Patients below 40 should avoid knee replacement surgeries, say experts

Doctors have warned that knee replacement surgeries in osteoarthritis patients less than 40 years of age can do more harm than good.

Osteoarthritis in young people may be caused by surgical removal of an injured meniscus, C-shaped cartilage in the knee, or injury to the articular cartilage (chondro) and the bone under it, or insufficiency of the ligament. This disturbs the alignment of the knee by placing abnormal stresses on the cartilage of the affected compartment, thus causing pain and difficulty in walking.

According to doctors, there are other procedures that can be used to avoid knee surgeries.

"Simpler technically demanding procedures like cartilage regeneration surgeries are done with the help of keyhole made into the joint and cartilage harvested and grown in the lab. These procedures can manage early degenerative changes that happen only in half the need to start with mostly the inner side. If treated on time, they can give almost like natural cartilage growing there and can avoid knee replacement surgery," said Dr Shubhang Aggarwal, Senior Joint Replacement Surgeon, and Director, NHS Hospital, Jalandhar.

"The need for knee replacement surgery in young arthritic patients who have degenerative changes in one compartment of the knee joint is overemphasised. Even though we do robotic surgery which gives a perfect alignment and ensures that the implants which are put in last up to 30 years, still, it is advisable that in very young patients especially with osteoarthritis alternate methods of treatment even if they are surgical should be considered." He added

Dr Vivek Mahajan, senior orthopaedic at Indian Spinal Injuries Centre, said, "Usually in younger patients, the cause of knee pain is due to meniscal tear or ligament injury or cartilage damage which if neglected can lead to osteoarthritis in future. These injuries should be addressed in time and can be managed by simple arthroscopy or keyhole surgery which can prolong the life of knee joint."

Some of the experts also suggest that degenerative or inflammatory arthritis at a young age would be treated by non-operative treatment like weight reduction therapies, physiotherapy etc.

"As far as a knee replacement is considered, it is usually recommended in the older age group. Generally, the procedure is offered after the age of 60. That does not mean that patients below 40 should continue to suffer even if they have significant pain because of arthritis. Inflammatory arthritis such as rheumatoid arthritis can damage the joint at a relatively young age and cause serious disability. This may need a knee replacement at an early age. Generally speaking, degenerative or inflammatory arthritis at a young age would be treated by non-operative treatment such as weight reduction physiotherapy, special disease-modifying drugs, cartilage enhancing drugs etc," said Dr Yash Gulati, Senior Consultant Orthopaedics, Joint Replacement and Spine, Indraprastha Apollo Hospitals, New Delhi.

"Surgery is offered if non-operative treatment does not succeed. The leg can be realigned by doing osteotomy of the leg bone in younger patients. Now, a very modern, less invasive partial or half knee replacement surgery is available which gives wonderful results in partially damaged knee joints." he added.