Does running really cause degenerative knee ?
Does Running Cause Degenerative Knees?
There is a saying of a famous Chinese Martial art novel Master, Gou Leng: “True is false and false is true”. I believe that this is a very appropriate way to begin this article as the reflection of this wise Master echoes the point I would like to put forward.
Heart disease is the number one cause of death globally, taking an estimated 17.9 million lives each year. This is not surprising since, whether the real cause is heart disease or not, various deaths are linked to diseases of the heart such as asthma, or cancers, coronary artery disease or strokes. These deaths will be recorded as heart failure or as the heart having stopped functioning.
However, statisticians’ data generally does not look at the root cause of why the heart stops working; this can result in many Thai people becoming anxious that they can commonly die from heart disease. This can be terrifying and can often lead to panic with people searching for the correction or prevention of the disease.
Furthermore, there have been several large news reports on the correct practices and procedures to avoid such incidents. One of these such practices is of aerobic exercise, such as running. The aim of this exercise is to stimulate an individual’s heartbeat up to 80% of the maximum capacity, allowing it to beat at that speed for 15-20 minutes. Reports stated that, consequently, this would also help reduce the amount of bad fat such as LDL cholesterol, triglyceride and increase the amount of good fat HDL cholesterol. Additionally, this would reduce the chance of developing a plug of the blood vessel where blood is transported the blood to the heart, which is the cause of
heart disease. In the past there have been large initiatives that have urged many Thai people to run every day. However it was not foreseen that so many people of 40 years old and over would visit a doctor with symptoms that are not connected to heart disease. They would often complain of knee ache, swollen knees and degenerative knee at an unexpected accelerated rate.
In 1993, the University of California conducted a study to see if running causes degenerative knees. During this study, 35 athletes were observed and investigations were initiated. X-rays were taken of their wrist bones, spines and ankles every year for 5 consecutive years. The results found that their knee degeneration rate was not different from other people, which proved that running does not accelerate degenerative knee or effect it in a negative way. So, with this conclusive evidence, why did so many Thai people who ran at that time acquire knee ache and degenerative knee? After the results of this study, various doctors and specialists studied this and they discovered that there is generally a difference in the muscle strength of Thai people and Westerners,. The real cause of the incident is that the muscle of Thais is not as strong as their Western counterparts. Furthermore, Westerners, especially European or Americans, often take exercises or play sports continuously, rather than solely when having leisure time or after retirement. Due to this continuous exercise, their muscles become stronger in general, particularly their back and thigh muscles. There is no condition of muscle regression as the muscle is able to balance the tension and relieve the pressure of the body weight.
It could also be argued that many of the young Thai generation will stop exercising for a long period of time after their teenage years. Many of them will graduate and start a new career where their demanding schedule could mean that they are simply too busy to take exercise or continue playing sport regularly. One condition that can gradually occur in the body is the atrophy of the muscle. Usually occurring in the back or the legs, this is a condition in which the muscle fiber will decrease in size until so much strain is put on it that it cannot withhold the weight of the body. The movement
within the usual daily routine will gradually and continuously create inflammation of the muscle that will accumulate within the muscle.
When it was asserted that running could prevent heart disease, large numbers of Thai people started running in public parks without knowing whether the muscle around their knee was strong enough to maintain constant exercise, or whether their muscles could withstand their body weight during the running process. Long-term running without a strong surrounding muscle to protect and relieve the repeated pressure on the knee cartilage can create considerable strain on the muscle. Consequently, this can accelerate the inflammation, eroding and degeneration of the knee. This is especially true for the elderly, whose cartilage is already in a regressive condition and they will often complain of swollen knees and knee ache around 3-4 days after starting running.
In conclusion, you can start to understand how important the muscle around the knee is. Following this article, I will explain further how it is possible to test whether this muscle is strong or not.
Artificial Knee joint Solution
Hyaluronic Acid (HA) is the compound in the knee joint solution. It is sticky and highly elastic and it helps the joint, especially the knee joint bone disc surface, not to get too much pressing or bumping pressure when we walk or run. The compound also helps grease the cartilage surface when we bend or stretch the knee. It reduces friction or pressure, which in turn helps protect from degeneration of the cartilage. This results in reduction of inflammation, aching, swollen, reddening and heating up of the knee. The normal level of the knee joint solution is only 1-2 cc.
