OVERVIEW
Have you got a “noisy” knee, through which you hear rubbing, cracking or popping sounds? A study published in the Arthritis Care & Research in May 2017, states that all this, despite the absence of pain, may be the first signs of osteoarthritis. Besides, we are talking about one of the most common degenerative diseases of the human body, and a very common cause of disability in the adult population. According to the Arthritis Foundation, in the US alone, over 27 million people have some form of arthritis, most of them in the knee joint.

HIGH RISK GROUPS
The disease manifests itself when the cartilage (a “cushion” which is responsible for the smooth, minimally frictional movement of the articular surfaces and the simultaneous absorption of shocks) that covers the bones, is worn. Although age is an important risk factor (aging of the population is also responsible for the steady rise in numbers, since 1990), yet even younger people may be diagnosed with osteoarthritis. Heredity, injuries, infections and obesity, are some of the causes of the disease.
Women over the age of 55, those with hereditary abnormalities regarding the shape of the bones surrounding the knee joint, those who have to kneel too much during work, do squats or lift heavy weights, but also those who play sports such as football, tennis and long-distance running, are considered more vulnerable. Also, those suffering from rheumatoid arthritis, an autoimmune disease with an inflammation of the synovial membrane, are most likely to present knee cartilage problems.

WHICH ARE THE SYMPTOMS?
Actions of everyday living, such as getting up from a chair, walking, climbing stairs and running, are particularly painful for the patients. Apart from pain, which subsides when resting, there is swelling due to an accumulation of fluid, a burning sensation in the joint, stiffness, especially in the morning or after resting, and bony projections (osteophytes) form along the joint margins. At an advanced stage of the disease, a deformity of the joint axis, or even a contracture, are also observed.

WHICH IS THE BEST TREATMENT?
Treatment depends on the diagnosed stage of the condition. The goal is to reduce pain and stiffness while maintaining the joint functionality. Weight loss is the first suggestion: Given that forces which are equal to three to five times the body weight are applied upon the knees in every movement, diet can reduce the pain. Exercise can do the same (swimming is an ideal option), as movement and flexibility increase, and the muscles are strengthened.
Usually, anti-inflammatory and pain relief drugs are prescribed. Injections of corticosteroids, hyaluronic acid inside the knee are a very powerful weapon, for the improving of the joint functionality. Regarding patients who can not perform simple, day-to-day activities, physiotherapy is also recommended.

TOTAL KNEE REPLACEMENT (ARTHROPLASTY) – PROCEDURE
However, in cases where conservative therapy fails and the knee remains non-functional, thus significantly affecting the patient’s quality of life, replacing the worn joint with an artificial one is an option. According to OECD data for its member countries, total knee replacements almost doubled between 2000 and 2013, especially in Germany, where they increased by 90%. The increase in rates is due to the fact that nowadays, there are new types of implants with a longer lifespan, suitable for younger and more active patients.
In total knee replacement, the surgeon replaces the damaged knee surfaces with artificial materials, of special alloys and plastics. Minimally invasive total knee replacement (MIS), in which the incision is shorter and no cross-section of the quadriceps tendon is performed, is considered the most modern technique. Moreover, there is the possibility of the unicompartmental knee replacement, only at the site where the articular cartilage is damaged, which may - even in Greece - be performed through robotic surgery.
After total or unicompartmental knee replacement, the patient is immediately and completely functional and independent, regarding their daily activities, while they need to follow a personalized physiotherapy programme, of 3-4 weeks.

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