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Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study)

BMJ 2012; 345 doi: (Published 29 August 2012) Cite this as: BMJ 2012;345:e5339

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Re: Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study)

Dear Editor,

Osteoarthritis is quite a frequent problem, and is associated with increasing disability and limitation of movement. Wear and tear of the articular cartilage is said to be the main cause, but as yet the origins of arthritic pain of a knee is not clear. Unfortunately in some cases the same knee pain has persisted despite having undergone a total knee replacement surgery (TKR).

Why be hasty for advising TKR? Our experience has shown that while evaluating and managing a patient with arthritis knee, the following conditions should also be entertained and must never be ignored, as they could be co-associated, and may be the main cause of pain, limitation of movement and weight bearing :

• Bursitis of the bursae around the knee joint, including pes anserine bursitis

• Hoffa's syndrome

• Patellar tendinitis

• Plica syndrome, etc.

Total replacement of knee joint can be undertaken once the above mentioned conditions are treated or are ruled out with certainty. While at it, and considering the deficiency states the geriatric population lands up with, it would also be prudent to consider the chances of apparent or hitherto unapparent osteoporosis and deficiencies of Vitamin D and of calcium, and maybe some associated deficiency of ascorbic acid as well.

We have found that physiotherapy (SWD, TENS, ultrasonic therapy, interferential therapy, etc) might be of considerable help, along with judicial use of NSAIDs, weight management, use of insoles and heel cushions, and gradual graded exercises in step up fashion. Our experience says that physiotherapy under direct supervision, or by the treating physician himself / herself for occasional serious patients could help alter the course of their disease rapidly and quite convincingly as well (Figure 1). The swelling and pain subsided considerably in a day, and this patient could once again indulge in all household chores and daily activities. We as doctors perhaps just need to stop the spin and extricate our patient from a vicious circle of pain, swelling, limitation of movement and weight bearing, etc. We have found that once a patient is free from pain and swelling, and once again mobile, the chances of recurrence of symptoms can come down markedly.

We need to be slightly more conservative about our interpretations of radiological findings, as we feel that all those radiological findings will continue to persist. We have to decide in the best interests of any of our patient whether it will be the patient that we would be treating or the radiological findings, which may be present even in any normal individual upwards of 30 years of age or so. We feel that the radiological signs are like the graying of hair with aging and likewise the attrition of teeth with aging, which shall continue to worry us with growing age. Therefore our prime concern In respect of osteoarthritis of knees ought to be to resolve any precipitating factor or any coexisting issues as already mentioned afore. Advising a knee replacement should be the last resort.

Much more research needs to be done. As already stated earlier by us, presently we as a team are unable to follow this up to see the response in a large number of patients as we would certainly have wanted, and we do not have any kind of support, financial, administrative, governmental or institutional, etc. We would be happy if our efforts could prove to be more beneficial to the aged population worldwide, as also all those not so old but have been troubled by osteoarthritis of knees, and our research is carried on to its conclusion with the right spirit and efforts.

Best regards.

Dr (Lt Col) Rajesh Chauhan

Dr. Ajay Kumar Singh Parihar

Dr. Shruti Chauhan

Shivendra Pratap Singh Chauhan

Competing interests: We had presented and discussed our views and techniques used to manage osteoarthritis of knees, along with some ten other newer approaches and techniques at the Commonwealth’s Medical Association’s Annual Conference in September 2012 at Chennai, INDIA, and also at the ICON 2012 and the Third International Congress of Family Medicine that were held at Chennai, INDIA, in Sept 2012.

21 April 2013
Dr (Lt Col) Rajesh Chauhan
Consultant Family Medicine
Dr. Ajay Kumar Singh Parihar, Dr. Shruti Chauhan, Shivendra Pratap Singh Chauhan
Family Healthcare Centre, Awas Vikas Colony, Sikandra, AGRA
154 Sector 6B, Awas Vikas Colony, Sikandra, AGRA -282007. INDIA