BENGALURU: When you think of arthritis, you think of the elderly it affects. We usually do not associate arthritis with children and young adults. Contrary to this misconception, it also affects young adults. Age is not a factor for arthritis; it can affect young and old alike. Approximately five per cent of the population aged 35 to 54 years has radiographic signs of knee osteoarthritis. An early diagnosis may be key in preventing joint damage and the deterioration of cartilage. Young adults usually develop arthritis following knee fracture, ligament injury or infection. Arthritis can develop in young adults without trauma or infection also. These patients usually have bowed legs and overloading of inner compartment leads to degeneration of joint. The predominant symptoms of osteoarthritis of the knee are pain, swelling, stiffness and a decreased activity level. The pain generally worsens with activities and improves with rest. Commonly, wasting of the thigh muscle occurs. This in turn may increase pain and may also cause symptoms of giving way. Symptoms such as locking and catching may also be present.
A painful osteoarthritic knee in a middle-aged recreational patient is one of the most difficult problems to manage. In cases of Osteoarthritis in young patients the inner compartment of the joint is worn out commonly. This results in a bow-leg deformity. With the development of the deformity, the inner compartment is further loaded more. This results in a vicious cycle. To stop this, a corrective bony procedure is carried out so, that the limb become straight and more load is transmitted to the relatively well preserved outer (lateral) compartment.
This procedure is carried out on the upper end of the leg bone (tibia) to make the limb straight and hence it is called high tibial osteotomy (HTO). This procedure gives good results if only one compartment is affected and the age of the patient is below 50 years. Various studies have shown that the majority of the pain can be relieved for up to 10 years. The restrictions on the activity following a high tibial osteotomy are also often less than that following a knee joint replacement. Performing a high tibial osteotomy avoids the risks of putting an artificial knee joint in a young patient which may need to be changed after 10-15 years. The author is Sr Consultant Orthopaedics, arthroscopy and Joint Replacement surgeon, Manipal Hospital, Old Airport Road, Bengaluru