping them flexible. Over time, cartilage begins to stiffen and damages more easily. As a result, it gradually loses its ‘shock absorber’ qualities. Bones start rubbing against each other, and the pain begins.

By nature, women are at higher risk of osteoarthritis. The reasons include biology, genetic predisposition, and hormones. Unfortunately, a lot of women have added a fourth risk factor to the mix — obesity. Women’s bodies are designed to give birth, and that means the tendons in their lower body are more elastic than men’s. As a result, the joints move around a little more. When the joints have less stability, they’re more prone to injury. Because women’s hips are wider than their knees, their knee joints are not aligned as straight as men’s. The alignment of a woman’s body leads to a higher rate of knee injuries, and injuries can lead to osteoarthritis later in life. Osteoarthritis runs in families. Experts have found that the female hormone estrogen protects cartilage from getting damaged which can lead to osteoarthritis. But after menopause, when women’s estrogen levels go down, they lose that protection and may have a higher risk of developing osteoarthritis even if they are on hormone-replacement therapy (HRT).

Prevention

A number of factors may put a person at risk of developing OA. However, by making necessary lifestyle changes, one can keep OA under control to an extent.  

Maintaining a healthful weight: Excess weight puts extra pressure on the knees. Over time, this contributes to wear and tear of the cartilage. Extra fat can also cause the body to produce cytokines, a type of protein. This can lead to widespread inflammation, and it can change the way cartilage cells work.

Controlling blood sugar: High glucose levels can affect the structure and function of cartilage, and diabetes increases the risk of inflammation and cartilage loss.

Exercising regularly: Moderate exercise can help the joints stay flexible, strengthen the muscles that support the knees, and reduce the risk of many health conditions. It may help to garden, walk, or swim for 30 minutes at a time, five times a week.

Reducing the risk of injury: Cartilage that sustains damage from an injury is more likely to develop arthritis later. Reduce the risk of falling at home, wear shoes that fit well, and use protective gear while playing sports to prevent injury.

Avoiding overuse: Some sports or professions involve repetitive motions of the knee joint, such as kneeling or squatting. Varying activities and getting enough rest between periods of work or exercise may help.

Getting help: To prevent OA from advancing, ask a doctor for advice about treatment and lifestyle changes when discomfort starts.

Eating a healthful diet, getting enough sleep, managing stress, and staying active contribute to better overall well-being and a decreased risk of health issues, including OA.

Signs & Symptoms

Osteoarthritis most commonly involves the knee joint. Signs and symptoms of osteoarthritis include pain where joint may hurt during or after movement, tenderness, stiffness, loss of flexibility, grating sensation and bone spurs. OA of the knee takes several years to develop, and it progresses in stages. In stage, one patient may or may not feel pain and x-ray findings are minimal. But as it progresses to stage four, pain becomes severe. As a result, there is stiffness in the joint, constant inflammation, and less fluid around the joint. There is more friction in the joint and more significant pain and discomfort while moving. In severe cases, the bones may become deformed and angulated because of asymmetric loss of cartilage.

In a country like India, most of the patients come to a doctor at an advanced stage of arthritis. Many of them come with a deformed mal-aligned knee. In initial stages such as stage 1 and 2, patients can get relief by doing physiotherapy to develop muscle power, taking painkillers (under the strict supervision of doctors), taking supplements like glucosamine and chondroitin. Once disease advances to stage 3 and 4, chances of pain relief with medications decreases. Many patients get relief with an injection of hyaluronic acid along with steroid into the joint. But once all conservative treatment fails, it becomes very difficult for the patient to do daily activities and they become dependent on painkillers. This is the stage where we as orthopaedic surgeons have to offer the option of knee replacement surgery. Proper case selection, proper counseling regarding the outcome is very important to motivate people to undergo surgery. Success after a knee replacement surgery depends on many factors. Proper control of co-morbidities like diabetes, hypertension, cardiac, renal, or liver problems (if any) should be done before surgery. Effort should come from a patient, relatives, physiotherapist and the whole group of people starting from the surgical team to psychological counselor.

Dr. Samarjit Khanikar | M.S. Orthopaedic Surgery | Consultant, Narayana Superspeciality Hospital, Guwahati.

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