Early Treatment, Good Prognosis!

Osteoarthritis of the knee joint in the elderly population is well understood by the medical fraternity as well as the general public which has made its management optimal with the advantage of combined decision-making by the patient and the treating doctor. The unnecessary delay in treatment due to apprehension is reduced with the patient’s expectation of leading a pain-free independent life and the medical advancements that have made total knee replacement almost a day-care surgery. The satisfaction seen on the patient’s face during a post-operative follow-up visit to the doctor’s office says it all.

What is alarming now, is many people in their 40s and 50s present with knee pain which they were neglected for a long time, reasons being:

• “I thought it will get better with time.”
• “How can I get arthritis at this age itself ,doctor!”
• “I was managing with pain medicines and liniments.” and so on

Investigations like x-ray and MRI reveal moderate and even advanced osteoarthritis in some of these patients. Many defer further treatment denying to accept their health condition and presenting later with a worsened condition. The concerns with early onset osteoarthritis are significant disability during the most productive part of life and a restricted lifestyle leading to a sedentary way of life and psychological torment.

Causes of Early Onset Osteoarthritis

Secondary Osteoarthritis

Predisposing conditions like rheumatoid arthritis, gout and other inflammatory and auto-immune disorders.

Alignment Issues

Mal-alignment at the knee joint due to ankle, hip or spine dysfunction can lead to abnormal loading within the knee or between the knees with resultant early wear and tear changes.

‘Compounded’ Injury

Repetitive micro-trauma due to sports, occupation or poor posture can accumulate over time and manifest as osteoarthritis with some inciting event.

Neglected Injury

Ligament injuries at a younger age like a meniscal tear or anterior cruciate ligament (ACL) injury when not treated properly, usually present with on-and-off exacerbations of pain which subsides with pain medications and rest. However, they cause biomechanical disadvantages, straining other normal ligaments and ultimately taking a toll on cartilage. These individuals are at a higher risk of developing osteoarthritis at a much younger age.

Non-Modifiable Risk Factors

Even some fit otherwise active persons also present with arthritis owing to genetic predisposition. But they usually do well due to their physical activity and fitness.

Also read: Osteoarthritis – Age Related Disorder

Prevention of Osteoarthritis

Maintain Muscle Tone and Bulk

Muscles act like internal brace and reduce the stress and strain on the joint. They not only avoid injury but also attenuate the degenerative cascade.

Body Mass Index

Increasing BMI leads to early osteoarthritis due to overload; reducing the body weight reduces the load thereby preventing early OA knee.

Proper Treatment

Early consultation and prompt treatment for ligament injuries prevent the onset of OA knee.

Osteoarthritis Treatment

Total knee replacement is a promising option in older patients with severe knee osteoarthritis, but not in young patients where preservation of native joints is important. Knee preservation techniques including PRP injection, viscous-supplementation, radiofrequency ablation of pain generators, arthroscopic repair or reconstruction of ligament injuries, cartilage repair with mosaicplasty and off-loading procedures like high tibial osteotomy provide satisfactory results. These procedures when done at the appropriate time can delay the progression of arthritis and hence reasonably postpone or even obviate the need for knee replacement surgery.