Men’s Health Month: Movember 2023 How to improve your knee knowledge (before any damage is done)

November is Men’s Health Month – a hugely important annual awareness campaign that shines a light on the issues which can affect the wellbeing of men. And, deservedly so, the initiative often focuses on issues such as mental health, the risk of male suicide and encouraging men to open up and talk – as well those conditions that only affect men, such as prostate and testicular cancer.

However, as a global health initiative, “Movember” also provides an ideal platform to explore a condition that affects over 10 million people in the UK. Of those diagnosed with osteoarthritis, 5.4 million people are suffering specifically with knee osteoarthritis – and around 8.7 million men of all ages are estimated to be living with a musculoskeletal condition.

So, what can be done – particularly amongst younger men – to help stave off this painful and sometimes debilitating condition that can impact mobility and overall wellbeing (as well as having a really damaging effect on sporting performance and ability to take part in popular pastimes such as skiing, football and golf).

Here, leading hip and knee surgeon, Mr Rishi Chana FRCS Tr&Orth , talks through some of the steps that men (from a young age) can take to try to avoid the risk of developing osteoarthritis as they get older, as well as understanding the early warning signs (which might mean they’re more likely to develop the condition as they age) and the latest, non-surgical treatment innovations.

“To take it back to basis”, explains Mr Chana, “the knee is comprised of three main compartments, the patello-femoral compartment, the medial compartment and the lateral compartment and every single individual – male or female - wears out one compartment more than the other

This can result in knee cap arthritis (where the pain goes through the whole knee, from the front into the back into the back of the knee). “Men and boys can also develop genu valgum (more commonly known as knock knees) which is basically due to the outer compartment is wearing out. When the medial or inner compartment wears out, this leads to a bow legged configuration sooner rather than later.

“So, warning sign number one; anyone with crepitus (that’s crunching or grinding) and discomfort in their early 20’s into their 30’s will be at risk of developing osteoarthritis later on.

“Another common condition which affects young adults is called chondromalacia - a softening of the cartilage, eventually leading to knee osteoarthritis (OA). Knee OA is essentially ‘wear and tear’ arthritis relating to the articular cartilage that covers the bone ends, allowing you to walk comfortably on the knee - when this thins and wears out it causes mechanical arthritis (specifically, osteoarthritis).

“Bad habits are undeniably linked to lifestyle choices, increasing the risk of arthritis as you become older. As with everything in life, balance is key and maintaining good fitness without overdoing things is an important starting point.

“Too much unsupervised weight exercise can damage the knees. Equally not doing enough exercise and sitting at a desk all day will also damage the knees because the muscle will simply waste away.

“Maintaining a healthy, protein-based diet with good vitamins and minerals (such as calcium Vitamin D levels Vitamin C, E and Vitamin A) is also key and will help promote healthy cartilage and joints.

“But I’m afraid though, there is very little evidence about Amino acids and Glucosamine and Chondroitin about promoting any cartilage growth – although there’s probably no harm in trying these supplements for improved joint health.

So, is there a prevalence of young people under the age of 40 reporting pain and discomfort from osteoarthritis?

"Well, we have certainly seen the profile for joint replacements in cases of knee arthritis is getting younger, and in my opinion, this is for two reasons; one is that the joint replacement technology is improving, therefore the scope for a joint replacement lasting 20+ years is much stronger, allowing us to consider joint replacement surgery in those who are symptomatic, even in their early 40’s or 50’s.

“The other reason is that a partial knee replacement is an easier operation to recover from than a full knee replacement, as this is a minimally invasive surgery, with much smaller scar, only replacing the focal arthritis of the patello-femoral or medial compartment of the knee. The surgical procedure takes about an hour, with a four to five week recovery.

“However, we always do everything we can using non-surgical or minimally invasive treatment first – which might include painkillers, physical therapy and joint injections (more of that later!)

“Physiotherapy certainly helps with the quadriceps and hamstrings and with the ‘bulking up’ of these two muscles. The Vastus Medialis Obliqius (a teardrop-shaped muscle that helps move the knee joint and stabilize the kneecap) is the first muscle to disappear and the quadriceps muscle is the last to come back. It’s therefore important to have good working muscles as the knee joint is a simple slightly “sloppy hinge” and without the muscles it won’t function.

