By Dr. Tan Boon Cheong
MBBS (MU), MS Ortho (MU)
One of the most common cause of knee pain, especially when oneself is approaching middle age, is usually links to degenerative joint disease (age as risk factor) but it is more complex as some young people have it too and for some it may be hereditary.
By definition knee osteoarthritis is defined as chronic joint disorder in which there is progressive softening and disintegration of joint cartilage, accompanied by new growth of cartilage and bone at the joint margins and capsular fibrosis. The prevalence of knee osteoarthritis increases with age (>45 years) and females have a higher incidence compare to male.
Knee pain is one of the most common chief complaints for knee osteoarthritis. The knee pain usually takes place with prolonged walking or standing. Resting the joint will relieve the pain. Stiffness is another common complaint. The stiffness happens after prolonged immobilization especially when getting up from a sitting position or early morning when one tries to get out from the bed to walk. The patient will need to stand for a brief second before he/she can start to walk. After a few steps, the patient will feel easier to walk. Frequently, the patient may have episodic attack of knee swelling due to inflammatory process that takes place. When the knee osteoarthritis become more advance, the patient will have deformity which most of the time the leg appear curve inward, and if the patient both knees are involve; then the deformity appear like an ‘O’ shape (in most of the patients). Knee osteoarthritis has no immediate threat to one’s life, but it reduces the quality of life due to persistent pain and immobility.
The management of knee osteoarthritis starts with the establishment of its diagnosis. Beside a good history given above, an examination by a doctor will help to come to this diagnosis and exclude other causes of knee pain. A plain X-ray of the knee with the patient standing will be good enough to tell the grading of the knee osteoarthritis. Kellgren and Lawrence classification system (Grade 0 to 4) is usually use.
The treatment of knee osteoarthritis will depend on the severity of it and how much the symptoms affecting the patient on daily basis. Joint supplements such as glucosamine sulphate and chondroitin have been used widely for knee osteoarthritis. Analgesia (pain killer) can be used but will give grieve side effects if abused. Intra-articular injection of hyaluronic acid (gel), PRP (blood) and stem cells have been widely introduce but their effectiveness and cost should always take into consideration. Surgical intervention such as total knee replacement surgery will be the last resort when everything fail and the pain has affected the quality of life tremendously. Beside all the above medical treatment, the lifestyle of the patient should also be modified such as exercising and weight management.