Arthritis – Fact & fiction

Arthritis is on an alarming rise in India, with approximately 180 million people affected, according to studies. It is also something that’s common among the Indian elderly. Orthopedic surgeon Dr Deepak Inamdar tries to separate the fact and fiction regarding osteoarthritis for us.

Knee replacement for arthritic knee

Osteoarthritis/Arthritis means wear and tear of the cartilage, which is of two types – primary and secondary. Primary is due to the normal ageing process, i.e., it happens to almost every one universally and secondary is due to a pre-existing cause, disease, trauma or condition from birth. Primary arthritis is more prevalent in knee joints among the Asian population, due to habits. In the West, there’s a higher prevalence of osteoarthrosis of hips compared to the Asian population. Osteoarthritis affecting the knee joint is universal and often part of the ageing process. Cartilage is a tissue with a very low metabolic activity and hence can’t be regenerated at a pace which can outrun its wear. The knee as a joint is abnormally shaped. Unlike the ball and socket of the hip, it is primarily designed to bear weight and provide stability, which makes it vulnerable to wear. This wear happens more on the inner aspect of knee and in later cases can affect whole of the knee joint resulting in pain in the whole of the knee.

Hip arthritis

Therapies which work only in very early osteoarthritis of the knee are:

•  Arthroscopic debridement
•  Cartilage regenerating medication dyacerin, glucosamines)
• * Viscosupplementation with hyaluronic injections
• Physiotherapy and analgesics. However, these therapies may only prolong and help an individual to be pain free for a few years and if lucky, with activity modifications, keep the pain at bay for some more years.

Treatment for advanced osteoarthritis

Hip replacement surgery

High tibial osteotomy, Uniknee replacement and Total knee replacement. These are still the gold standard and only available options that have stood the test of time. Questionable therapies exist widely all around the world which do not hold water for the simple fact that no one can reverse the ageing process or a worn out cartilage, despite the advancement in science. Knee replacements work for the fact that they replace the worn cartilage and hence give a relief from pain.

Photographs courtesy: Dr Deepak Inamdar