“Following that, depending on the patient’s symptoms (such as pain, stiffness, lack of mobility and swelling), joint injections could be considered as an effective and evidence-based means of temporary or long term pain relief (depending on the type of injection administered). Ideally, the combination of a joint injection and physio will help maintain good function and keep swelling, stiffness and pain at bay as well as avoiding the need for a partial or a full total knee replacement for as long as possible."

So, if you’re a young man in your 40s or 50s, what do you need to know about your knees and how joint injections work?

"The Arthrosamid® hydrogel injection - this is a specially formulated polyacrylamide injection that uses a non-biodegradable hydrogel technology, which works by helping to cushion the joint, thus reducing the pain and decreased stiffness associated with knee OA, improving mobility and reducing swelling. The injection is administered in an outpatient setting and so far the evidence shows that it lasts for about three years¹ (possibly even up to five as we see more data emerge), with a single injection of 6ml of the 2.5% polyacrylamide maintaining a statistically significant reduction in pain in patients with knee osteoarthritis (OA).

There are very few side effects, other than a slight discomfort in some patients in the first few weeks or as the hydrogel takes time to dissipate within the knee itself. There is also evidence showing that the hydrogel helps ‘space out’ the inflammatory cells or cells that cause pro inflammation, helping with pain, swelling and stiffness dissipated on a cellular level, which other joint injections do not."

So, is Arthrosamid the right injection for you?

"Well, Arthrosamid is approved for symptomatic treatment for knee osteoarthritis and degenerative changes within the knee including medial meniscal tears. In my view, anyone who has crunching, grinding, crepitus and deep seated pain and discomfort in the knee from the age of 20 to the age of 100 could benefit from Arthrosamid.

“I have injected patients with knee osteoarthritis with excellent results (even as young as 47) allowing them to continue ‘avoiding’ surgical intervention for as long as physically possible.

Conversely, the Arthrosamid injection is also an ideal option for older chaps (particularly those keen to get back on the golf course!). Other health conditions, medications and the risks associated with anaesthesia means that surgery is often not ideal in the elderly. Therefore, Arthrosamid – with a potential promise of five years pain relief - could provide an excellent quality of life and in my opinion, is fast becoming a major game changer!

Steroid injections – these simply masks the symptoms and decreases the pain and swelling within the joint using a potent anti-inflammatory pathway that the steroid is a chemical makeup of and in my professional opinion, I think this only really lasts for 3-4 months. This is regularly used in conjunction with physical therapy in order to give the patient a pain-free ‘window’ (an opportunity to rehabilitate the knee and the symptoms so that they can continue to manage with just physio thereafter). To my mind, the repeat steroid injections don’t really work, the first injection is the best one. The second injection works at 50% and the third injection is pretty useless!

The hyaluronic acid (HA) injection - this is a chemical makeup of a special lubricant within the knee joint which this can be combined with steroid - or not – to help lubricate the knee. This also helps reduce pain and swelling and has slightly better long term data than a steroid injection. This option may last for several months at a time in helping reduce knee pain, stiffness and swelling and allowing beneficial physical therapy to take place.

Mr Chana concludes;

“My advice to men suffering with creaky knees (who we all know can be sometimes reluctant to seek medical advice) is always to book an appointment with an expert orthopaedic surgeon without delay. As part of the initial assessment, we will listen to your medical history, examine you and take some imaging, that allows us to quantify and qualify the level of arthritis (and ongoing risk of arthritis). We can then make an individualised, tailored plan, using a shared decision making process. My patients are involved every step of the way, as I explain the pros & cons, risks and rehab involved, in order to help my patients to make a firm and informed decision."

Mr Rishi Chana is a dedicated hip and knee specialist, specialising in joint preservation and reconstruction with expertise relating to all adult hip conditions. His private practice locations include the BMI Princess Margaret Hospital in Windsor, Spire Thames Valley Hospital in Wexham and BMI Chiltern Hospital in Buckinghamshire. Follow Mr Chana on Instagram @Londonhipsurgeon

^References:

^{1 Henriksen, M. et al. (2023). 3 year results from a prospective study of polyacrylamide hydrogel for knee osteoarthritis.. Osteoarthritis and Cartilage, 31(5), P682–683. doi:10.1016/j.joca.2023.02.023}