Do you need a Kneecap ??

Yes & no.You certainly don't need a kneecap or hinged brace for arthritis. You are much better off & much more comfortable doing exercises & making subtle changes in your lifestyle. If you have end stages knee arthritis, then also you won't benefit from any braces, you may be better off getting a knee replacement.

If we are able to diagnose isolated arthritis of one half of the knee replacement.

If we are able to diagnose isolated arthritis of one half of the knee, then you will benefit from an offloading brace.The problem with the offloading brace is that it also offloads your purse! Most such braces are very expensive.Another problem is that you need to wear them throughout the day, which may be a challenge n our mostly tropical climate & if you are fond of tight clothing.Sometimes these braces simply don't fit us diameters & that causes the brace to lift off the skin in some places.An ill-fitting brace will not work for you & might actually be counterproductive by constantly rubbing against the skin & eventually ulcerating it!

How Soon will the braces start having its effect?

We are all in a terrible hurry to see results, especially after spending a fortune on the offloading brace. Results in terms of pain relief take time . just like a new shoe, the knee may feel sore. Some people don't obtain that much of pain, but their mobility & joint flexibility improves. In a nutshell, it is unrealistic to expect magic from the braces. Be prepared to wait out a few weeks for its effects to kick in.

Are offloading braces available in India?

Yes, but only on a doctors prescription.All the braces available off the shelf are mostly useless from afar as knee osteoarthritis.

Shree Meenakshi Orthopedics & Sports Medicine Clinic has all the modern equipment and techniques to perform all kind of orthopedic surgery  Dr. Raju is a well-known surgeon for knee injuries and one of the best orthopedic doctors in New Delhi. The hospital has a good hold on knee surgeries and has a high rate of successful surgeries.

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Mail us @  drrajueswaran@gmail.com

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Injections for Knee Arthritis

Sometimes knee arthritis simply does not respond to medications & physiotherapy. It becomes desirable, then to inject the knee joint to improve the symptoms of arthritis. Here are some facts you should know before getting that jab.

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1) Will it be painful?

That’s the most obvious question in everyone’s mind. The knee joint is the largest joint of the human body. It has lots of space inside to accommodate the injection & if carefully given (without the needle touching the bones of the knee), it is essentially a painless procedure after the local anaesthesia is injected in the skin. This injection (local anaesthesia) is done with such a tiny needle that its prick into the skin is virtually painless.

2) Will it be harmful to my knee & body?

This depends on the type of material injected into the knee joint. The most commonly injected material is a depot (oil based) preparation of a steroid like methylprednisolone. It works wonders for the acutely inflamed knee of inflammatory arthritis (like rheumatoid), but is merely a short term time buying procedure for the more common osteoarthritis. Repeated injections (more than 4 in a year) can be detrimental to the knee’s cartilage & will hasten its breakdown, thereby accelerating the progress of arthritis. Being oil based, very little of the steroid escapes into the body & is thus safe from that point of view, but caution is exercised in those with diabetes, glaucomas & kidney problems.

The second category of injection material actually lubricates the joint. It contains a high viscosity material that mimics the properties of healthy joint fluid & improves joint lubrication. It works best in early stages of osteoarthritis & its benefit has been shown in clinical trials (OASIS) to last upto an year (Synvisc One). It is of little use in very advanced stages of osteoarthritis & in all stages of inflammatory arthritis (rheumatoid). Apart from minor pain at the needle entry site that may occur in a few people, this injection is very safe & gaining popularity because of its joint preserving nature.

The third category of injection that is slowly emerging as a new entrant is the stem cell injection (Platelet Rich Plasma or PRP). Here 30 - 50 ml of one’s own blood is purified into 3-5 ml of platelet rich plasma & injected back into the knee. It is still in the experimental stages with inconsistent results. However since it is the patient’s own blood that is injected in a filtered manner, it does not have any side effects. The initial post-injection period is however more painful compared to the above two injections.

3) How long will the effect last & how often can it be repeated in osteoarthritis?

With the steroids, effect lasts for 2-3 weeks, synvisc one works for an year & with PRP the results are not yet known. Steroids are best not repeated, synvisc one can be repeated as many times as desired & with PRP the protocol of repeat injections has not yet been firmly established.

4) What precautions need to be taken for these injections?

If you have diabetes or glaucoma, please inform your orthopaedic surgeon. It is better not to get injected with steroids in these cases. Always get the injection in a sterile environment like the minor operation theatre. Rest for 1-2 days after the injection. Pain may temporarily increase immediately after injection, ice packs & anti-inflammatory medicines will take care of it.

Have realistic expectations from the injection, do not expect it to do magical things. Synvisc one for example starts working only after a month of injection. Do not expect the injection alone to do the trick for you, continue with exercises & lifestyle modifications (refer to my earlier blog). So if your orthopaedic surgeon recommends an injection, do not go into a panic mode, educate yourself about the injection & take a careful prepared decision that can change your lifestyle.