Orthopaedics: On the bend

By at home

woman suffering_knee_pain_01_11_12Your knees are the key to your mobility and any damage can have a severe impact.

The knee has a simple purpose. It needs to flex (bend) or extend (straighten) to allow the body to carry out its daily activities. Any swelling, stiffening, tears or sprains can stop this from happening, leaving you unable to walk on the affected leg and hobbling about with difficulty.

Knee Osteoarthritis

This condition affects the knee joints. The main symptoms are pain and stiffness. Knees may be most painful when walking, particularly uphill or upstairs. They may also feel stiff in the mornings or after a period of rest, but walking for a few minutes should ease this. Sometimes the affected knee may feel like it’s giving way.

What causes it?
Osteoarthritis can affect one or both joints. Many factors increase the chances of this disease: the risk rises with age, and usually starts from the late 40s; it’s twice as common in women as it is in men and also presents in people who are overweight, especially middle-aged women.

At present there’s no cure for osteoarthritis, although medicines and therapies can help relieve symptoms. Injections are sometimes given directly into a very painful joint. Surgery may be recommended if pain is severe; arthroscopy involves inserting a small scope into the knee, enabling the surgeon to remove damaged parts of the joint (this is called ‘debridement’) that may be causing pain. This procedure is most commonly carried out to replace knee joints. A newer alternative to total knee replacement surgery suitable for younger patients is called ‘resurfacing’, replacing only the worn-out, arthritic areas.

Knee injury

There are many different structures inside and outside the knee. These include ligaments, which connect your bones together, articular cartilage, which covers the end of the shin bone and thigh bone in the knee joint, and a crescent-shaped disc called a meniscus. Damage to any of these structures can cause swelling, pain and stiffness, making daily weight-bearing and movement very difficult.

What causes it?
Direct blows to the knee or violent twisting and stretching during sporting activities and accidents such as falls put the joint through a greater range of motion than it can tolerate, causing tears and strains.

Rest and painkillers are a common treatment, but depending on the injury, physiotherapy sessions may be required to strengthen the knee muscle. In severe cases, undergoing surgery may be necessary to repair the injury.

Joint replacement
When less invasive treatments have failed, a joint replacement may be necessary

This involves replacing painful, worn, arthritic or cancerous joints with artificial ones, known as prostheses. The entire joint is not always removed. Sometimes surgeons only replace the damaged parts. The most common replacements are hips and knees, but shoulders, ankles, fingers and elbows can also be replaced. Prosthetic joints can be made from plastic, metal or a combination of the two. Older patients who are not particularly active, and those with weak bones, will usually have their new joints cemented into place. Younger patients who have good bone quality are generally given an uncemented joint, although this method has a longer recovery process. With good physiotherapy and rehabilitation, the prognosis of major joint replacement surgery is excellent in 95% of cases.

Picture credit: Shutterstock

This article was first published in Dr Hilary Jones’ Healthcare Guide Sept 2012. [Read the digital edition here]

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