Many people think that osteoarthritis or degeneration of the joints only occur in elderly population, but in fact, it can happen to everyone. However, the older people may deteriorate more quickly than younger people, like a car being used for a long time. Other factors are injuries or damage from accidents or diseases such as gout, rheumatoid arthritis and psoriasis which are gene-related conditions. Our Hip – Knee A r t h r o p l a s t y s p e c i a l i s t o f Bone and Joint Clinic at Bangkok H o s p i t a l H u a Hin, Dr.Thanawaj Tre e ra s a h a g u l s a i d t h a t t h e o s t e o a r t h r i t i s of the knee joint is caused by the degeneration of the joint surface which is covered by a special type of cartilage that has a glossy appearance coated by joint liquid called synovial fluid working as lubricant. After using them for a long time, the knee joints can degenerate along with other joints in your body. Symptom-wise, the patients will experience soreness and agonizing pain with difficult of movements.
Not only for the elderly (over 60 years old) face the osteoarthritis, but also the younger people or working adults can suffer from it too. The incidence of osteoarthritis of the knee is higher in women than in men especially in those who are overweight with the pressure constantly pressing the knees leading to more degeneration. While men are usually related to sports, accidents and taking steroids for a extended period of time.
Dr.Thanawaj shares that the osteoarthritis always disturbs patients with pain, swelling and warmth on the skin surface of the affected knee joint from the inflammation of knee synovial membrane. It is rather uncommon for both knees to have active inflammation at the same but if one side has degenerated, the other side tends to follow accordingly. Hence, to delay the degeneration, the patients should receive proper treatments at the early stage. In principle, the osteoarthritis is divided into 4 stages.
Stage 1: Start with a change of cartilage surface of the joint with noises during the movement, or a slight limitation of movement without pain.
Stage 2: The joint surface begins to deteriorate more and becomes visible in the x-ray. Stage 3: The joint surface damages are more prominent with a loss of surface smoothness and narrowing of the cartilage thickness.
Stage 4: The whole surface of the knee joint is damaged and deformity of the affected knee has become visible. At this stage, the patients are suffering more and may require the arthroplasty. The symptoms of hip degeneration are similar, which is pain and limited movements of the motion. The cause is partly gene-related and it is more prevalent among Europeans while Asians and Middle Easterners suffer more from knee degeneration. This may be because the life-style and culture such as kneeling and sitting on the ground during praying. The hip degeneration is often caused by diseases such as psoriasis, rheumatoid arthritis and avascular necrosis of the femur head.
The treatments in each stage are different. The aim of treatment is to relieve the pain and swelling of the affected joint. The possible causes such as overweightness can be targeted with life style modification and, if necessary, combining with medications in the stage 1 and 2 can be effective. In stage 3 when bone irregularities are developed, oral medications may not be helpful and especially in stage 4 when operation is the treatment of choice. For younger patients of stage 1 and 2 who started to have slight deformities of the knee, operation is recommended as an early intervention otherwise, the progress to stage 3 and 4 can happen in a short period of time. There are two types of corrective operations, one is joint preservation, as the name suggests, the whole joint is reserved. The other technique is joint replacement.
The doctor will evaluate the patients and plan the surgery which is the most appropriate individually. The artificial joints function for 12 – 15 years in average. The components of the artificial joints are metal at each base with the plastic part in the middle. The metal surface vary in each model from regular metal component to special alloy which is more durable. The material used on the knee joint mostly are polished metal and plastic. There are two separate parts in the hip joints, one is the plastic socket, the other is the head of femur which can be metal or ceramic which are more smooth and resists to a wear and tear process.
“The durability of the knee or hip artificial joints, which are replaced in the body, depends on a few factors such as physical condition, activity levels, body weight and etc. If the patient does not use it heavily, it can be used for a longer time.” The surgical procedure for both knee and hip joint replacements normally takes 2-21/2 h ours. After the surgery, the patient is required to stay in the hospital for a few days and, after a full recovery, can return to their normal life activities. BONE AND JOINT CLINIC, BANGKOK HOSPITAL HUA HIN