introduction
Osteoarthritis is the most common cause of knee pain and are discussed here. Osteoarthritis is a common problem shared by 80% of the general population radiologic evidence of osteoarthritis by 65 years of age. The disease process begins around the age 20 yrs and 40 yrs manifest. More than 40% of the patients is not clear from the radiology osteoarthritis.
pathogenesis
the exact etiology is unknown. By chemical stress on the articular cartilage and subchondral bone leads to wear and tear for this structure. inflammation of the joints is minimal compared with other arthritis and seen mostly in advanced disease. Osteoarthritis pain may be due to the following reasons:
1. Trabecular Micro-fracture
2. intraosseous hypertension
3. Periosteal irritation
4. synovitis
5. Stretch joined capsule and ligaments
6. muscle spasms
central sensitization contributes sufficient in producing pain.
clinical features
Pain around the joints which increases with weight bearing and movement and improves with rest is the most common presenting symptom. It may be associated with morning stiffness and swelling in the joints. The clinical signs of pain, crepitus, joint effusion, decreased range of motion, valgus / varus deformity etc. The X-ray showed a decrease in joint space, the formation of osteophytes and subchondral bone osteoporosis.
Treatment
Non-pharmacological therapy
1. Reduction of weight loss and obesity decreases the load on weight bearing joints and thereby inhibiting the disease process.
2. quadriceps strengthening exercises- This is especially useful for patients with osteoarthritis of the knee. Strengthening the quadriceps muscle increases knee pain and function.
3. Walking sticks which will be held in the hand opposite the affected joints, reducing the load on the joints and is associated with reduced pain and improved function.
4. The use of deformity stabilization- the right shoe for varus or valgus deformity of the load transfer to another compartment and an idiot the disease process.
pharmacological therapy
1. Paracetamol / acetaminophen should be used as first line therapy. The recommended dose is form 1500 mg / day to a maximum of 4000 mg / day. Although paracetamol does not have anti-inflammatory properties, it still provides good pain relief and osteoarthritis also did not show a major inflammatory component.
2. Those who do not get adequate relief with oral paracetamol should be given weak opioids such as tramadol, codeine, or dextropropoxyphene together with Paracetamol. There are several combinations of paracetamol with opioids should be tried and can be used for a long period without any significant side effects.
3. In the next line of NSAID therapy can be attempted. Ibuprofen 1200 mg to 2400 mg / day is the first line NSAID. If the aid is not adequate, paracetamol can be added up to 4 g along with ibuprofen. This drug should not be used for prolonged periods.
4. There are several disease modifying agent that has generated a lot of interest. Some of them help in the regeneration of cartilage and others inhibit degeneration. The agents who assist in the regeneration is gulcosamine sulfate and chondroitin sulfate. The agent that inhibits degeneration basically an enzyme inhibitor such as:
• Collagenase polysulphuric acidic glycosaminoglycans inhibitor-
• elastase inhibitor- pentosan polysulphate
• Metaloproteinases doxycycline inhibitor-
intervention
1. Intra-articular injection-patients with severe knee pain treatment, joint effusion and signs of local inflammation benefits with intraarticular injections of corticosteroids (triamcinolone 40 mg). It will be effective in the short term to reduce pain and improve quadriceps strength. Some patients will need about 3 to 4 injections in a year, using aseptic precautions, the rate of infection is negligible. Sometimes a mild flare up can be seen in arthritis following intraarticular injections, more than 3 to 4 injections a year, should be considered for either joint lavage or surgery. repeated injections (> 4 / year) is not recommended for fear of damaging cartilage of weight bearing joints.
2. Tidal irrigation- principle is the washing of inflammatory mediators, debris and adhesions abuse. Closed tidal knee irrigation with normal saline was performed under local anesthesia; This is as good as arthroscopic lavage. Copy is inserted into the knee to distention of the capsule and then withdrawn. A total of 1 � to 2 liters are used for this type of irrigation. Patients feel an improvement in their joint mobility along with a reduction in stiffness. This procedure must be performed under aseptic precautions.
3. This will be useful Arthroscopy- meniscal tears and other internal derangements.
4.-surgery patients have very severe symptoms should be considered for surgical options such as tibial osteotomy, arthroplasty and joint replacement. Surgical options should be considered, after the medical line of treatment fails. Surgical options should be delayed as much as total joint arthroplasty may last between 10-20 years. Patients should modify his / her lifestyle to a certain extent because of the ergonomics joints replaced.
5. Prolotherapy and Prolozone Therapy. Injection proliferants network (such as ozone, dextose etc.) in the joints and around the joints to reduce pain, inflammation and strengthen the ligaments. It is also claimed that it encourages the growth of cartilage.
6. Stem cell therapy- As usefulness in other degenerative diseases, it is useful in osteoarthritis of the knee as well.
7. Pulsed Radio-frquency Procedure (PRF) – This procedure is a procedure that is very effective and was first performed in India. PRF is also effective in nociceptive pain by reducing inflammation.
About The Hospital:
Also our hospital is only for pain management, only hospital in world exclusively for pai management and pain intervention.
The hospital is highly reputed hospital which has different specialization in the era. The hospital has the dedicated and determined doctors who are responsible moreover. As the doctors understand their responsibility very well.
Contact Us
Daradia Pain Hospital
Visit Us
327, 9/2 DG Block, Action Area 1D,
New Town, Kolkata – 700156
Call+919339657857
Or +919163730004
Email: Info@Daradia.Com
Website: https://daradia.com
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