• Knee problems – in young and old patients by Dr. Vijay Mohan Budnar

    Human beings have adopted an upright posture for walking. This has its advantages. But being the pillars of support for our body, they are prone to many problems in life


    Knee pain in young patients(11 – 35 years)

    Knee pain can start during the growth spurt between the ages of 11 and 16. Commonly this is because of a mis-match between between growth of bone and muscular adjustment. Rarely small alterations in alignment of bones under the kneecap (Patella) can cause problems

    The treatment for this is mainly physiotherapy and wait for normal growth process to complete. If pain still persists, minor re-alignment surgery of the kneecap and it’s tendon can clear problems


    Sports injuries can cause problems in the young. Usual sports such as football, volleyball, gymnastics or even accidents can damage ligaments (ACL) & meniscus (knee washer). It is much better to treat these problems through keyhole (arthroscopic) surgery as soon as possible, to enable normal physical activity and minimise future problems


    Knee pain the middle aged (35 – 50years)

    The most common reason is early wear & tear of knee cartilage (osteo-arthritis). Common reasons for early onset arthitis are obesity, lack of appropriate exercise, previous neglected injury etc. A thorough clinical assessment and radiological investigation can rule out serious problems. Sometimes blood tests may be needed to differentiate from rheumatoid arthrits (inflammatory arthritis).

    The treatment depends on the severity of symptoms. Short course of simple pain-killers, weight reduction and exercise of muscles around the knee (Quadriceps & hamstrings) can control symtoms in most patients. Cycling is a better exercise than walking, but may not suit some women. Certain cartliage protective injections may have a role in the very early stage of arthritis, but evidence for this not yet clear


    In some patients, along with cartilage damage there may be a tear in the meniscus (knee washer tear). These patients can get good relief with keyhole surgery.


    Knee pain the elderly

    The cause of pain in majority of patients is osteo-arthritis. With an increasing life-span & changing life-style, the problem is on the increase. The main symptoms are of pain on standing / walking, stair climbing / descending, getting up from a chair and on kneeling down. Knee swelling and difficulty with bending are other symptoms

    Short term pain killers can help, but usually repeated courses are needed. This can have side-effects on the kidneys, stomach or breathing

    Cortisone injection into the joint can help for upto 6 months. It can be given once in 4 four months, until its effect starts diminishing. However infection in the knee has to be ruled out before injection

    The best and permanent cure for osteo-arthritis is knee replacement. This can be partial or total.


    Partial knee replacement

    The knee is composed of three compartment, one on the inside of the leg, one on the outside and one under the kneecap. When wear & tear affects only one part of the knee, a partial knee replacement (unicompartment knee replaceement) may be adequate. All ligaments are preserved during surgery and the recovery is quicker. If the partial knee eventually loosens in 20-25 years it can be taken out and converted to a simple total knee replacement


    Total knee replacement

    This is the only option when wear & tear affects two or all three compartments of the knee. The operation has been performed for over 50 years and the standards have vastly improved. Having trained with some expert surgeons in Bristol, United Kingdom, I have good evidence to say that there is 85 – 90 percent satisfaction and relief from pain after knee replacement. A well performed knee replacement in a patient who loses some weight after the operation can last upto 20 years. Patient should be aware of a very small risk of infection, stiffness, mild residual pain and blood clot in the leg after the operation. The risk of all these put together is under 5 percent.


    A general check-up is necessary to ensure patient’s fitness for surgery. The operation takes 45 – 60 min. Patients can start walking on the same or next day. Post-op physio and good pain contol can ensure a safe discharge in 3-4 days. Patients notice improvement in pain and movement on weekly basis. By six weeks they can usally commence normal activity, apart from deep squatting. Although some new knee systems on the market promise  high flexion, there are concerns with its long-term performance and I do not recomment this type of replacement


    Do not delay in seeking expert advice regarding knee pain as many easy solutions are available!


    Dr. Vijay Mohan Budnar

    Knee replacment & Arthroscopy Specialist (Orthopaedic Surgeon)

    MBBS, MRCS, MSc. (Ortho Biomechanics), FRCS (Ortho) CCT-UK