Knee Joint Pain
There are several causes of knee joint pain, however, Osteoarthritis of knee joint is one of the commonest problem affecting late middle and old age people. It is one of the most commonest cause of knee pain in India. 80% of general population above the age of 65 years have radiological evidence of osteoarthritis. The disease process may start at around 25-30 years of age and starts manifesting itself at around 40 years of age.
Pain around the knee joint that increases with weight bearing and movement, and improves with rest is the commonest presenting symptom. It may be associated with morning stiffness and swelling of the joints.
Clinical signs are tenderness, crepitus, joint effusion, decrease range of movement and varus/valgus deformity etc. X rays shows decrease joint space, osteophyte formation and subchondral osteoporosis.
Treatment
Non Operative Treatment
• Reduction of weight and obesity
• Quadriceps strengthening exercises.
• Use of walking stick in the opposite hand of the affecting joint.
• Deformities stabilization by using braces/shoes to correct varus/valgus deformity.
• Pharmological treatments
•Drugs such as paracetamol should be used as first line of therapy.
•Those who do not get adequate relief from paracetamol should be given medicines like tramadol codeine or dextroproproxyphene alongwith paracetamol.
•Various NSAIDs (ibuprofen diclofenac etc) can be tried
•Some disease modifying agents such as glucosamine chondroitin etc with or without oral collagen have provided variable results.
Interventional Treatment
• Prolotherapy And Prolozone Therapy: in this procedure injections of tisssue proliferants like ozone dextrose etc. in and around the joint reduces pain and inflammation and also strengthens the ligaments. It is also claimed that it promotes cartilage growth.
• Intraarticular injections of steroid with local anaesthetic will be effective for short term period in reducing pain and inflammation. This can be followed up with viscosupplementation (for eg. Synvisc)
• Tidal Irrigation : In this procedure closed tidal knee irrigation with normal saline is done under local anaesthesia. the principle is to wash off the inflammatory mediators joint debris and breaking adhesions.
• Stem Cell Therapy : it may usefull for promoting cartilage growth and other tissues in and around the joints.
• Arthroscopy : This procedure is useful for many internal derangements of the knee joints such as meniscal tear etc.
• Surgical Treatmemt: Joint replacement
| PROLOZONE THERAPY | INTRAARTICULAR STEROID THERAPY |
| Better relief of pain and muscle stiffness | Comparatively lesser pain relief |
| 8-10 or even more injections/year can be done | Not more than 4 steroid injections/year are recommended |
| Surgery has been averted in many patients as basic degenerative pathology is reversed | Patients eventually need surgery if pain not controlled by injections |
| Very safe. No ozone related side effects documented | Side effects of steroids including osteoporosis may be found in some cases |
| Can be used in diabetics and patients with metabolic abnormalities | Preferably avoided as hyperglycemia pituitary suppression etc are known to occur |
