This is the common perception of knee osteoarthritis in our country, where primary hip osteoarthritis is rare. However, in the recent past, it has been discovered that not only older people are at definite risk for osteoarthritis, but many more middle-aged and even young people. Osteoarthritis is the most common form of joint disease (arthritis) and is one of the leading causes of disability in older people in India and in many countries. It is the common perception that the inevitable wear and tear only with aging leads to osteoarthritis, but this is not the whole truth. As we will see, not only the elderly, but others are also vulnerable to osteoarthritis.
Osteoarthritis (OA) in the peripheral joints most commonly affects the knee joint, and the disease can affect one or more of the three compartments of the knee. The knee joint acts to transfer force from the thigh muscles to the leg to move the body. The loads exerted on the surface of the knee during normal daily activities are two to seven times the body weight. Therefore, it is not surprising that the knee is so vulnerable to wear and tear (osteoarthritis). Osteoarthritic changes in the joint decrease the effectiveness of load transfer during these activities. Overall health is affected and knee osteoarthritis has been shown to account for more limitations in walking, climbing stairs, or other daily activities than any other disease. The form of the disease in the elderly is called primary osteoarthritis, while the affliction of the young and middle-aged is called secondary osteoarthritis. Let’s take a look at the risk factors for developing secondary osteoarthritis, which encompasses other age groups of people in the general population.
These are of two categories, general or systemic and local risks.
General risks
Evolution
Man, along with two other mammals, the elephant and the bear, are the only animals that have straight knees. Evolutionarily straight knees are invaluable in minimizing energy expenditure when walking so that the body does not lean from side to side as it would if the knees were bent in a two-legged creature. The price or side effect of the upright posture is the transmission of weight that occurs through the inner half of the knee joint. Therefore, the inner half of the knee is susceptible to wear out in the normal course of time.
Genetic factors
These play an important role in a widespread form of the disease that is known to affect some communities and families. Research is underway to identify the exact genetic location that increases susceptibility to OA.
Diet
Many degenerative diseases such as osteoarthritis are the result of tissue damage from attack by “free oxygen radicals.” Normal cartilage cells are known to reduce free radicals. Antioxidants like vitamin A, C, and E have the potential to protect against such tissue damage. In one study it was found that people who consume high amounts of vitamin C have a 60 to 70 percent reduction in the risk of progressive OA. High levels of vitamin C intake were also found to be associated with a reduced risk of knee pain according to the same study.
Vitamin D plays an important role in bone mineralization. The results of the previous study show that high levels protect against disease progression.
Bone mineral density
About three decades ago, surgeons who removed the head from the upper end of the femur in elderly patients with hip fractures in partial hip replacement operation, observed that the terminal bone rarely showed arthritic changes. Since then, many studies have confirmed the inverse relationship between osteoporosis and osteoarthritis. Research is currently underway to determine whether prescription drugs for osteoporosis, such as calcitonin and bisphosphonates, prevent the radiological changes of osteoarthritis and prevent the breakdown of cartilage.
Female hormone deficiency (estrogen)
The incidence of knee OA is increased in postmenopausal women, suggesting that estrogen deficiency could be a risk factor and that postmenopausal women are more susceptible to osteoarthritis. Despite the obvious correlation, more research is needed to understand the relationships between bone mineral density, estrogen, and OA. As women are the preponderant sex suffering from knee osteoarthritis, women-specific knee implants or prostheses have been developed for a total knee replacement, as the majority of people (two-thirds) who undergo knee replacement knee are women.
Local risk factors
Obesity
The increase in body weight contributes to the increased load transmitted through the weight-bearing knees by a factor of three to seven times the body weight and leads to accelerated wear of the articular cartilage. The relationship between obesity and osteoarthritis is stronger for bilateral disease than for unilateral disease and is higher in women than in men. Since the load transmitted to the knees varies between three and seven times the body weight, a reduction in weight leads to a three to seven times decrease in the pressure on the knees. Also, knee alignment can affect the impact of body weight on the knee joint. Bow-legged knees are more stressed by body weight, resulting in more severe internal compartment arthritis.
Physical activity
There is no evidence that participation in mild or moderate levels of physical activity (walking, running, dancing, biking, gardening, and outdoor sports) throughout the life cycle increases a person’s risk of developing knee OA . This means that even middle-aged people can safely participate in these activities without the risk of developing osteoarthritis.
However, participation in high intensity contact sports is strongly related to the development of knee OA in elite athletes. Many professional tennis players, runners, and soccer players are more likely to have knee arthritis and patellofemoral OA than controls of the same age.
Occupational activity
Men in occupations that require repetitive overuse of the knee joint, eg, carpenters, painters, miners, dock workers are at increased risk of developing knee OA. Bending over, kneeling, squatting, climbing stairs, and lifting heavy loads all cause abnormal joint load on the knee joint and damage cartilage. Risk factors are similar in both men and women.
Injury
Several studies in Europe and America have confirmed that knee injury is a strong predictor of the development of knee OA. Most knee injuries involve the anterior cruciate ligament (anterior cruciate ligament and anterior cruciate ligament tear is often associated with meniscal damage or a medial collateral ligament tear. Anterior cruciate ligament injuries occur after vehicle accidents two-wheeler, home and outdoor accidents. Both ACL deficiency and meniscal tear are closely linked to early degenerative arthritic changes. Although at present it is not clear to what extent the common ACL reconstruction operation can delay the onset of arthritis, some studies show that early ACL reconstruction with meniscus sparing rather than menisectomy provides the greatest protection. It is seen in patients who have undergone a partial or total menisectomy, an operation usually performed by surgeons.Suturing and meniscus transplantation are ways of protection against osteoarthritis. The first operation is available, but the last one has not yet started with early teething problems. . A meniscus transplant facility was announced in Chennai. last year, but the supply of grafts has not arrived.
Mechanical environment of the knees.
It is easy to understand how any joint or bearing can wear out quickly by understanding what happens to your car’s tires if the alignment and balance are not perfect or the pressure is higher or lower. The tracks on the overloaded part of the tire wear out more. The same analogy applies to the knees. Knees that have a bend like the one pictured will wear out faster. Increased joint laxity and accompanying age contribute to OA.
Muscular strength
It is a well-known observation that people with OA have quadriceps muscle weakness. The decrease in muscle strength was assumed to be the result of disuse atrophy secondary to knee pain; however, it has recently been observed that many patients with asymptomatic knee arthritis have weak muscles. Therefore, it makes sense to develop thigh muscles to prevent arthritis or improve symptoms after its development, but it should be noted that increased muscle strength will not stop the progression of the disease.
In summary, knee osteoarthritis once considered an inevitable consequence of aging is now recognized as multifactorial, as a result of the interaction of a variety of general and local factors such as age, genetic predisposition, obesity, trauma, and physical properties. joint mechanics. The traditional surgical treatment of OA “a total knee replacement” is the best long-term cost-effective solution. However, there are other operations such as an osteotomy to correct the alignment of the bones around the knee, ACL reconstruction, cartilage surgery, and medications available for different groups of affected patients. They will not condemn the patient to developing osteoarthritis at a younger age and will become candidates for a total knee replacement.