Knee Osteoarthritis and Surgical Interventions Consideration in ageing with Associate Professor Sameer Viswanathan

In this podcast, Associate Professor Samir Viswanathan explores the multifaceted aspects of knee osteoarthritis, drawing on his extensive background in orthopedic surgery, including fellowships in hip and knee arthroplasty and foot and ankle surgery. He begins by addressing the prevalence of osteoarthritis, noting that it affects approximately 32 million adults in the U.S. and 2.1 million Australians, with a notable increase projected in the coming years. He emphasizes the significant symptoms associated with the condition, such as pain, stiffness, swelling, and reduced range of movement, and discusses the common risk factors, including age, obesity, genetics, and the higher incidence among females.

Professor Viswanathan elaborates on the diagnostic approach, particularly discussing the Kellgren-Lawrence grading scale for osteoarthritis, which aids in assessing the severity of joint degeneration. He underscores the importance of proper imaging techniques, advocating for a series of weight-bearing X-rays, including views that highlight specific joint compartments to capture the extent of arthritis. He cautions against relying solely on MRI scans unless there is ambiguity in diagnosis, as X-rays remain the gold standard for identifying osteoarthritis in the majority of cases.

The lecture progresses into the realm of non-operative interventions for knee osteoarthritis. Professor Viswanathan echoes the views of previous speakers on weight management and how it plays a critical role in alleviating symptoms. He discusses a range of non-surgical treatments—such as corticosteroid injections and acupuncture—acknowledging the mixed evidence on their efficacy but affirming their value in temporarily managing pain and delaying surgical intervention. He articulates a cautious approach to knee arthroscopy, reserved for specific cases, while detailing less common procedures like osteotomy and unicompartmental knee replacement, emphasizing patient selection and expectations for outcomes.

Transitioning to surgical options, he describes the satisfaction rates associated with knee replacements, highlighting a general positive response from patients. He contrasts expectations for knee replacement outcomes with those for hip replacements, stressing that the functional improvements from knee surgery may not always match patients' pre-operative aspirations. Key insights include managing patient expectations pre- and post-surgery, with a focus on educating patients about realistic outcomes, the potential for pain and stiffness, and the importance of rehabilitation.

Professor Viswanathan concludes the lecture by touching on the evolving nature of post-operative care and the financial implications of undergoing surgery. He highlights the advancements in surgical techniques that have reduced hospital stay durations significantly—from traditional long stays to now allowing many patients to return home just a few days post-operation. He discusses the introduction of no-gap surgery options, which lessen the financial burden traditionally faced by patients undergoing hip or knee replacements, ultimately leading to improved accessibility for older adults requiring these essential procedures. The lecture encapsulates a holistic view of knee osteoarthritis management, threading together clinical insights with practical considerations for both healthcare providers and patients.

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