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 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.
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