Human body like all other earthily matters is subject to wear and tear .The knee joint is no exception. The knee joint rests between the thigh and the leg, acts in sync with the hip and ankle joints for smooth propagation of the body. The main parts of the knee joint are the Synovial fluid (the lubricant between both joints), Menisci (Cushion which acts as Shock Absorber), four large ligaments (strong bands that prevent the bones moving in the wrong directions or dislocating) and a muscular envelope that imparts extra stability and power to the joint. Pain generator in the knee can be due to any one of the anatomical guardian of the knee e.g meniscal tear, ligament injury, cartilaginous defects or multiple. For instance, in Osteoarthritis (OA) knee, it mostly starts with the synovial fluid and cartilage alteration and then spreads to the other structures.
The most common causes of OA are accidents or trauma, sports injuries, lack of movement or wear and tear in day to day life. Prominent symptoms of OA are joint pain, stiffness, swelling, clicking or locking of joints. Osteoarthritis is an endemic for the society, which only affected population post 50 – 60 years a decade or two back but now the minimum age for the same has greatly reduced to our youngsters, due to increased work hours and changed job descriptions.
OA per se is of two kinds- Primary (Idiopathic) and Secondary. The cause behind the primary OA remains largely undefined, genetic factors, age-related physiological changes, ethnicity, and biomechanical factors likely play an important role. Whereas the secondary OA is a sequel to fracture, infection, Inflammatory Arthropathy (e.g Rhematoid Arthritis) that are relatively well understood. Hence, Root Cause Analysis remains the mainstay before establishing a plan of treatment at the earliest, otherwise they can cause irreparable damage to your joints.
Most widely practiced treatment regimen in this part of the world still remains NSAIDS, exercises and if non-responsive Total knee replacement. But there are large amount of clinical trials coming up with excellent results in favour of joint preservation provided if they are properly diagnosed at the right time. Early detection holds the key to better biological recovery.
Recent advancement in joint science provides us with quite a few e.g. Mosaicoplasty, Bone Marrow Aspirates, Ozone Therapy, Synovial Fluid Replacement and Autologous Chondrocyte Implantation (ACI). Among them ACI is perhaps the most natural and biological therapy where healthy cartilage is harvested from normal site and implanted in the damaged areas after lab culture. Even after considering all these intricacies in the knee, one should not underestimate the role play of the hip and knee because the whole lower limb does not work in isolation. So many a times if a specialist looks at the knee as a single unit and rush to a decision for surgical intervention, the outcome probably will not be encouraging. UKR/ Customfit/ Navigation (Computer Assisted) are new entrants in our armamentarium, boosting superiority of one over the other but scientifically that knee will be the best that suits you the best depending on the actual pathology, specialist’s experience and the most important your choice. Lastly but not the least, cutting edge world class conservative rehabilitation for joint care and accurate QOL assessment for every patient is a must to the road to full recovery keeping in mind that care is not only customized but individualized only with the goal to maximize comfort to the patient, the ultimate decider.