01/05/2020
HOW TO LIVE WITH YOUR OWN KNEES & FOREVER ...
A picture tells you as much as a 1000 words will ... here I am pleased to share an image posted by another knee preservation enthusiast ... this is in continuation of the earlier post on PFO (Proximal Fibular Osteotomy) ... favouring 'how to live with your own knee & forever' …
Today, the parents of a friend doctor couple came to me for consultation (I do get quite a few relatives of doctors, especially those looking for an alternative to Knee Replacement); It was about the mother's (aged 77) left knee, which continued to trouble her despite a month's treatment with a well known physiotherapist in her neighborhood. Even as I struggled to recognize her (it was 5 years since I saw her last for the knee problem), I could identify her left knee as the source of her slight hobble in the gait.
That she has 'bow knees' was apparent. 3 or 4 out of 5 patients with Knee Osteoarthritis will have bow knees, meaning that the medial compartment will be affected first, with narrowing of the gap between the thigh (femur) bone and the leg (Tibia) bone, on its inner aspect. When the patient walks, she is putting weight on the inner, worn out hurt area of the knee, and & to avoid doing so, she has to walk with an exaggerated awkward lateral swing of the lower torso.
After a careful history & examination, and seeing past records, we got a set of new x-rays to see if the knees OA had deteriorated further.
In her own words, this patient was apparently doing well, as she had not much pain, if at all in the past 5 years, till the recent aggravation. But the x-rays done today told a different story, showing a deterioration with a decrease in the medial tibio-femoral joint space in both the knees. From Kelvin-Lawrence grade 3 (early) they had progressed to Kelvin-Lawrence grade 3 (late). I explained what it meant indicating patient tolerance (willingness to live with a little pain). But is there a way, where knee stops degenerating, or going from bad to worse?
Counselling & further management: I reminded her of the role of exercise in maintaining erect posture, and strengthening the quadriceps muscle, the one which helps straighten the knee especially when getting up from a seat or on the stairs. She had been regularly exercising but had not gone beyond lifting 2 kgs with her quadriceps muscle all this while. She was also on regular calcium, Vit D and a bisphosphonate for osteoporosis.
Seeing her hesitate when I reminded her that her exercise could have been better and can minimize her dependence on pain medication, we discussed the merits & demerits of a relatively minor procedure to correct the maligned knee or PFO as it is known in short. Immediately impressed, the elder gentleman, wanted to know the success rate, the time taken to return to normalcy and the costs.
Quoting success as a relative quantity, involving successful counselling, gauging correctly the patient's expectations, and significantly, underlining its true value in minimizing/delaying the possibility of needing TKR in the near future, the positive benefits were made evident.
The couple left satisfied, with a promise to get back soon, after discussing with the children, their newfound hope.
