World Arthritis Day 2024: Though typically knee arthritis is considered a problem of the elderly population, more and more people are presenting at a young age with symptoms of knee pain and arthritis. It is important to rule out inflammatory arthritis such as rheumatoid arthritis by doing a battery of blood tests. Inflammatory arthritis can be managed with various medications to prevent further progression.
However, the majority of patients have early-onset osteoarthritis. Obesity and joint injury are strongly associated with early arthritis of the knees. Similarly, patients with constitutional varus deformities of knees are prone to develop early arthritis which is common in India. Injury to the knee like ligament and meniscal tears also predisposes to early arthritis.
Arthritis In Young Adults
Dr. (Prof.) Amite Pankaj Aggarwal, Senior Director and HOD - Orthopaedics and Joint Replacement, Fortis Hospital, Shalimar Bagh explained that the main goal of treatment in osteoarthritis is to minimise pain and improve functionality. This becomes critical in young people, who have to maintain an active lifestyle. Conservative treatment for knee osteoarthritis includes weight loss, modification of activity, nonsteroidal anti-inflammatory drugs, physical therapy and bracing, in select cases.
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This should form the initial treatment approach. In some cases, intra-articular injections like hyaluronic acid, cortisone etc. can be given. Various studies have shown that exercises that increase strength, flexibility and aerobic capacity are likely to be the most effective in lower limb OA. In patients who do not respond to conservative treatment, surgical options need to be considered e.g., High tibial osteotomy, partial knee replacement and total knee replacement.
As per Dr. (Prof.) Amite Pankaj Aggarwal, Senior Director and HOD - Orthopaedics and Joint Replacement, Fortis Hospital Shalimar Bagh, High tibial osteotomy (HTO) is usually the surgery of choice in young patients with medial compartment osteoarthritis and varus deformity. In HTO, the mechanical axis is redirected from the area of degeneration within the joint to a relatively well-preserved region resulting in freedom from pain.
This is achieved by making an osteotomy in the proximal tibia, realigning the bone and fixing it with plates and screws. Once healed, the patient not only becomes pain-free but also there is no activity restriction of kneeling and sitting cross-legged, unlike knee replacement. HTO can delay knee replacement for up to 10-15 years. Partial knee replacements are an alternative to HTO especially in advanced disease. It has the advantage over total knee replacement in maintaining normal knee kinematics and better and quicker functional recovery.
However, relatively higher revision rates in young patients remain a matter of concern total knee replacement is the treatment of choice in advanced arthritis and in inflammatory arthritis. With the use of the latest implants and modern technologies like robotics and computer navigation, very good results are obtained. Improved materials like oxonium prolong the survival of implants and are the implant of choice in young individuals.
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