As we age, our HA is lower, especially the ones who suffers from degenerated knees. The patient with severe degenerated knee has HA that is almost dried up. At this stage, the knee degeneration symptom will spread out rapidly. Some will develop an obvious bowleg within a year.
Scientists try to find methods to slow down the drying up of the knee joint solution. They believe that if the solution can be maintained it will help slow the knee degeneration. The artificial knee joint solution was first produced 30 years ago. The effectiveness was not satisfactory. After being injected for one to two weeks, as doctors pierced into the knee to inspect, it was found that there was none left. 
In the year 1997-2004, scientists finally were able to develop the artificial kneecap solution of which the quality is close to the natural knee joint solution. The solution is produced from natural sources i.e. Rooster Combs or from Bacterial Fermentation. The application started in North America, Canada and Europe. The solution was injected into the final stage degenerated knee, and also used to inject into the hip joint and the ankle joint. The number of the patients that need to have the operation to change to the artificial knee joint was surprisingly reduced.
The three advantages of using the artificial knee joint solution are reducing pain, decreasing stiffness and can postpone the knee operation (Knee Arthroplasty Surgery) for 1 to 1.5 years.
The injection method is to directly inject the solution into the space of the knee joint. The doctor might inject the anesthetic at the skin in the area before the injection. This will reduce the pain during the injection of the solution, and this should be done only by an expert. In order to be effective, as being practiced internationally; the dose is to inject once each week for five (5) weeks in a row. At present, it is also the practice with the patient who went through the microscopy therapy of the bone.
The disadvantages can be e.g. allergies to the solution causing rashes on the injected are and high costs. When I first used it three to four years ago, the price of the solution was almost 20,000. Now as it proven to be effective, there are more manufacturers that produce the improved quality products with lower prices.
Above all, the degeneration of knees is nature to all. There are many factors that stimulate the inflammation and pain. So it needs consideration to get the treatment according to the real cause, not to depend only on the solution injection. Ask the doctor if it is worth to do so before you go for it.
What is the artificial knee joint?
There are many cities in the western countries that surprisingly have a lot of senior citizens commuting using buses to get to different towns. Most of these are towns near the beaches, which are quite a distance, where old retirees live alone while having a good rest in the last period of their lives. They do not want to be a burden to their families so the number of these oldies living alone is increasing as time goes by.
As it is the culture of many foreign countries, a lot of senior citizens live alone. They have no one to look after them or even relatives to live with. When they get sick and get difficulties in walking, it will have a big impact on them. When the knee joints degenerate and they start to feel the pain as they walk, they do not hesitate to see the doctor, thus, undergoing an operation to put in the artificial knee joint that helps them to be able to walk again. They do not usually wait until the knee sags or bows too much.
The operation to change to artificial knee joint in the foreign country
Usually it is the patients who ask for the operation in order for them to have their normal lives back. The artificial knee joint is made from a premium quality metal and plastic which can be put into a human flesh without body resistance. It is a Medical Grade, and it is much more expensive than the Engineer Grade that we use in the industry.
The scar of the artificial knee joint operation
The artificial knee joint is designed to be as close in shape as the real knee joints. The knee joints consist of the surface of the joints of the thigh bone (Femur) where it touches the bone of the leg end (Tibia). They are connected with the surface of the kneecap (Patellar). When in good condition, this joint surface will be smooth and slick in order to reduce the friction pressure when we bend or stretch the knee. This is to prevent the joint from heating up and getting inflamed which eventually damages the joint surface.
The severely degenerated knee joints, narrow gap between the joint surface, with the sprouting bone and the knees are also bowed
Similar to the real knee joint, the artificial joint has the metal surface that is very smooth and so shiny that the doctor can even use it as a mirror. There is also a Polyethylene plastic, which is also smooth and slick on the surface of the metal to prevent them from touching each other.
The annual exhibition of the bone surgery tools in Australia
The development of the artificial knee joint is like the development of the car — it gets better and better every year. A new car model has more features for us to choose from. The artificial knee joints, in the present, also offer many designs to suit the patient’s condition, i.e. the model that gives Maximum Flex and Extension, the model with more Rotation Degree (Closer to the original joint); there is also one model that is specially made for female patients. There are more leading companies that conducts research and compete in the manufacturing of the artificial knee joints.
The artificial knee joint, though, is not a permanent thing. After its use in daily life for some time, it will wear out. Luckily, the wearing is only at the plastic surface which can be replaced by a small surgery.
