What is knee joint?
Knee joint is made up of three bones namely thigh bone - femur, leg bone - tibia and the cap - patella. There is a layer surrounding the joint called as knee joint capsule. There is normal jelly like lubricant fluid in the joint known as synovial fluid. The soft disc - cushion between the two bones of joint is called meniscus. The synovial lubricating fluid keeps the meniscus wet and slimy which in turn allows smooth easy movement of joint by providing cushioning effect. Over a period of time with age, the synovial fluid gets reduced making the meniscus dry. This dried out meniscus (cushion) gets friction during movement of bones.
How to grade the arthritis of knee joint ?
The meniscus is quite thick to start with. The space what we see between the two surfaces of bone is the actually the thickness of the meniscus - cushion which helps in easy movements of the joint. Over a period of time with age it gets rubbed between two surfaces and the thickness reduces so that the surfaces come nearer and you see the space between the bones in x ray is getting reduced. So with friction a disc which initially suppose of 5 mm get thinner and thinner to 5-4-3-2-1 mm and a time comes when the bones touch each other, when bone surfaces get friction to each other there is formation of osteophytes - bony spurs which produces the friction sound on bending and straightening the knee joint. on repeated friction of two hard surfaces the smooth surfaces become rough and cause much of pain on movement.
Stages of Osteoarthritis Knee - Clinical and X ray Signs
- Pain just started
- X ray almost absolutely normal
- Pain increases
- Pain on getting up from sitting position
- Difficulty in long distance walking
- X ray : Decreased joint space medially
- Difficulty in stair up-down
- X ray : Gross reduction in joint space
- X ray :Bone spur - osteophyte formation
- Waddling gait due to inability to take load on limb
- Difficulty in activities of daily living (ADL)
- Cant sit on the ground with crossed leg
- Avoid going out for socialization just due to pain
- While going to meet relatives, a thought comes to your mind that whether he stays on ground floor or higher & would need to climb stairs which may force to avoid going there
- Bent legs - X ray : 'Zero Space'- Bone on bone appearance
- Rough articular surfaces - Totally lost joint - subluxation of joint
Lubricant Injection - Visscosupplementation
SYNOVIAL FLUID REPLACEMENT THERAPY ( SFRT )
Increases the jelly like fluid- synovial fluid which is almost equivalent to the natural synovial fluid which is there in a normal knee joint. Increase the level of Sodium hyluronate , the normal ingredient of the healthy articular cartilage, which makes the articular surface smoother. Decrease the stiffness of joint and make it more free for movement, decrease pain while walking, increase capacity to walk. So the overall speed of arthritis get reduced. PATIENT CAN enjoy life with NATURAL KNEE. Need for medicines becomes almost nil and in turn saves from its side effects.
DescripPatient's age, life style, problems in activities of daily living, walking and stair pattern and x ray changes can decide whether a particular patient can have benefits from such an injection or not. Lubricant injection - SFRT gives best results in stage one , stage 2 and early stage 3. Means if you take injection in early stages of arthritis , it may slow down to get it to advance stage and give maximum benefits. Its of no use once there is advanced arthritis of grade late three or four. For those patients total joint replacement is the only & best answer. Till Jan 2018, @ Shaurya Hospital , Dr Jigar Shah has given SFRT to more than four hundred patients ( Age 35 to 81) with highly satisfactory results.tion