Knee pain is a very common musculoskeletal complaint with nearly 40% of adults above the age of 50 reporting symptoms. It is recognised as a major cause of functional limitation and disability.
There are many conditions than can contribute to knee pain. Due to the complexity of the knee joint, pinpointing the exact reason for pain can be challenging and requires a comprehensive assessment. However, one of the most common causes of knee pain is osteoarthritis.
We asked Mr Raj Thakrar, Consultant Knee and Trauma and Orthopaedic Surgeon, to tell us more about knee osteoarthritis, and the unique approach to surgically preserve the joint to manage the condition.
What is osteoarthritis?
Osteoarthritis is the most common form of arthritis. It is a joint condition characterised by the progressive loss of the smooth cartilage layer that covers the end of bony surfaces resulting in the two rough surfaces rubbing against one another. The knee is one of the most commonly affected joints in the body.
Who gets knee osteoarthritis?
The condition can affect any age group but is most common over 50. The exact cause remains unclear, but certain things such as previous injury, age, female gender, family history and obesity are associated with increased risk of developing the condition. Typical symptoms are pain, stiffness and swelling of the knee. The severity of symptoms varies and may be intermittent or continuous.
How is osteoarthritis diagnosed?
As part of the initial assessment, a detailed history is taken and the knee joint examined. The surgeon would also examine other joints in the body such as the hip and lower back to rule out referred pain. The diagnosis of osteoarthritis is often confirmed by X-rays of the knee joint. Further investigations such as an MRI scan may be performed to assess the distribution of arthritis and to plan future management.
Management of knee osteoarthritis
The aim of treatment is pain relief and the restoration of function. This is commonly achieved through an initial focus on exercise, weight management and by modifying activities. Additional treatment options such as painkillers and joint injections may also be recommended.
However, these treatments may not be effective and so surgical options may be considered. The approach to surgery should be focussed on preserving the natural knee joint where possible. This can be achieved through the technique of knee osteotomy surgery.
What is an osteotomy?
An osteotomy is a surgical procedure performed around the knee with the aim of realigning the leg to help relieve pressure off the arthritic part of the knee joint.
When is an osteotomy needed?
To a varying degree, the average person may be either ‘knock kneed’ or ‘bow legged’. Over time, this alignment may increase contact pressure within one compartment of the knee and exacerbate pain from osteoarthritis. An osteotomy realigns the leg through cutting the tibia (shin bone) or femur (thigh bone), to shift the weight distribution off the damaged part of the knee, helping to relieve pain. It is important to stress that surgical management should be considered only after failing non-operative treatment of osteoarthritis.
What are the advantages of an osteotomy over a knee replacement?
Osteotomy surgery aims at preserving your own knee joint, and so delaying the need for a knee joint replacement. It can allow patients to lead an active lifestyle for many years with no restrictions, including engagement in impact sport.
What does osteotomy surgery entail?
Your surgeon will arrange specialist full leg standing X-rays to assess the alignment of your legs and confirm your suitability for osteotomy surgery. The osteotomy is planned using specialist digital templating software to 0.1mm accuracy. Precision equipment is used to either create a wedge or take out a wedge of bone from the tibia or femur. Occasionally both bones will require procedures simultaneously. This is referred to as a “double level” osteotomy. The osteotomy is then fixed with plate and screws. Over 95% of patients are discharged home the following day after their procedure. You are encouraged to mobilise immediately post-surgery with the assistance of crutches for the first few weeks.
How can I find out more?
Mr Raj Thakrar is a Knee and Trauma Orthopaedic Surgeon, specialising in knee osteotomy surgery. Read more here.
Mr Thakrar has regular clinics at One Hatfield Hospital. Just call our reservations team to book an initial consultation.
Mr Raj Thakrar will be offering free mini consultations for all knee concerns at One Hatfield Hospital from 6 – 7.30pm on Thursday 15 October. Our free ten-minute mini consultations provide the opportunity to meet with our consultants to find out more about a treatment or procedure without any obligation to go ahead. You can talk to Mr Thakrar about all knee conditions including osteoarthritis, cartilage damage, instability, sports injuries and trauma.
You can register here. Following your mini consultation you will usually require a full consultation should you wish to proceed with treatment.