 Hello everyone, I'm Dr. Rewit Lakshman, Senior Consultant Orthopedics and Joint Replacement at Manipal Hospital, Sajapur. So today I'm here to talk about a very common problem which has faced most of our parents or elderly people in our family or in our surroundings. Majority of the patients above the age of 55 at least visit to a doctor or an orthopedic surgeon's clinic basically for knee pain, at least once in their lifetime. These knee pains are very peculiar to these people because they have started gradually over a period of time and it has increased so much so that even the simple menial tasks of day to day life becomes challenged over a period of time. Now our Indian people are very well tolerant to the pain so they won't tell you that they have knee pain but how you can know that they are suffering with it. Their social life has decreased. All the activities which used to help them keep pace with the life have decreased over a period of time. Like a simple act of going to a vegetable seller or going to a market to do their jobs or simple act of meeting their friends in the apartments and going for various social functions that has decreased over a period of time. So this tells us a story. The story is they are maybe restricting their lifestyle and probably the pain is the limiting factor over there and they don't want to burden you with these issues. Now the times have changed. The lifestyle have changed. The overall mortality rate, the life expectancy, the quality assisted life years has improved in India. Consider every consider to what it was about 15 to 20 years back. Most people want to enjoy their life to be fullest and it is our duty to help the senior citizens or the elderly in our family to relieve them of this debilitating pain and give them a life they want to enjoy or make them more productive in their senior years. The simple most answer is it is an age related knee pain. Considering our Indians have got a very peculiar type of lifestyle like sitting on the floors, sitting cross leg. Many of them would have used Indian toilets which was a vogue up till 20-25 years back for a long long time. So they take a toll on the knee over a period of time. Most of the osteoarthritis are degenerative in nature. They are not hereditary. There is no loss of fluid in the knee while this happens. The fluid remains the same but it is because of excessive wear and tear because of various lifestyle issues that leads to deformity and pain in the knee over a period of time. Generally in the case of ladies it starts a little bit early post their menopause because osteoporosis is one of the leading causes of it. The weight remains the same. The bone becomes a little weak. It will lead to little bit of deformity to start with initially and as they will continue to ignore it they will start to decrease the pain. It starts with little bit of deformity initially and if ignored can lead to gradually increasing varus or the bony which is most common and in rare cases a valgus or a nock knees. Nock knees are generally more painful because it is not natural to have a nock knees compared to the bolex. A simple visit to an orthopedic surgeon and a standing x-ray will tell us the whole story. Probably we cannot do anything to go away but we can manage it. So there are various grades of arthritis starting from grade 1 to grade 4. Grade 1 to 3 can be very well managed with medications, physiotherapy, exercises and loss of weight. Also a little bit of lifestyle modifications like sitting cross leg on the floor, not using Indian toilets and keeping oneself limited to the western lifestyle. So this should take care of arthritis starting from grades 1 to grade 2. They can very often develop degenerative meniscal tear which are again managed conservatively because meniscus is one structure which will help us and which will guard the obvious onset of arthritis in these cases. Now coming to grade 4, now you have been diagnosed with a grade 4 osteoarthritis. It means the meniscus is out of picture here and there is bone to bone friction causing to increase of pain, increase in swelling, increase in deformity. So every step here in some cases even at rest there is a severe amount of pain which is debilitating in nature and completely restricts one's activities. The simple measures will be if a patient was not diabetic but over a period of time has become a diabetic, he or she was not a hypertensive, over a period of time have become hypertensive. So in those cases what happens is we come to know maybe the activity, the pain, the suffering has increased and leading to all these lifestyle conditions.