To get a good result when changing to artificial knee joints, you need to know how to maintain them. You are not to put hard load on the joints, not to bend the joints to sit on the floor or lift heavy stuff. It is also imperative to regularly exercise to have a strong muscle around the knee so that the bumping pressure on the joint is reduced. Keeping the wound clean in very important. An artificial knee joint is a foreign thing in the body so it is also prone to infections. When we have infected wounds on the skin, decaying tooth or having tooth extraction, we need to be very cautious not to get any infection since it can get into the blood stream and could accumulate around the artificial knee joint. This will stimulate the knee tissue to get infected. As a prevention measure, take the anti-infection medicine before you go to see the dentist or when you get a skin infection. Take good care of your artificial knee joints so they will stay longer with you.
Do you have Knee Arthritis? : PART 1
Identifying the Early Stages of Knee Arthritis
Arthritis of the knee is a symptom of the wear and tear of the cartilage surface between the joints, making the knee wear out and eventually collapse. Additionally, as an x-ray will clearly show, there is also a ‘sprouting’ of the bone taking effect. Some people believe that if a person is under the age of 60 then this should not be any cause for concern as there is no chance for further damage to occur. However, although this line of thinking may have been accurate in the past, it is not necessarily true in the today’s present climate where people carry out activities that exert more pressure and harsher work on the knee joints. It could also be argued that in the past people would exercise the muscles around the knee a lot more regularly.
Furthermore, incidents of knee arthritis are now being discovered in an increasing amount of patients of a much younger age although, naturally, incidents are more common as an individual gets older. Unfortunately, if we do not pay enough attention and recognise the signs of arthritis it is possible to develop the symptoms without being aware. The symptoms of knee arthritis can be divided into 6 steps, from the least to the most severe as follows:
Step 1
Although at this early stage, individuals should not be overly concerned, as the joint surface is smooth all over and still intact, it is often considered the most important stage of prevention because, if it is detected early enough, the symptoms can be identified and averted from advancing to a further, more serious condition. At this early stage, the patient will feel fatigued but will not feel any pain and will also still be able to walk normally. Negative aspects of this stage can be experienced at night, where an individual will often feel an uncomfortable tiredness and will find it increasingly difficult to go fall asleep. A patient will often find his pain can be relieved by asking a family member to give him/her a leg massage each night.
It should be mentioned that the fatigue of the knee is not directly related to the amount it is used. Individuals who spend the majority of the day sitting down, without walking a great deal, can also acquire symptoms. The signs at this early stage can be seen in people who do not regularly exercise or who don’t consistently play sports, however, these individuals may fashionably take exercise some of the time, e.g., aerobic exercise or yoga. In these cases, often the muscle above the knee is simply not strong enough to withstand the pressure exerted on it and, subsequently, after persistent daily use, it becomes increasingly weaker. This can be very uncomfortable and even regular activities such as walking around a shopping mall can be a painful and exhausting experience. Moreover, if the thigh, leg and calf muscles are repeatedly overused during the day, such as when sitting with a posture that bends the knee for a long time, the muscle will have a gradually accumulated inflammation.
In the evening, the muscle inflammation can develop to the extent that the patient will feel the fatigue; this is why most patients often only feel the pain at night, after continued use during the day. After rest and relaxation during the night, the muscle has had time to recuperate and the muscle fatigue will usually have subsided by the morning. Some patients find that a traditional Thai-style massage is very effective in relieving the muscle fatigue of the day, as it can relax the muscles and help relieve any discomfort, and they will often opt to have a massage after finishing work for the day.
Another symptom of the muscle being increasingly fatigued is in the form of a loud noise within the knee, when going up and down the stairs. This can often be so loud that others can hear it. This is caused by the need for the leg muscles to exert more force during the movement of the leg which, consequently, causes the connecting tendon to make noises when moving. If there is frequent movement of the joint, e.g., riding a bike, taking a long walk or doing aerobic exercises; then there will be increased friction on the cartilage surface. The joint will become worn out and inflamed, followed by the second step of the incident.
As they can also be affected by the symptoms in this first step, young people should be encouraged to take care of their knee muscles. It is essential not to underestimate the importance of taking care of the knee at this early stage to avoid further complications.
