How to help patients identify the right knee problem?

Knee pain is one of the most rapidly growing causes of disability globally and every family would have a member- young or old suffering from it at some point. The internet provides a plethora of free information to those who want knowledge on any particular topic. Even those who are not learned get enough feed on various treatments through social media which are now extensively being used as advertisement channels.

Despite all the available knowledge, it is most surprising that chronic health problems like diabetes, heart disease and others are on an alarming rise!

A healthy joint is comprised of bones that are coated with a layer called cartilage that allows smooth gliding movement of the bones. Wear and tear of this cartilage constitutes arthritis. Knee pain can however be caused by a variety of causes other than friction due to cartilage loss: muscle soreness, injuries, inflammation of tissues, nerve related problems are probably amongst the major ones.

Correct treatment hence needs a thorough assessment. Each causative factor then obviously has a specific solution to mend it. Proper evaluation of the knee pain is therefore the key.

A search for specialist medical practitioner in India typically leads one to Arthroscopy/ Sports Injury/ Joint Replacement / Pain Specialist or to ads that claim success with new advances or with allied health products.

Patients often fall prey to newer advertised treatments without side effects and don’t experience benefits either. Further there is running from pillar to post for repeated opinions and having repeated investigations like X-rays, MRIs with the resultant expenditure. There is dearth of matching the problem to the correct specialist in our healthcare and information systems.

The best approach to the problem is therefore to have a team approach with comprehensive care and trust provision. We need to have specialist doctors who would willingly spend time listening to the patient, examine them and order only necessary tests that are relevant. Tests need not be done to look for a problem, rather to correlate an impression or confirm a suspicion.

Doctors need to have a team where each aspect of the treatment is dealt with by the appropriate expert e.g. in case of knees, many of us have very subtle abnormalities of bone shape through our genetics. These combined with bad lifestyle and posture habits have forced the youth to experience knee symptoms as well.

Patients need to be counselled and educated well on these aspects by trained staff. Surgery needs to be offered in the right perspective rather than as an only option, which perpetrates fear and increased chance of neglecting injuries. If anyone has had surgery – either simple keyhole or joint replacement, it should be undertaken at a world standard level such that recovery is quick as possible.

A thorough rehabilitation specialist is a vital part of the team where patients advised against surgery are treated with equal passion, as also the operated patient made to get back to sport or quality of life activities as applicable.

A comprehensive knee or lower limb care centre should also have easy referral to the relevant specialist doctor in cases of causes of pain referred to the knee but from a remote/ general cause. More awareness and expansions of such centres of excellence with a patient centric and scientific approach is clearly the need of the hour.

Patients also have the onus of taking responsibility of their problems and following the advice given: they need to respect the doctor’s time and visit with pre- arranged appointments. If they undergo surgery, they need to demonstrate willingness and take the efforts, undertake exercises to rehabilitate back to their quality of life.

By Dr Yogeesh Kamath, Consultant – Orthopaedics, Hip & Knee Joint Replacement Surgeon, Sports Injury, KMC Hospital, Mangalore