 Hi viewers, my name is Dr. Alan Jadhav, I am a senior consultant and head of the orthopedic department at Manipal Hospital, Mahadeva, in Pune. Today I am going to take this opportunity to talk about common problems of knee arthritis and the treatments that are available for this. So what do you understand by knee arthritis? In order to understand this problem, let us look at the model of a normal knee joint which is in my hand here. This is the femur bone which is the thigh bone, this is the tibia bone which is the shin bone. Both these bones are lined with a special coating which is called as the articular cartilage and there is a shock absorbing disc which is called as the meniscus in between the two bones. Articular cartilage is a very specialized tissue which acts as like a shock absorber. It allows pain-free movements and mobility to the knee joint. This cartilage does not have any blood supply or any nerve supply. So any injuries to the cartilage or anywhere in here does not heal itself. While this cartilage is normal, you can run, jump, do a lot of things and there is no pain. But when the cartilage starts thinning out, then the pressure of normal activities goes to the bone and that's when the patients start getting pain and limitation of mobility. So arthritis is the wear and tear of the cartilage. The common reasons for developing knee arthritis are if somebody has injury to the knee joint, if somebody has rheumatoid arthritis, it is also happening because of aging. There is normal wear and tear of the knee cartilage. If somebody has had a knee infection or they have neglected their ligament injuries or their meniscal injuries, these people will go on to develop arthritis. When people develop arthritis, they start getting knee pains, swelling, maybe the knee might feel wobbly and they may feel that knee is giving way. Normal activities like walking, climbing stairs, sleeping get disturbed. While diagnosing knee arthritis, we listen to the patient's symptoms carefully, then do a clinical examination and then suggest x-rays. Normally, three types of x-rays are done. A front view which is the AP view which is done in the standing position, the side view or the lateral view and an axial view which shows the articulation between the knee cap which is the patella and the dystrophema. Now, on the basis of the x-rays, we classify the arthritis into four grades which effectively are early and late stages. The treatment of knee arthritis depends on the patient's symptoms and their stage as determined on the x-rays. We always follow a step-ladder approach for the treatment, so it is in the first instance changes in the lifestyle. What does that mean? You avoid squatting, kneeling, rapid use of stairs, you keep your weight under control. Secondly is to learn and do regular knee exercises for strengthening of the knee muscles. This is extremely effective, introduces the burden of the knee and the patient's symptoms can come down even without medications. Third is taking safe painkiller medications. So most commonly used medicine is paracetamol tablet which can be taken as required. In addition we also give patients gels to apply on the knee especially after bath and after some warm fermentation in the evening. Majority of the patients will be comfortable with this line of treatment. If they continue to have pain even after having done all of these tests, then the options that are available to us are called as viscose supplementation which is effectively using a lubrication material that is injected into the knee joint. This allows the knee to become pain-free by separating the two worn out surfaces. The thickness of this lubrication fluid is such that it can act as a weight bearing surface. The effect of viscose supplementation injection can last from 6 months to 12 months. It is commonly used in the early stages of arthritis. These injections can be repeated if the patient symptoms worsen may be after 6 months to 12 months. In the same line we have two more options of injections into the joint. These are called as platelet-rich plasma or PRP injections or a bone marrow aspirin concentrate. The philosophy of these is PRP and BMAC can allow early healing of the cartilage and reduce the patient's pain. In those patients where everything has been tried or suddenly their knee has become painful or if they have had a history of trauma, only in that circumstances we advise them to undergo an MRI scan. And if the MRI scan shows a meniscus tear or a root of the meniscus tear, then such patients are advised to undergo knee arthroscopy wherein we go and clean out the meniscus or repair it and that will reduce the patient's pain. In those patients who are presenting to us in the advanced stage of arthritis where only one compartment of their knee is affected, maybe the inner compartment or the outer compartment, such patients are eligible for partially replacement where only the worn sites of the worn out compartment are replaced. It's a very good operation, generally reserved for people who are younger than 60 years or 4 age who are active. The life of this partially replacement can be anything between 15-20 years. Later on, if their arthritis progresses into their normal compartment or there is any wear and tear of the partially replacement, these patients can undergo revision into a totally replacement. Lastly, for those patients who are presenting with really advanced stage arthritis affecting all the compartments of the knee joint, we advise them a standard totally replacement. And what does this involve? Here we can look at this model. In this model we can see any implant of the totally replacement. This is the femoral component which is made of cobalt chrome. This is a tibial component which is made of either of cobalt chrome or titanium. And in between these two metals, there is a high grade plastic or polyethylene component. Because of this arrangement, the patient's pain goes away. The sizes of these implants are determined during the operation and we aim for fitting the best possible implant for the patients so that they can get good pain relief and modern implants do allow high knee bending. Knee replacement is a very safe operation. It's a very effective and successful operation. You can say 95-98% of the patients are completely satisfied with their knee replacement. Nowadays, we do a fast track knee replacement where the patient can go home in 2-3 days time before going home. They are able to walk, they are able to sit, they are able to climb stairs and by the time they go home, they are able to look after themselves independently. They will need a blocking support like a stick or a walker for 2-4 weeks depending on their progress. So if you have any issues with your knee like arthritis or ligament injuries, do not hesitate to contact us at Manipa Hospital Balegh. Thank you for watching.