What are the indications for knee joint preservation and knee replacement surgery?

Usually, joint preservation is the first choice for doctors to restore the normal function of the knee joint. Certain factors must be considered when choosing between preservation and knee replacement options. Some of the factors that influence this decision are:

1.Age of the person: It has been generally observed that conservation techniques tend to give better results in younger people, but these techniques may also be preferred by older people who are not fit for health. They undergo major surgery.

2.Human weight: The load on the joints is directly proportional to the person’s weight. Losing just 1 kg of weight can reduce the stress on your knee joints by up to 3-5 kg. Weight loss for overweight people is one of his joint preservation strategies.

3.Body Muscle Strength and Conditioning: Human muscles not only play an important role in moving joints, but they also protect them by absorbing shock. Regular exercise helps maintain and restore muscle strength, which reduces stress and pain in your joints.

4.Severity of cartilage defects: Cartilage acts as a cushion between the two bones of the knee joint. Thinning or erosion of smaller areas of this cartilage can be successfully treated with minimally invasive joint repair procedures. However, if cartilage loss is significant, the bones come into direct contact with each other. Friction caused by direct contact between bones leads to bone damage. In these cases, joint replacement surgery is more appropriate.

Several of the knee defects listed below indicate indications for joint preservation.

• Damage to ligaments and articular cartilage due to traumatic or progressive degeneration (wear and tear).
• Meniscal tears occur in the rubbery knee cartilage that supports the femur and shin bone.
• Osteoarthritis – Inflammation of bones and joints
• Osteochondritis dissecans – Cracks in the articular cartilage and underlying bone.
• Patellar instability occurs when the patella moves out of the groove at the end of the femur.
• Synovial chondromatosis of the knee is a benign tumor that develops in the lining of the joint.
• Valgus or varus deformity, knee deformity

What are the non-surgical approaches to preserving the knee joint?

Physical Therapy: Lack of physical activity often leads to joint damage, and physical therapy and exercise are part of the defense against such damage. It’s on the front line. It can be difficult to move during an acute pain episode, and inappropriate exercise choices can cause even more damage. Therefore, an individualized exercise program under the supervision of a qualified physical therapist and orthopedic surgeon will help restore function and reduce pain.

Exercise: A customized exercise plan not only improves a person’s overall health, but also helps strengthen and increase mobility of the muscles, ligaments, and tissues in the injured area.

Analgesic modalities such as IFT, ultrasound: Local application of analgesic modalities such as ice, massage, deep heat, and sometimes nerve stimulation and ultrasound have proven helpful in some cases. .

Lifestyle changes: A sedentary and stressful lifestyle can have a negative impact on a person’s overall health and bone health. Quitting harmful lifestyle habits can help preserve your knee joints. Some approaches are:

Weight Loss: As mentioned earlier, the knee joint takes the brunt of excess body weight, so it has to work harder. Weight management strategies under the supervision of a qualified physician can make a big difference in removing harmful forces from the knee joint.

Yoga, Meditation, and Dietary Changes: Relaxation through lifestyle management techniques such as yoga, meditation, and dietary management strategies under the supervision of a qualified nutritionist can help reduce knee joint pain.

Simple Painkillers, NSAIDs: Nonsteroidal anti-inflammatory drugs available over the counter can help relieve acute pain and swelling in the knee joint. Taking such drugs for a long time can be harmful, so they should only be taken under the supervision of a doctor or orthopedic surgeon.

Chondroprotectors: Chemicals naturally produced in the body, such as glucosamine and chondroitin, are commercially available as packaged dietary supplements. These may also be prescribed by your doctor. Glucosamine plays a role in repairing articular cartilage, while chondroitin prevents certain other enzymes from destroying articular cartilage.

Relief Orthoses: External aids such as knee braces and knee bandages may be beneficial in some cases by reducing pressure and increasing stability. Additionally, assistive devices such as walkers, canes, and crutches take weight off arthritic knees. This reduces pain when walking or straining, and also reduces the risk of falls.

Injections into the joint:

• Steroids: If NSAIDs do not produce the desired results, corticosteroids may be prescribed in the form of injections into the joint space to reduce inflammation. Corticosteroid analgesia results from the stimulatory effect of steroids on prostaglandin synthesis. Steroids also reduce the activity of collagenase and other cartilage-destroying enzymes.
• Viscous Replenishment with Hyaluronic Acid: Synovial fluid containing hyaluronic acid is the body’s own lubricant in joint cavities. Joint pain can be a symptom of hyaluronic acid deficiency. Topically supplementing this acid in the form of an injection cannot stop the progression of arthritis, but it can relieve pain and stiffness in some cases.
• Prolotherapy (Regenerative Injection Therapy or Prolotherapy): Injecting a natural irritant, often a type of sugar called glucose, into the soft tissues of an injured knee joint is called prolotherapy. Stimulants trigger a healing response in the body.
• PRP / Adipose Tissue / BMAC: Concentrated platelets from human blood are called platelet-rich plasma (PRP). In addition to having blood-clotting properties, platelets also contain proteins called growth factors that the body uses to heal injuries. PRP may be used as a joint-sparing approach when more conservative options such as physical therapy, bracing, and activity modification are ineffective.
• Radiofrequency Ablation (or RFA): This technique involves applying electrical current from radio waves to heat a small area of nerve tissue around the affected knee joint. This weakens pain signals from the affected area. RFA is generally well tolerated and rarely causes complications.