Many people suffer from knee pain. While a sedentary lifestyle and lack of activity lead to knee pain in several people, many others suffer due to osteoarthritis.
Knee replacement surgery is the most common and effective way to treat severe knee pain and stiffness caused by arthritis or injury.
Dr Raviprasad Kattimani, Orthopaedic and knee replacement surgeon at Sparsh Hospitals in RR Nagar, Bengaluru speaks to South First on common causes of knee pain, how to diagnose, and solutions. He debunks myths about knee pain and walking. Some dos and don’ts for those with osteoarthritis.
Q: What are some causes of knee pain?
A: The cause of the condition depends on the patient’s age and medical history. If there is a history of trauma, it may involve damage to the surrounding tendons, ligaments, or muscles. In the absence of such damage, inflammation, such as rheumatoid arthritis, could be the cause. The most common cause in elderly individuals is osteoarthritis.
Q: How much can lifestyle contribute to knee pain?
A: Lifestyle is directly related to knee problems, especially in osteoarthritis. A sedentary lifestyle, lack of activity, and consumption of junk or highly processed foods are direct insults to the knee joint, leading to early arthritis.
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Q: Where do we feel knee pain? Are there different types of problems depending on where the pain is in the knee, and can you explain where these might happen?
A: Above the kneecap (Quadriceps Tendonitis): The quadriceps tendon, which connects the thigh muscles to the top of the kneecap, can become inflamed due to overuse or strain.
Underneath the kneecap (Patellar Tendonitis): Patellar tendonitis, also known as jumper’s knee, often occurs with activities like jumping or walking downstairs, where the tendon that connects the kneecap to the shinbone gets irritated.
Inside of the knee (Meniscus Tears or Ligament Sprains): Meniscus tears or ligament sprains, such as medial collateral ligament (MCL) injuries, commonly occur due to twisting or direct blows, and are frequent in sports injuries.
Outside of the knee (Meniscus tears or strains in runners): Meniscus tears or Iliotibial (IT) band syndrome, a condition common among runners, can cause pain on the outer knee due to inflammation or overuse.
Across the knee, all over (Osteoarthritis): Osteoarthritis typically causes diffuse pain throughout the knee due to wear and tear on the cartilage, especially in older adults.
Q: We often hear that knee pain is due to osteoarthritis. What is it?
A: Earlier studies suggested that osteoarthritis was due to wear and tear of the cartilage, which cushions the ends of the bones in your knee joint. However, recent literature shows it involves the entire joint. Once the cartilage wears down, the muscles, ligaments, and meniscus are also affected over time, leading to bones rubbing against each other, causing pain, swelling, and stiffness.
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Q: Does osteoarthritis affect only the elderly?
A: Whenever a young person complains of knee pain, I strongly recommend not to ignore it. It could be inflammatory arthritis, rheumatoid arthritis, or, if they have a skin condition like psoriasis, it could be psoriatic arthritis. Excessive alcohol and red meat consumption may lead to gout, which can destroy the joint. If someone has an infection elsewhere, it could spread to the knee, leading to a secondary infection called septic arthritis, which can be life-threatening. Any joint pain, especially if accompanied by swelling, fever, or multiple joint pains, should prompt a doctor’s visit.
Q: Is it possible to prevent osteoarthritis?
A: It can definitely be prevented with a healthy lifestyle. Regular exercise—150 minutes per week—will help reduce the weight on the joints.
Q: Is it safe for patients diagnosed with osteoarthritis to walk?
A: This is the most common question my patients ask—whether it’s safe to walk with arthritis. Many believe that walking will wear out the knee further, but it is a myth. Walking strengthens the surrounding muscles and improves joint mobility. Without walking, joints become stiff. We strongly recommend walking, and for those with osteoarthritis, swimming or even walking in the water (water walking or aquatic therapy) is excellent for strengthening muscles.
Q: How do we know if someone needs surgery?
A: Not all osteoarthritis patients need surgery. Surgery is considered when non-surgical interventions have been tried and failed. Signs that surgery may be necessary include:
- Pain while resting
- Difficulty getting up from a sitting position
- Pain during night
- Inability to perform daily activities like going to the toilet, cooking, or visiting a neighbour
- Knee deformity, like bowing or bending
- Difficulty in bending the knee
If an x-ray shows bone erosion, then knee replacement surgery is often the best option.
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Q: How do you diagnose osteoarthritis?
A: Since there are different types of arthritis, it’s best to consult an orthopedic surgeon or rheumatologist. Diagnosis typically begins with an x-ray. If there is suspicion of inflammation, blood tests like rheumatoid factor, serum uric acid, and MRI scans may be done.
Q: Should we be afraid of surgery?
A: It’s natural to feel anxious about surgery, but with the latest technology and advancements in anesthesia, knee replacement surgery is safe. While there is a small risk of complications (such as infection, blood clots, or stiffness), the success rate is very high, and the risk of dissatisfaction is about 10% globally.
Q: What are some advanced technologies at Sparsh?
A: At Sparsh, we use a robotic system that precisely determines the cuts required during surgery. This system scans the knee joint, minimising soft tissue cuts and ensuring a more accurate alignment of the implant. The result is quicker recovery, less pain, reduced blood loss, and minimised human error.
Q: Do injections help with osteoarthritis?
A: It depends on the stage of osteoarthritis. For early-stage (Stage 1 or 2), where the joint space is preserved, knee injections may help. Options include steroid injections, platelet-rich plasma (PRP), or hyaluronic acid. However, these are less effective in advanced stages (Stage 3 or 4), where the bone is eroded.
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Q: What role does physiotherapy play?
A: Physiotherapy is crucial in treating knee arthritis, especially in the early stages. Strengthening the quadriceps can reduce the load on the knee joint and improve gait. If left untreated, knee pain can cause hip pain and other complications. After surgery, physiotherapy is vital to prevent stiffness and ensure the success of knee replacement surgery.
Q: Are there yearly tests for bone health?
A: A healthy lifestyle is essential. Regular tests should include:
- Serum calcium (especially for postmenopausal women)
- Serum phosphorus
- Alkaline phosphatase (to check bone activity)
- Rheumatoid factor (if there’s suspicion of rheumatoid arthritis)
- Serum uric acid (if there’s a history of gout or alcohol consumption)
- Bone density tests (for those with a family history of osteoarthritis, on steroids, post-menopause, or undergoing chemotherapy).
Q: Tips for healthy knees?
- Lead a healthy lifestyle
- Regular exercise
- Good diet
- Avoid alcohol and red meat
- Avoid junk food
- Maintain a healthy weight
- Prevent injuries to avoid arthritis.
Exercises one can do with knee pain?
- Walking
- Swimming
- Cycling
- Static quadriceps exercises
- Water walking
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What should patients with knee pain avoid?
- Running
- Jumping
- Going up and down stairs
- Bending the knee
- Sitting cross-legged
- Using an Indian toilet.
This is a partnered article with Sparsh Hospitals, RR Nagar in Bengaluru to spread awareness on diagnosis, prevention, tips to manage knee pain and prevent knee replacement surgery.
(Edited by Ananya Rao)
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