Wish you health and no knee pain.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 2
The Development of Symptoms
Early signs that the second stage of knee arthritis has commenced is when the knee joint starts to ache, becomes swollen, reddens and heats up. At first the ache will not be severe, however, after more than general use of the knee, e.g., when walking for long distances; sitting for a long period of time; tripping but not falling down; or walking on a non-smooth surface, such as in the garden or in the golf course, the patient will develop this ‘ache’. Additionally, some swelling will also start to develop along the knee joint line. When the skin in this area is touched or caressed, the patient will often feel a sensation of heat and feel like the area itself is ‘warming up’. When compared to the other knee, the effected knee will be redder in colour.
Elderly ladies who enjoy walking when doing various activities often complain of an annoying ache that will intermittently occur, making an everyday activity, such as a trip to the shop, an unpleasant experience. This is also true of elderly people who like to visit foreign countries on holiday. As they explore new and exciting settings, they will often find that they need to walk further distances than usual; unfortunately this can lead to problems when they arrive back home. For example; going to visit the Great Wall in Beijing is a very popular activity when visiting China, especially for the elderly. It can be a really captivating experience and something that is often cherished for life. Friends will often walk up together in a group, going as far as possible, whilst holding hands. When walking up the great wall, each step is very big with the fort distances in the wall far apart. In fact, it can be so steep that you almost need to climb to make progress. This can have an unfavourable effect on the knee.
Subsequently, usually a few days after returning from the excursion, it can be a common occurrence for the knee to become swollen and start to ache. Moreover it can also become difficult to put weight on the knee when taking a walk. Unfortunately, in some circumstances, a wheelchair will be required. A visit to the orthopedic doctor to investigate the symptoms can sometimes result in a diagnosis of Knee Arthritis, which can be both regrettable and very daunting news to hear.
Another common mistake made by individuals who are suffering, is regarding the inflammation of the knee cap. On discovery of this symptom, the patient will usually tend to it by applying a hot compress of giving a massage. Regrettably, this can have an adverse effect and actually make the knee become more inflamed. Furthermore, when there is inflammation present, the area around the knee has already become more heated, therefore a massage, or using the hot compress, will increase the pain, often to the extent that the patient is unable to walk. The correct treatment here is to use the cold compress. Nevertheless, there are some exceptions. For example, in cases where the heat has accumulated in the knee joint, such as when an athlete has just finished a run, and the muscle is so tense and tight that it is depleted in oxygen, it is advisable to use the hot compress to relieve the pain. The aim of the treatment at this stage is to quickly reduce the inflammation. Patients are advised to take a rest and not to go on long walks. If the patient feels in so much pain that they feel a visit to the doctor is required, then then they will often be prescribed pain killer medicine including preliminary advice on knee arthritis.
Another type of knee disease that patients often mistake for knee arthritis is gout in the knee joint. The symptoms are quite similar, however, in gout the pain is more sudden and severe and often the knee will become a lot more swollen. Another significant difference is that in gout the skin tends to heat up a lot more. The pain can be excruciating for a patient and usually they are unable to walk and can have great difficulty sleeping. Gout is caused by the accumulation of uric acid in the joints, and the knee joint is no exception. Even when there is small stimulation (such as when wearing new shoes), as this can affect the knee when walking it can also lead to severe pain of the knee joint. It is thought that consuming too much high protein (poultry, animal visceral, all kinds of legumes… nut and pea, vegetable sprouts, alcoholic drinks) is a major factor in the build-up of high uric acid in the body. For those that have an abnormal digestion, the protein will be changed to uric acid.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 3
The Effect on Living Standards
Surgeons perform an operation to change to an artificial knee joint, in an overseas hospital.
During the third stage of knee arthritis, a patient usually cannot bend their knee all the way through and can find it problematic to extend their leg fully. Towards the end of this stage, a patient will also have great difficulty squatting. Furthermore, when bending their knee more than 90 degrees, they will find it very painful indeed. This can have a dramatic effect on a person’s standard of living. In Thailand, in rural areas in the north, where families often enjoy sitting on the floor when having meals, this issue can be a real hindrance in day-to-day life. Whether people choose to sit with a posture of sitting with the two legs tucked back to one side (pub-piab) or sitting with both legs crossed (kud-smarti), it will still prove exceptionally difficult to sit for a long period of time and will certainly be more problematic than it was in the past. A person who is suffering in this particular way will often need to pause during their meal in order to stretch out the leg and relieve the knee pain. Other issues arise when visiting the temple and siting in the pubpiab posture. Whilst listening to the monks saying the prayer, it can become very difficult to sit for long periods of time. Therefore, during such an enlightening moment when complete focus is craved, this could produce unwanted negative thoughts and could even result in a person privately wanting the prayer to end more quickly.
