WE assume that aches and pain are part of ageing. When we see the elderly struggling to walk or complaining of knee pain, we call them ageing-related problems, but it may be osteoarthritis.

Osteoarthritis is a progressive and degenerative disease where the articular cartilage of the knee gets worn out over time and has a significant impact on quality of life as severity progresses.

Osteoarthritis of the knee can be the result of modifiable or non-modifiable causes, explains UM Specialist Centre Quaternary Care Hospital consultant orthopaedic, and hip and knee surgeon Dr Veenesh Selvaratnam.

The non-modifiable causes include genetics, age (increasing age), ethnicity (Asians are more predisposed to osteoarthritis of the knee) and gender (women are more affected than men).

The modifiable causes, meanwhile, include previous trauma or injury to the knee. This could be due to road accidents or sports-related injuries, or any previous fracture around the knee joint which puts individuals at higher risk of developing osteoarthritis of the knee.

Weight gain or a high body mass index is also a risk factor and people who “overuse” their knees, such as sportsmen, or those involved in high-impact activities face a similar risk.

“It is predominantly a disease of the elderly and in Malaysia, among those aged 55 and above, 30 per cent have some form of knee arthritis,” says Dr Veenesh.

Among those above 60, 35 per cent have some symptoms of osteoarthritis of the knee.

IMPACT ON DAILY LIFE

In general, the impact of osteoarthritis of the knee would depend on its severity, which is usually based on a grading of one to four, with four being the most severe, says Dr Veenesh.

Patients in mild stages would still be able to carry out normal activities with some lifestyle modifications.

But those in severe stages of the disease, with “bone-on-bone” osteoarthritis of the knee (where the thigh bone is in contact with the shin bone of the knee), would experience pain, swelling, stiffness, deformities of the knee like bow leg or knock knee and be unable to walk even short distances.

They will also experience pain during rest and at night, and be unable to do normal activities.

Management of the disease would depend on its severity, says Dr Veenesh.

In the early stages, it can be managed without surgery. Patients will have to undergo lifestyle modifications (such as losing weight), or be prescribed painkillers and anti-inflammatories to manage pain.

Some individuals may also benefit from physiotherapy or wearing knee braces.

Dr Veenesh says injections to the knee may also be prescribed to help patients manage symptoms. These include steroid or hyaluronic acid injections or PRP (platelet-rich-plasma) injections.

“All these measures are meant to help patients manage their symptoms. It’s not a cure for the condition.”

However, once patients start experiencing bone-on-bone osteoarthritis of the knee coupled with pain, surgery may be needed.

Dr Veenesh says knee replacements are nothing new, but in Malaysia, in the last three years, robotic-assisted knee replacements have been initiated.

Robotic technology acts as an excellent preoperative planning tool for surgeons, he says, and more importantly, surgeons are able to carry out this plan in a precise manner during the actual surgery thanks to the same technology.

“Robotic-assisted surgery doesn’t replace the skill of the surgeon. The knowledge and experience of the surgeon still counts in a knee replacement.”

It also takes an experienced surgeon who has done many knee replacements to use the technique effectively, adds Dr Veenesh.

Robotic technology acts as an excellent preoperative planning tool for surgeons, explains UM Specialist Centre Quaternary Care Hospital consultant orthopaedic, and hip and knee surgeon Dr Veenesh Selvaratnam.

Robotic technology essentially assists the surgeon by enabling him to be more accurate and precise during knee replacement surgery.

By using it during the preoperative process, surgeons can better decide on the right alignment and sizing of the implant that has to be put into the knee, and during surgery, this plan can be executed in a precise manner. This results in a better outcome for the patient.

Dr Veenesh says with conventional surgery, although the outcomes are generally good, some patients may still complain of discomfort because the sizing and alignment of the implant are not a perfect match to the patient.

While there is some evidence that robotic-assisted knee replacements result in better outcomes for patients, long-term research on the subject is still needed, he points out.

Ultimately, the success of the procedure would depend on the surgeon’s skills and knowledge.

For the patient, it results in a better range of movement, freedom from stiffness and swelling, generally gets them more active and improves quality of life.

ROBOTIC-ASSISTED KNEE REPLACEMENT

• Enables the surgeon to create an ideal surgical plan.

• A sophisticated preoperative and intraoperative alignment tool.

• Surgery is done with a robotic arm which enables greater precision.

• Suitable for patients with symptomatic painful end-stage knee osteoarthritis, inflammatory arthropathy, or degenerative knee diseases.

OSTEOARTHRITIS OF THE KNEE – SYMPTOMS

*Knee stiffness

*Swollen knees

*Pain

*Crepitus (clicking/popping/cracking sound in the joints)

*Reduced range of motion

*Bowed legs

Swelling is one of the common symptoms of osteoarthritis of the knee. Picture credit: Freepik

Source: New Straits Times