Narayana Health Care

Knee Pain in Elderly- Causes, Symptoms, Relief:
The Knee joint of the human body is the largest joint in the body and bears much of the body’s weight when we walk, run or climb stairs as it takes the most stress. It is also more prone to injuries and degeneration. In western countries almost one in every three persons over the age of 45 report some type of knee pain which increases with age.
Knee pain in the elderly can appear suddenly & acutely or it may develop over a period of time (chronic).

Some causes of acute knee pain are:

• Fractures and dislocations
• Sprained or torn ligaments
• Meniscal injuries
• Infection

Chronic pain may occur due to:

• Arthritis
• Osteoarthritis
• Rheumatoid arthritis
• Gout or Pseudo gout
• Osteoporosis
• Bursitis
• Infection
• Chondromalacia patella
• Iliotibial band Syndrome
• Post Traumatic arthritis

Out of all the cases mentioned above, arthritis is the most common cause of non traumatic knee pain in the elderly population. Age is the major reason for osteoarthritis of knee. For some individuals it may be hereditary, while for others, Osteoarthritis of the knee can result from injury, infection or even from being overweight. Women are at more risk of developing the same. Osteoarthritis is also called wear and tear arthritis. It is a condition where the natural cushioning between joints, which is the cartilage, wears away and the bone ends of the knee joint, rub more closely against one another. This results in pain, swelling, stiffness, decreased ability to move and sometimes formation of osteophytes (bone spurs).

• Can Osteoarthritis be cured?
  There is no definite cure for osteoarthritis, but treatments can help reduce pain and maintain joint movement.

Medications:

• Acetaminophen
• NSAIDS
• Opioids
• Glucosamine and chondroitin
• Diacerin
• Newer molecules- Univestin, Aflafin etc.

Though, medicines are useful in decreasing pain and inflammation, a combination of these are used to treat osteoarthritis. But all the above medications should be used with proper caution and excessive use can cause adverse effects.

• Intra articular Injections:

Injection of corticosteroids, into the knee joint may decrease pain and inflammation in early stages of osteoarthritis but the number of injections that can be received, are limited.

Injection of lubrication which is composed of hyaluronic acid may offer pain relief by providing some cushioning. This is because, the Hyaluronic acid is similar to a component normally found in our knee joint fluid.

• Therapy: Exercising, developing the muscles around knee and maintaining a healthy weight is a very effective way to treat osteoarthritis. The following too help in keeping osteoarthritis in check on early detection.
• Physiotherapy
• Occupational therapy
• Braces or shoe inserts
• Acupunctures
• Surgery: Various surgical procedures are also being done depending on the stage of osteoarthritis and age of the patients.

1. High tibial osteotomy: This is a very rewarding form of surgery done in osteoarthritis. Patients of younger age group with arthritis involving only partial knee joint and which may be due to problems with alignment of the knee joint gets benefited through this procedure. Part of the cartilage which is damaged due to nonalignment is relieved from bearing the weight by surgically correcting the alignment of the bone below the knee joint (tibia) and a metallic implant is fixed till the osteotomy heals. However, this procedure is not helpful in the advanced stages of osteoarthritis.
2. Arthroscopy: The role of arthroscopic lavage of knee joint for osteoarthritis is controversial and its use depends on centre to centre. In our set up we don’t advocate its use as we believe that even if we get some result from this procedure, it is very temporary in nature. By doing arthroscopic surgery, damaged part of the cartilage and synovium is removed by introducing endoscope (arthroscope) into the knee joint.

3. Joint Replacement Surgery: A popular form of surgery, it is a form of resurfacing procedure. Surfaces which come in contact with each other are removed and replaced with a metallic or plastic implant. knee replacement surgery (use this anchor text) is the proper name for joint replacement surgery.

Arthroplasty has revolutionized the treatment of osteoarthritis of knee. Thousands of patients are relieved from pain worldwide by undergoing this procedure.

We follow a fixed protocol for each and every patient of arthritis who needs joint replacement surgery. Our team comprises of Orthopedic Surgeon, OT Technician, Physiotherapist, Anesthesiologist, ICU Expert, Pain Expert, Dietitian and trained nurses. From the day of admission, complete care is taken to prepare the patient mentally and physically to undergo a major procedure like this. A fully dedicated operation theater is where we perform joint replacement procedure where the chances of infection, which is one of the most difficult complications, is minimum post-surgery. Anesthesiologist and pain experts take proper care to keep the patient pain free during and after the procedure. Physiotherapists are allotted to each patient for proper rehabilitation after surgery. Post-operatively patients are allowed to sit and move their knee from post operative day one and then allowed to walk from day two with support. Stay in the hospital varies from 4-6 days. Stitches are removed after two weeks and arrangements are made to continue physiotherapy at home for at least two to three weeks after surgery.

One of the major concern for joint replacement surgery is the cost of the procedure. Since its inception, Narayana Super specialty Hospital at Amingaon, has been carrying out large numbers of joint replacement procedures at very low cost and we are continually trying to cut the cost of procedure further so that it can be made available to all in the society.

The satisfaction that is obtained after treating a patient and gifting them a pain free life is divine.

Dr. Samarjit Khanika
Orthopedics Consultant at Narayana Superspeciality Hospital, Guwahati
Department of Orthopedics and Joint Replacement.