Elderly people who are living in town will often not be aware of the problem as quickly as their upcountry counterparts. This is due to the fact that in their daily life they do not usually put as much strain on the knee. Unfortunately, some will only realise the problem exists when the arthritis has reached stage 4, or even stage 5, already.
On long distance journeys, when needing to use the toilet, the elderly will often require a sitting-type toilet as the squatting type cannot be used anymore due to the fact that they cannot bend their knees. This is one of the reasons they are often reluctant to go out. Although in Thailand sitting toilets are becoming more and more common, they are still outnumbered by squatting-type toilets, particularly in rural areas. One method of countering this problem is by using a portable sitting post with a tripod, which can be placed on top of the squatting toilet and used to sit on. Younger, more able family members can help to carefully attach the tripod, taking appropriate care to secure it and also wiping around the toilet floor as it can often be very slippery when wet.
When elderly family members are staying at home, it’s important to modify the restroom to meet their specific needs. If present, any squatting-type toilets need to be removed with new, sitting-type toilets installed in their place.
Additionally, the restroom should be modified further to ensure its safety. As sitting for long periods of time can result in blood not circulating to some parts of the legs (and therefore making it difficult to stand) the restroom should also be equipped with a hand rail. This is very important as, when standing up, the leg could have difficulty supporting the weight of the body, resulting in the individual staggering and falling down to the floor. If this does occur more problems are created due to the fall. For example, a problem often seen from this is a broken hip bone or broken vertebrate (sagging down of the spinal cord). Another area to consider is the emotional effects to the person after the fall and their loss of confidence. Holding on to a hand rail for a while will help individuals gain strength and consequently provides more safety, drastically reducing the risk of an accident. The position of the hand rail should be in proportion with the elderly person’s height, within the distance of their reach and should help facilitate them to sit down and standup. This can be installed by a family member at home, providing they have the correct materials and tools. For an example of how the hand rail should be attached, it would be beneficial to refer to a hospital toilet for the handicapped.
It’s worth noting that there are some occasional exceptions. One of the elderly who I am sure does not have knee arthritis is Luang Por Koon. We often see him sitting in a squatting position with a cigarette in his hands. We have to accept that, although he is advanced in his years, his knee joints are still in good shape and strong as he can sit with the knees fully bent without any sign of pain. However, this is a unique case and it is quite extraordinary!
Taking all the above points into consideration, if you want to continuously be able to squat for a long time, you need to ensure that you take good care of your knee joint today.
Wish you well and no knee pain.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 4
Pain Increases When Bending the Knee
If stage 4 of knee arthritis is reached, as well as becoming unsteady in the way in which they walk, the patient will also feel considerable pain when bending their knee. This often results in individuals simply attempting to avoid exerting any pressure on the knee at all. Often, for those who are afflicted with stage 4 osteoarthritis, there is a need to stretch out the knee and lift up the hip or even lean the whole body to one side so that the feet can be lifted and will not touch the floor during a walk.
When doing this for a prolonged period of time, it results in tissue around the knee joint adapting to the body’s new method of use. Consequently, the knee joint starts to seize, and it becomes increasingly difficult for an individual to bend their knee to the same extent as they could previously. Finally, they will reach the 4th stage of osteoarthritis, which produces unstable, wobbly walking. When reaching this point, a walking stick is required to assist with balance.
At this stage, patients tend to walk without bending their knee. Consequently, in an attempt to avoid the pain, this often involves them lifting their hip and adjusting their body posture instead. Through doing this, they can make forward movements with only minimal aching of the knee joint. However, this can lead to exhaustion when doing regular activities, such as taking a long walk. Although, initially this may not be noticed, after a longer period of time the ‘wobbling’ will become obvious, and the individual will start to stagger, swaying left and right in an almost mechanical way, rather like an old-fashioned robot. The reason for comparing this ‘wobbly’ walking to a robot from the past rather than a modern-day robot is because technology has advanced to the extent where a robot can move like a human with fully working knee joints. For example, when observing ASIMO the robot, its walking technique is comparable to a human’s. It can bend its knees and ankles effectively and can also walk steadily with its body upright, without teetering at all and therefore it looks considerably better than a human with this stage of knee arthritis.
