Introduction:
The knee joint is one of the synovial joints present in the body. A pair of long bones are articulated against one another, separated by a capsular ligament and articular cartilage. Like any mechanical component, the joint is prone to wear and tear depending on its use or abuse, especially with sports, athletics, old age, and arthritis.
What Are the Principal Contents of the Knee Joint?
The knee consists of three main bony components and an array of ligaments, cartilage, blood, nerve, and muscle supply. The components can be sub-classified as follows;
1. Bony Components
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The thigh bone or femur.
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The shin bone or tibia.
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The kneecap or patella.
2. Ligaments
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Anterior cruciate ligament.
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Posterior cruciate ligament.
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Medial collateral ligament.
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Lateral collateral ligament.
3. Cartilage
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Medial meniscus.
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Lateral meniscus.
The joint is outlined by a layer of a fluid-filled membrane known as the synovial membrane.
When Does Knee Pain Occur?
The knee joint is among the most used body parts, prone to heavy stress and wear and tear for decades. The quality of the bone and the nature of the exertions subjected to it cause significant stress to its components, resulting in a wide array of problems leading to knee pain. The common causes behind this are,
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Tear in the ligaments.
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Arthritis or inflammation of the joints.
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Tear of cartilage meniscus.
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Loss of blood supply to the bone.
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Trauma or injury to the joint.
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Increased body weight.
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Fracture of the joint.
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Repetitive strain or common overuse.
When To Consult A Specialist?
Knee pain is the principal cause for patients turning up to consult specialists in the field. Other symptoms may include;
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Crackling sounds.
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Discomfort while performing menial tasks like walking, climbing stairs, or getting up from a chair.
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Swelling of the joints, which is not relieved by medication.
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Locking of the joints.
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Instability of the joint.
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Loss of range of motion.
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Stiffness.
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Bow-legged knee deformity.
How Is It Diagnosed?
After taking clinical and personal history, the specialist conducts a local physical examination of the affected areas, followed by medical imaging such as X-rays, MRI (magnetic resonance imaging) scans, and CT (computed tomography) scans to identify the location of the underlying pathology. The treatment plan is then devised accordingly.
What Are the Diseases that May Necessitate a Knee Replacement Procedure?
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Osteoarthritis is an age-related "wear and tear" type of arthritis. It is usually seen in patients 50 years of age and older but may occur in younger people. The articular cartilages that act as cushions between the bones soften and wear away with time. The friction between the bones leads to knee pain and stiffness.
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Rheumatoid arthritis is a disease where the synovial membrane surrounding the joint becomes inflamed. This can damage the cartilage. Eventually, this leads to cartilage loss, pain, and stiffness, termed "inflammatory arthritis."
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Post-traumatic arthritis following a severe knee injury due to fractures of the bones around the knee. Tears or damage to the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
What Is Knee Replacement Surgery?
A knee replacement is also called knee arthroplasty. It might be more accurately termed a knee "resurfacing" because only the surface of the bone requires replacement.
Knee replacement surgery consists of the following steps as enumerated below;
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Bone Preparation: The damaged cartilage surfaces at the ends of the femur and tibia are removed.
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Positioning the Metal Implants: The joint surface is recreated by replacing the cartilage and bone with metal components that may be cemented or uncemented.
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Resurfacing the Patella: The surface beneath the kneecap is resurfaced with a plastic button which may not be required in all cases.
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Spacer Insertion: A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
What to Expect Post Knee Replacement?
Although the procedure has its limitations, a dramatic reduction in knee pain and a significant improvement in performing everyday activities of daily living is seen in most cases; however, total knee replacement does not allow movements more than before arthritis sets in. In addition, with regular use and activity, every knee replacement implant begins to wear its plastic spacer, which may speed up due to excessive movement or weight and cause a painful loosening of the prosthesis. Thus, most specialists advise against high-impact activities such as running, jogging, jumping, or other high-impact sports after surgery. Following a total knee replacement, unhindered activities include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports. With appropriate activity modification, knee replacements can last for many years.
What May Be the Complications Post Surgery?
The postoperative complication rate following a total knee replacement is low, with chances of a knee joint infection in fewer than 2 % of cases with cardiovascular complications such as a heart attack or stroke are even less frequent. However, chronic systemic diseases may increase the potential for complications which though uncommon, can prolong or limit full recovery.
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Infection: Infection may occur at the surgical site or around the prosthesis within days or weeks of surgery and, in some cases, even years later. Minor infections are treated with broad-spectrum antibiotics. Significant or profound conditions may require additional surgeries, removal, or replacement of the initially placed prosthesis.
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Blood Clots: Blood clot formation in the leg veins is one of the most common complications. This can be life-threatening if the clot breaks free and travel to the lungs. A prevention program includes periodic elevation of the legs, lower leg exercises to increase circulation, support stockings, and blood thinner medication.
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Implant Problems: Implant surfaces may wear down with time, even with the advent of improved technologies perfected over the years, and the components may loosen. Scarring of the knee may occur, and movement may be more limited, particularly in patients with little activity before surgery.
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Continued Pain: This complication is rare, and most patients experience excellent pain relief following knee replacement.
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Neurovascular Injury: Damage to the nerves or blood vessels around the knee can occur during surgery, a rare complication.
Can Knee Pain Occur Years After Knee Replacement Surgery?
Implant surfaces wear away with time. Even with the advent of improved technologies perfected over the years, the components may loosen. Scarring of the knee may occur, and movement may be more limited. This is particularly seen in patients with little activity before surgery.
What Is the Remedy for Pain Occurring Years After Knee Replacement Surgery?
Recurrent knee pain can be treated with the following modalities if pain occurs years after the original surgery;
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Non-Surgical remedies
Before opting for a repeat of the knee replacement surgery, the following non-surgical treatments may be opted:
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RICE Protocol: This protocol involves four steps, namely rest, elevation, compression, and ice application. Usually, this provides pain relief in cases where the implant causes a delayed hypersensitivity reaction.
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Pain Management: Non-steroidal anti-inflammatory drugs such as Ibuprofen may be prescribed. Certain cases may require the use of opioids to manage extreme pain. However, such treatments should be provided in the short term, as opioids may give rise to addiction and dependence.
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Physical Therapy: The attending physician may require the patient to undergo physical therapy, strengthening exercises, and apply braces and other orthopedic devices to manage and diminish the pain.
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Repeat Surgery
If the treatments mentioned above fail to control the pain or result in increased pain, the implant most likely has been worn away with either minimal or extreme levels of activity or natural wear and tear. Such cases require a repetition of the original surgery to change the previously placed implants. The surgery steps are the same as the original, involving the removal of the implant, reshaping the bone, and putting the new implants. The follow-up and recovery phase involves pain management using drugs and therapy.
Conclusion
The knee joint is among the most used body parts, prone to heavy stress and wear and tear for decades. The quality of the bone and the nature of the exertions subjected to it cause significant stress to its components, resulting in a wide array of problems leading to knee pain. However, in most cases, patients experience a dramatic knee pain reduction and significant improvement in performing everyday activities of daily living. In addition, the postoperative complication rate following a total knee replacement is low, with chances of a knee joint infection in fewer than 2 % of cases.
