LIFETIME HIP & KNEE

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#113: How Knee OA gets worse

This happens a fair bit..

Last week I wrote about John's LEFT knee..

'..as that cartilage thins, the gap between the bones on the outside of the knee gets less. AND that increases the deformity still further.'

'Knee Osteoarthritis can be Self-perpetuating'

No sooner had someone asked 'How so..?'

Than ideal person pitched up for knee replacement..

Marie's* Right Knee

A quick check that Marie* (*name changed!) was happy to share her story.

And here's her x-ray films (see 1. below) from the last 3 years..

1. Marie's RIGHT knee 3 years ago

There's the blue line from Centre of hip to Centre of ankle

Running just outside the centre of Marie's RIGHT knee

Not by much BUT enough, over an 85-year lifespan

Of perhaps 250+ MILLION steps, to lead onto..

Inflammation + Cartilage damage.

The root cause of Marie's knee osteoarthrtis (OA) is that slightly under-developed outside of knee.

Two years later (see 2. below), and we're looking at..

Cartilage thinning
Increased Deformity
More Knock- kneed alignment

2. Marie's RIGHT knee 1 year ago

At that time she was okay.

Marie kept going..

Staying active..

Staying strong.

Fast-forward another year..

(to a few months ago)

And this was the shape of Marie's knee (see 3 below)..

Long leg alignment X-ray film lateral OA knee

3. Marie's RIGHT knee a few months back

That blue line is way out to the outside of Marie's right knee

Every step is jamming all the force through the outside of her knee.

Inflammation. Pain. And now, a feeling of Instability..

Her knee felt like it was going to give way with every step.

She tried a stick, and got back on an exercise bike.

(30+ minutes most days at nearly 90 years 👏👏)

And still that Right Knee was getting in the way of everyday life.

Now I'm a fairly anti-surgery hip + knee surgeon

'Put it off for as long as possible' is the mantra I practice by..

People ask..

Will it get worse?

AND the answer is usually 'not necessarily'

Optimise Bodyweight, build Activity, think about how you Move about

AND you can keep inflammation settled.

BUT, when it gets to this point..

This level of deformity (see 3.)

That knee is not getting better.

AND is likely to get worse.

So, we got on with a RIGHT Total Knee Replacement.

One of the 4 Technical Goals is Leg Alignment..

4: Marie's RIGHT Knee Replacement

And we got that blue line back to the middle of the knee.

Marie should do well.. 😁

A well aligned knee, and a strong leg attached to a determined patient.

Next week 🙏

I'll look at the driver of medial knee osteoarthritis. A look at OA on the inside of the knee..

And then flip things around to think about how some people can keep running well into their 80s with no Knee OA.

There will be lessons in that to inspire us all 😃

Hip + Knee Pain TOOLKITs 🛠️

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