Perhaps we will see robots competing with humans in 100 metre running races in the future? As time progresses, eventually the robot will surely win as, where the human knee joint will wear and tear due to repeated use, if a robot’s knee joint becomes damaged or ineffective it can simply be replaced with the same or a more optimised version. Furthermore, although the human knee joint can be replaced with an artificial one, it is simply not the same standard as the original. Moreover, we can replace the knee joint but cannot stop the deterioration by time, of the body or the spirit of youth.
Regarding the knee, when the patient continually walks, they become increasingly unsteady and will often rely on a walking stick to help support themselves. However, factors such as choosing an inappropriate walking stick or / and holding it in an incorrect way can actually increase the pressure exerted on the degenerated knee joint which will ultimately result in further deterioration to the joints themselves. When considering the improper use of walking sticks, whenever a patient does have knee problem and opts to use the stick as an aid, patients almost always hold the walking stick on the same side of the leg that bears the knee pain. Unfortunately, this only acts to compound the problem as it causes them to lean more and more to that particular side without noticing it. In addition to this, the arm handling the stick will also experience wrist ache because the body weight will not be put on that arm. This is simply not the correct way for a person’s body weight to be supported. The appropriate way to hold a walking stick is to hold it on the side of the fully-functioning knee.
To summarise, if the right knee is aching, when making strides with the right knee, the patient should hold the walking stick with their left hand, whilst ensuring the walking stick is kept in front of the body. It should also be kept level up to the tip of the right foot; this will distribute the body weight to put pressure on the stick, rather than directly onto the bad knee. Interestingly, in many Thai movies when the hero has a debilitating leg injury, the walking stick is often used on the wrong side. This goes against modern medical principles and certainly, in real life, we should aim not to neglect the knee joint in this way.
Ultimately, it’s better to take care of these small details so that we will have a fully-functioning knee that remains in good condition so that we can utilise it fully for many years.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 5
When an Operation is Required
To summarise, knee arthritis can cause the following issues:
- Fatigue of the knees and the area around the knee
- Aching, swelling, reddening and heating up of the knee joint
- Inability to extend or bend the knee fully all the way
- Walking will become unsteady and ‘wobbly’, like a robot
For further details about specific symptoms at the various stages of knee arthritis, please refer to previous sections of this article. I will now discuss the symptoms present a stage 5. This is a crucial stage in the process as it has come to the point when, unfortunately, the patient will require an operation. At present, there are 2 operating procedures that are proven to be effective. The first method is to straighten the tibia (Tibial Osteotomy) and the second one is Total Knee Replacement.
When considering the lifestyle of Thai people who are living upcountry, a good place to get a feel for the Thai way of life is to go to the busy morning market. Every day, early in the morning, all kinds of people, from all walks of life gather together. There is a real Thai feel to this and lots of information can be gathered about how the community functions as a whole just by observing different people. Students can be seen leaving their homes for school before stopping on the way to buy Kao Gang, a traditional Thai fast food (rice with curry) to take for lunch; the monks gather with their alms, lined up so that local people can make offerings; the elderly can be seen chit-chatting in the coffee shops; some people can be seen practising Tai Chi. Overall they look alert and healthy. Even for people with bow legs which can be obviously seen, they can often still walk easily without any signs of pain.
Bow Legs
Bow leg is the last stage of knee arthritis. At this stage, the straightened knee will start to bend, like a bow. Some patients will have developed a bow knee gap so wide that a small child could walk through it. People often question why this is referred to as a bow knee. The explanation is that the body weight is constantly pressed onto the inner side of the knee joint when an individual stands up. Subsequently, when the cartilage surface becomes more worn and torn, the inner side of the knee joint will be dilapidated before the outside surface. This will continue until the inner surface of the knee joint collapses, and the bending angle increases in size. The more the knee bends the shorter the leg becomes, which eventually makes an individual stagger as the walking process becomes much more difficult for them.
Often people put the knee support (elastic band) around the knee to prevent it from bending further, or in anticipation of it straightening. However, the reality is that this is not helpful at all in the recovery process. Conversely, it will actually compound the problem by accelerating the bending. The reason for this is that the knee support will wrap tightly on the knee joint and consequently reduce the joint movement, resulting in the muscle around the knee receiving less exercise from its restricted movement.
