Why knee pain develops at old age?
Knee pain in old age is usually due to age related wear and tear of the knees called osteoarthritis (OA). The covering of the bony ends undergo "wear and tear" causing pain, swelling and difficulty in walking.

There may be a genetic cause in some people, which increases their chances of developing osteoarthritis.

What if I have a previous injury to my knee in the past? Will I be at risk for developing OA as well?
Abnormal functions of the knee joints resulting from fractures of the knee, torn cartilages and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear -- just like the out of balance tyre that wears out too soon on your car.

How I can understand that I have OA?
If you have knee pain during walking, climbing stairs, standing from squatting or prayer time etc. at the age of 50 onwards means you might have some degree of OA in your knees. the pain may be associated with night crump and recurrent swelling of the knees. Sometimes, your knee may become bowed or there may be bony outgrowth at the bony ends which can be identified by x-rays. When the condition is long standing it becomes worse and the pain may persist all the time and may even keep you awake at night.

How I can confirm my diagnosis?
The diagnosis of a degenerative knee starts with a complete history and physical examination by a doctor. X-rays will be required to determine the extent of the degenerative processes and may suggest a cause for the degeneration. Other tests may be required if there is reasons to contributing to the degenerative processes. Blood tests may be required to rule out a systemic arthritis -- arthritis that affects the whole body (such as Rheumatoid Arthritis) or infection in the knee.

Is OA related with diet?
There is no proven relation with food habit and development of osteoarthritic knees. But the diet which increases the body weight can indirectly aggravates the condition. Weight control is specially important for people with OA, because being overweight puts extra weight on the arthritic joint and can add extra discomfort.

Is OA occurs male and female equally?
No, women are more prone to develop OA than men. Out of 3 women 2 are affected with OA at the age of 65 and more.

What are the treatment options?
There are following treatment options.

1. Medication and physiotherapy and occasional steroid injection into the knee.

2. Surgery: It is of two types a) Arhroscopic wash out. b) Replacement surgery.

What about steroids into the knee?
Steroid injection into the knee is commonly done in our country. the injection is a combination of local anesthetics as well as steroid. the anesthetic agent is short acting, which offers immediate pain relief but lasts for about 5-6 hours. The steroid helps to contain the inflammation in the knee and this may last for few weeks to months.

I have heard that steroids have serious side effects. Should I get a steroid injection into my knee?
Oral steroids have numerous side effects. All steroidal medications should be prescribed by a doctor especially if taken orally. However, local injections of steroids will act only in the knee and are NOT absorbed by the body. Hence, there will be no systemic side effects.

How many times can I get a steroid injection into my knee?
You can have it 2-3 times a year at the most. However, if there is no effect, it is of no use in repeating the steroid injection into your knee.

Is there any exercise that can help avoid surgery?
Physiotherapy is a very important component of orthopaedics. However, there are no known specific exercises that can prevent surgery or slow down the progression of OA. More importantly, you should stay active and continue walking as much as you can. Once you feel that the pain is getting you down, it is probably the time you should talk to your surgeon about the other alternatives. The use of a walking aid or cane helps to reduce the load on the knee joint and is a good aid from the beginning.

When do I need surgery?
If conservative treatment have not been successful in relieving pain, surgery may be considered. In the more severe cases of OA, where the joint is unstable or progressively deformed, surgical measures may be a better option.

The writer is an assistant professor of National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) , Dhaka.