Although osteoarthritis (OA) can affect any joint but knee is most commonly affected. Osteoarthritis of the knee is one of the five leading causes of disability among elderly specially women.
It develops when the cartilage (smooth, slippery, fibrous connective tissue which acts as a protective cushion between bones) around the knee joint begins to deteriorate or is lost. As the cartilage is lost, the joint space between the bones narrows and this is an early symptom of osteoarthritis of the knee that can easily be seen on X-rays. It usually occurs in knees that have experienced trauma, infection, or injury. Over a period of years, the joint slowly changes. In severe cases, when the articular cartilage is gone, the thickened bone ends rub against each other and wear away. This result in a deformity of the joint and normal activity becomes painful and difficult.
Dr Chia Shi Lu, Consultant Orthopaedic surgeon of Singapore General Hospital has shared his insights with Star Health on osteoarthritis and latest options for preventing and treating knee pain.
Star Health (SH): What are the causes of osteoarthritis in knee joint?
Dr Chia Shi Lu: The exact causes of osteoarthritis are unknown; however there are a number of factors that are commonly associated with the onset of the disease. Such as history of acute injury to the medial knee for example, meniscal or ligament trauma, prolonged and excessive use of the knee joint, previous fracture at that site of the knee, obesity, genetic factors etc. It does affect other joints such as the hip as well but Asians are more prone to knee osteoarthritis because of the common “squatting habit” in the toilets, in contrast with western patients who have hip damage more.
SH: Who is most vulnerable?
Dr Lu: Osteoarthritis of the knee is common in people over 50 years of age, in particular in women. Elderly women with medical problems like obesity or overweight, ageing, with a family history of arthritis could make them more vulnerable. It can affect either one or both sides of the knee joint however it occurs more commonly on the inner aspect of the knee. It is common in individuals who play intense physical sports, such as football. Previous injury to the knee is a strong indicator for development of osteoarthritis in the future.
SH: How many people need surgery for this?
Dr Lu: Most people with osteoarthritis will not need surgery. Surgery is a possibility for those with severely damaged joints who have trouble walking. Surgery may involve joint replacement in which the rough worn surfaces of the joint are replaced with smooth-surfaced metal and plastic pieces. The most common surgery now is knee arthroplasty where the damaged parts are removed and replaced by an artificial joint (prosthesis). The prosthesis is made up of metal (titanium or stainless steel) and special high-grade plastic components (polyethylene) allowing the joint to function normally.
SH: What is your advice for the readers to protect their knees?
Dr Lu: To strengthen your legs and knees, do this lunge exercise, down and up, with your body weight evenly between the front and back leg. Do not lean forward or back. Bend both knees to dip straight down, and come up again, gently, at least 10 times. Use good bending, shown in the right hand drawing above. Done properly, it should feel like exercise for the thighs and hips, not pain in the knees.
Avoid squatting on the balls of your feet with your heels up. Instead, to sit in a full squat, whether to rest, to do chores, or to go to the bathroom wherever there is no commode toilet, keep your heels on the floor. This is a customary sitting posture in much of the world. This reduces pressure on the knees and is a great stretch for your. Keep your knees over your feet, not drooping inward.
When going up stairs, keep your weight back toward the heel of the foot that is stepping up. Most people do not step this way because their leg muscles are too weak. They throw their weight forward, stepping up onto the toe. This transmits body weight onto the knee joint in a vicious cycle of weakness and pain. Keep weight back and knee pain will disappear.
Dr Md Rajib Hossain
Source: The Daily Star, November 08, 2008