At first, using the knee support will give the patient a feeling that the pain has been relieved. Furthermore, they will be able to do some activities, such as walking, in much more comfort. The patient may also believe that the knee joint will return to the same working condition as previously and that painkillers will not be necessary anymore. However, when this support is taken away, walking without it will become a lot more painful and the muscle around the knee is so emaciated that it becomes visibly smaller in size.
The muscle around the knee is very important within daily routines as it helps buffer the pressing force of the body weight on to the bone. These muscles also help hold the small tendons around the knee so that they don’t work too hard and become inflamed or torn. When using the support every day, these muscles tend not to be used because the knee has the support of the band. Occasionally, people actually become over-reliant on the support, to the extent that they are not willing to walk without it.
When bow-knee is obvious to see in a patient but there is no pain associated with it, there is not a need for a cure. However, aesthetically, some patients feel it is not a good look and they can often feel insecure about the way they are perceived by others when walking. Some, like people in more rural areas upcountry, can still walk for long distances without any issues; the bow knee alone is not the indication that there is a need to get the operation. However, if a patient has bow knee combined with pain, the discomfort will be comparatively higher when compared to a patient without bow knee. This is because each step of the walk will require a lot of energy. Additionally, the wear and tear of the cartilage would mean there is no coating on the bone to handle the friction of the walk. Subsequently, this would cause further inflammation on every step. The patient would certainly not be able to walk for longer periods. After persevering with all therapeutics without noticeably positive results, the choice is to take one of the above 2 operation methods.
For more details on the above points, please see High Tibial Osteotomy and Total Knee Replacement at the website: thaihappyhealth.com
The next article in the series (part 6) will discuss the last stage of knee arthritis, where the patient is not be able to walk at all.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 6
When a Patient is Unable to Walk
Stage 6 of Knee arthritis can be considered the final stage of the process. As explained earlier in this article, with all of the 5 stages of knee arthritis, it is generally accepted that a person’s quality of life is reduced. Clearly, as the symptoms reach an advanced stage, the patient will start to lose all confidence in walking for long distances. For example, when the children or even grandchildren want to take the afflicted family members out for a meal they will often feel the need to use excuses such as: the expense of going out, the meal being cooked insufficiently, or the restaurant appearing overly crowded. Often this is simply not the case. They are actually afraid of having knee ache and being a huge burden to the children, especially when they require extra support when visiting the restroom. In some cases, individuals can acquire knee arthritis at an unusually advanced age, as early as 50 years old. In these instances the patient’s general health is fine, but unfortunately their knees may have already given in. It is possible that they have now reached Stage 6 arthritis and that they are now unable to put weight on the impaired leg whilst walking.
This shows an elderly person with Stage 6 arthritis
The 2 main causes of stage 6 Knee Arthritis, as recognised by doctors and patients are: the inflammation of the knee joint and the weak muscle around the knee. More importance should be attached to the second cause in that, even after the High Tibial Osteotomy (HTO), where the tibia is straightened, or following a Total Knee Replacement operation (which cures the inflammation and knee ache), if a patient has existing weak muscles, the success of the operation is limited and results cannot be fully effective. Furthermore, usually the weak knee muscle continues without the patient being conscious of it; this is known as QMA (Quadricep Muscle Atrophy).
The demo of the computer- guided knee replacement operation
When looking further at the causes and symptoms of knee arthritis, it’s clear that not only does the knee ache when going up and down the stairs, additionally; the knee on the problematic side is without strength and cannot support the body’s weight to do various activities. The weak knee muscle can be seen at an early stage and it can also be the principle reason for the progression of the symptoms. An individual with weaker knee muscles can subsequently reach the last stage of knee arthritis at an accelerated rate, several times faster.
At this advanced stage, patients are usually unable to walk which can often cause a pressure wound at the hip area. The wound is persistent and can spread out to the extent that it reaches the bone. The patients can also easily contract a respiratory tract infection due to their decreased body movement. Moreover, the lungs expand less and the exhaustion of the bad air is reduced which, unfortunately, results in the germ being retained in the lungs.
A patient with stage 6 knee arthritis who is unable to walk.
If a patient reaches this final stage, they need to have Total Knee Replacement Surgery and muscle therapy, in order to recuperate the muscles and allow them to return to full strength so that they can perform daily routines sooner rather than later.
