Degenerative Hip & Knee arthritis (Osteoarthritis)

Read on to find details about one of the most common problems faced by not only the old generation but the young ones as well in todays fast paced world. Starting with an overview of Arthritis and its various grades in this article, we also talk about the replacement treatment and whether its required and some of the most novel innovations (SuperPATH) in this area.

With advancement in age, the protective cartilage around the major weight bearing joint slowly degenerates. With the thinning of cartilage, bone starts rubbing on bone leading to pain, stiffness and spurring or osteophyte formation. This condition is called arthritis and this usually affect most of us if we live long enough.

The arthritis in joints is graded into 5 major grades based on x-rays by the Kellgren and Lawrence grading:

1. Grade 0 (none): definite absence of x-ray changes of osteoarthritis

2. Grade 1 (doubtful): doubtful joint space narrowing and possible osteophytic lipping

3. Grade 2 (minimal): definite osteophytes and possible joint space narrowing

4. Grade 3 (moderate): moderate multiple osteophytes, definite narrowing of joint space and some sclerosis and possible deformity of bone ends

5. Grade 4 (severe): large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone ends

However, there is little clinical relevance of grading from the patient's point of view. Also, there may be major discrepancies between patient's level of arthritis and X-Ray findings i.e. some people may have relatively minor changes on X-Ray but they are miserable while some patients have shocking x-rays but are managing fine. Therefore, usually it is the patient's symptoms which define the treatment in arthritis and not the grading based on x-rays.

The treatment algorithm for arthritis is as follows:

• No treatment

• Weight loss

• Activity modification (stop running, jogging and jumping, use of western toilets and chairs instead of Indian toilets and sitting on floor etc.)

• Physiotherapy

• Use of oral medication

• Local corticosteroid injections

• Replacement surgery
  

When the patient first presents to the clinic with arthritis, their symptoms are matched to the treatment algorithm and the appropriate treatment is advised.

As the final step of the algorithm, replacement surgery may be offered to the patient when the pain becomes intractable and the quality of life deteriorates significantly. Joint replacement or Arthroplasty surgeries are now one of the most successful surgeries in orthopaedics with success rate in the high nineties. The best results are obtained when the patient selection has been appropriate and the surgeon and patient are on the same page.

Minimal access techniques for hip and knee replacement, like the "SuperPATH technique" is the new approach to such hip and knee arthritis; where the injury to the native tissue is minimum, blood loss is negligible, the surgery is done with minimal incision, have excellent postoperative results with the patient walking on the same day as the surgery and return to activity is much quicker as compared to conventional arthroplasty surgery.