What are the causes of knee pain?
There are many causes of knee pain, common causes are:
- Osteoarthritis of knee
- Spondyloarthritis of Knee
- Rheumatoid arthritis of the Knee
- Patellofemoral syndrome
- Meniscus or cartilage injury
- Injury of different ligaments of the knee joint
- Inflammation of any bursa of the knee joint
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Osteo-Arthritis of the knee is a widespread cause of knee pain of old age. It is one of the most typical causes of knee pain in India. It incapacitates many. Are you suffering from this? Apart from joint replacement, there are few non-operative knee pain treatments option.
Cryoneurolysis was done for the 1st time in India by us with encouraging results.
What is Osteoarthritis of the knee?
Osteoarthritis is the commonest cause of knee pain and it is discussed here. Osteoarthritis is one of the commonest joint problems with 80% of the general population of radiologic evidence of osteoarthritis by 65 yrs of age. The disease process starts by age of around 20 yrs and manifests around 40 yrs. More than 40% of sufferers have no radiological evidence of osteoarthritis.
What happens in osteoarthritis?
The exact etiology is not known. Chemical stress on articular cartilage and subchondral bone lead to wear and tear to these structures. Thus, joint inflammation is very minimum compare to other arthritis and is seen mostly in advanced disease. However, the pain of osteoarthritis may be due to the following reasons:
- Trabecular micro-fracture
- Intraosseous hypertension
- Periosteal irritation
- Stretching of joint capsule and ligaments
- Muscle spasm
- Low-grade inflammation of the knee joint
Central sensitization contributes considerably to producing knee pain in osteoarthritis. Central sensitization causes exaggerated pain in response to small injuries or tissue damage.
What are the clinical features of osteoarthritis of the knee?
Pain around the joint that increases with weight-bearing and movement and improves with rest is the commonest presenting symptom. Also, it may be associated with morning stiffness and swelling of the joints. Clinical signs are tenderness, crepitus, joint effusion, decreased range of movement, valgus/varus deformity, etc. Along with this, X-ray shows decreased joint space, osteophyte formation, and osteoporosis of subchondral bone.
What are knee pain treatments in osteoarthritis?
I. Non-pharmacological therapy
- Reduction of obesity- loss of weight decreases load on the weight-bearing joints and thereby retards the disease process.
- Knee pain exercises – It is very useful for knee osteoarthritis patients. Strengthening of quadriceps muscle improves knee pain and function.
- Patients are advised to use a walking stick to hold the affected joint’s opposite hand. Thus, it reduces the joint load and is associated with decreased pain and improved function.
- Deformity stabilization- use of proper shoes for varus or valgus deformity transfers the load to the other compartment and retards the disease process.
II. Pharmacological therapy
- Paracetamol /Acetaminophen is used as the first line of therapy. The dosage recommended is from 1500 mg/day to a maximum of 4000 mg/day. Though paracetamol does not have anti-inflammatory properties, still it provides good pain relief and osteoarthritis also does not show a significant inflammatory component.
- Those who do not get adequate relief with oral paracetamol should take weak opioids like tramadol, codeine, or dextropropoxyphene along with Paracetamol. There are several combinations of Paracetamol with opioids that are used for a prolonged period without significant side effects.
- The next line of therapy is NSAIDs. Ibuprofen 1200 mg to 2400 mg/day is the first line NSAID. If the relief is not adequate, paracetamol is added up to 4 g along with ibuprofen. These medicines are not used for a prolonged period.
- Co-analgesics like Duloxetine are the most commonly used co-analgesics. This is approved by US FDA for OA knee.
- Some so-called disease-modifying agents had generated a lot of interest in earlier days, claiming that some of them may help in the regeneration of cartilage and others can inhibit degeneration. These medicines are chondroitin, glucosamine, diacerein, doxycycline, etc.
Recent research and publications do not recommend these medicines (chondroitin, glucosamine, diacerein, etc); they do not stop degeneration and do not help in regeneration.
III. Interventional Treatment of Knee Pain
1. Intraarticular Steroid injections:
Patients with severe pain in the knee, joint effusions, and local signs of inflammation benefit from intraarticular injections of corticosteroids (triamcinolone 40 mg). This will be effective for a short-term period in reducing pain and increasing quadriceps strength. Some patients will require about 2 to 3 injections in a year, to use aseptic precautions, the infection rate is negligible. Sometimes mild flare-ups are possible in joint inflammation following intraarticular injections. Repeated steroid injections are not recommended for the fear of damaging the cartilage of weight-bearing joints.
Injection of tissue proliferants (like ozone, dextrose, etc.) inside the joint and around the joint reduces pain, and inflammation and strengthens ligaments. It is also claimed that they promote cartilage growth
High molecular weight hyaluronic acid resembling synovial fluid is very helpful particularly in early osteoarthritis with knee pain. Newer research publications on this issue indicate that visco-supplementation with a high molecular weight hyaluronic acid salt has anti-inflammatory action and regeneration properties apart from its lubrication effects. It also activates platelets and therefore it is very commonly used with platelet-rich plasma injection.
4. Platelet Rich Plasma Injection:
Like its usefulness in other degenerative diseases, it is useful in osteoarthritis of the knee also. It is becoming popular throughout the world. This treatment is also called regeneration therapy of the knee as it regenerates the degenerated knee and significantly reduces knee pain. A combination of PRP and hyaluronic acid salt is a very popular treatment for knee pain in knee osteoarthritis.
5. Radio-Frequency (RF) Procedure:
This procedure is very effective in knee pain treatment in knee osteoarthritis and is approved by the US FDA. Genicular nerves carrying knee pain are blocked with this procedure for the long term. 1.5 to 2 years of pain relief is very common with RF procedures.
Best knee pain treatment in Kolkata by the best knee pain doctors in Kolkata
- Surgical options like tibial osteotomy and total joint replacement are considered in patients having very severe symptoms and once the medical line of treatment and interventions have failed. But surgical options should be delayed as much because the total joint arthroplasty might last between 10-20 years. Patients will have to modify his/her lifestyle to a certain extent because of the ergonomics of the replaced joint.
Watch the video on Knee pain by Dr Gautam Das
Knee pain treatment | Knee Pain Doctors
A pain physician or physiatrist or orthopedic doctor can treat knee pain. Generally, if there is a need for knee joint replacement surgery, then surgery is done by an orthopedic surgeon. But non-surgical treatments for osteoarthritis of the knee (like regeneration therapy, PRP injections, radiofrequency procedures etc) are done by a pain management doctor.