The wound of the knee arthritis surgery, with HTO method
The wound of the knee replacement surgery, with MIS + computer- guided method
Do you have this stage of knee arthritis? If not, it is advisable to take the necessary steps in order to find a cure before it reaches this stage.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Bow legs (or bow knees) and knock-knee in children : Part 1
Recently there has been a new, revolutionary way of thinking towards the treatment of bowed-legs. Patients can wear specially designed shoes that are tailored to a patient’s particular needs and can therefore produce a change to the legs / knee structure. These custom made shoes, featuring patient specific insoles, can adjust the structure of the horizontal plane and the angle and the length of the legs. Fortunately, they can be fit as soon as the child is able to walk. Furthermore, they are also effective in elderly patients, where they can provide increased support in weaker areas.
Bow legs (or bow knees) and knock-knee in children : Part 2
It’s quite common for toddlers to appear mildly bow legged. In fact, toddlers can often have bowed legs that may even interfere with walking. Fortunately, bow legs usually begin to straighten once the child starts to walk and it can be thought of as a natural occurrence that the child will usually grow out of. Adolescents occasionally have bowed legs if the degree of deformation is rather severe which can cause a flaw in their appearance.
The Drawback of having bowlegs : Part 1
“Drawback of having bowlegs”
Most patients are usually taken by surprise when the doctor tells them they have bowlegs. They react as if it is impossible to have such condition at their age. “How is that possible?” is a typical reaction, while some conditions are severe. Worried they might be teased that a small kid can walk through their bowlegs!
Some patients try to find excuses like, “I was born with it.” or “Every time I wear shorts to play soccer, friends always tease me that my legs are not straight!”
This condition is inherited but there is nothing to be worried about. “Bowing” of knees or the technical term genu varum (genu = knee, varsus/varum = angles in) is part of the normal development of a person. It is the outward curvature (curved out or curving out) of the legs (x-shapedor o-shaped legs as described by some patients in Thailand) that causes separation of the knees when the ankles are close or in contact. The doctor needs to find out the severity of each patient’s condition though it really has serious consequences if left untreated.
When do you need surgery for bowlegs? : Part 2
“When do you need the surgery for bowlegs?”
Bowlegs (Varus knees) that reach these severe conditions need to get operated:
1. The two knees are bowed or curved outwards (curved out) resulting to unequal length.
This causes the patient to walk wobbly because the lengths of the two legs are unequal. The wear on the shoe soles are also unequal. When a patient is wobbly walking for a distance or standing for a long time, it will result in backache. The patient is usually unaware that the chronic backache is caused by bowlegs.
Varus knee (bow-legged) correction in young adults : Part 3
“The treatment for varus knee (bow-legged) correction”
Nowadays, there are only three standard treatments for varus knee correction to regain straight knees, which are acceptable for successful result.
1. Knee replacement
This technique is suitable for inactive patients (older that 65 years old) with severe osteoarthritis of the knee. They currently receive full alternative
reatment though the pain has not improved still. Knee Arthroplastydoes not really last forever since it can only be used and worn for an average of 10-15 years. Patients need to use it carefully, avoiding contact sports. Otherwise, it has to be replaced earlier than expected. Another major disadvantage of knee replacement is having catastrophic infections. Knee replacement is only reserved for elderly patients with severe stage of knee osteoarthritis since it is the last option left.
Types of Bowlegs and Operation Methods to Cure : Part 4
“The Latest and Most Innovative Operation Techniques for Bowlegs”
Advantages of Modified HTO with New Charnley Clamp:
- Small cut wound around 1.5 to 2 centimeters; less time spent on the operation.
- Minimal blood loss; no need to use the tube to drain out the blood from the wound.
- Less pain; short time spent in the hospital (only 2 to 4 days).
- The operating tools are newly designed to be of smaller size and not to be left permanently in the bone.
Modified HTO with New Charnley Clamp
The method is the same as HTO, the third method, in using the Titanium Pedicular screw external fixator. The modification made the operation procedure faster, and with the patient having a smaller cut wound.
The operation to correct bowlegs, knock-knees : Part 5
“The operation to straighten both knees at the same time with the new MHTO Method”
Frequent questions from patients who have bowlegs or knock-knees on both sides from a young age are:
- Can the operation be done on both sides on the same day?
- Is there a difference between knock-knees and bowlegs?
- Will there be a difference if the operation is done on one side at a time?
- And the most important question is: Has this kind of operation (same-day-both-knees) been practiced in Thailand?
The operation on both knees at the same time
