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Knee Arthritis Epidemic in India

Arthritis refers to an inflammation of joints. Knee arthritis is one of the major causes of arthritis in the Indian population. It may be an age-related degenerative change in the joint, known as senile osteoarthritis. It may also be rheumatoid arthritis or gouty arthritis. It is characterised by difficulty in walking, pain in the knees and noisy joints during the movements of the knees.

Are Indians more prone to develop knee arthritis?

Indians are more predisposed to developing knee arthritis than their western counterparts since they are genetically predisposed. The Indian way of life also contributes to increased chances of developing arthritis. Sitting cross-legged on the floor, the squatting position used by many Indians in the Indian toilet, heavy manual work, and relatively poor nutrition or overnutrition (obesity) are responsible for the increased number of knee arthritis cases in India.

India has a population of about 130 crores and about 15 crore Indians suffer from knee arthritis. In China, less than half of this number, around 6.5 crore people suffer from arthritis. In India, about 4 crore people are estimated to have an urgent requirement for a total knee replacement (TKR) surgery. This number will, however, keep on increasing.

Why has the number of arthritis patients increased?

One of the major reasons for it is the increased life expectancy, due to a thriving economy, advancements in healthcare and an increase in affordability and accessibility. Vaccinations against various infectious diseases and effective antibiotics are also responsible for the increased life expectancy at birth of Indians. It has increased from an average of 45 years before independence to about 75 years today.

The Indian Scenario, compared to the West:

In 1994, in India, around 350 knee replacement surgeries were performed and the numbers have since increased many folds. The current figures for the year 2019 show that about 1,50,000 knee transplant surgeries were performed.

However, compared to the Western economies, for example, the USA, the population is about 30 crores and annually about 7,00,000 knee replacement surgeries were performed. India fares poorly because it faces an acute shortage of medical facilities, coupled with a disproportionately low number of orthopaedic surgeons. The demand according to prominent orthopaedic surgeons would be a staggering 1,00,00,000 knee replacements. But, according to current estimates, there would be about 1 million knee surgeries by 2023. Considering that it is a huge improvement, compared to the population, it is still a small number. Nearly 90% population of needs it will still be deprived of a total knee replacement.

On the brighter side, several advanced techniques for knee surgery including, minimally invasive surgery, robotic-assisted arthroscopy has emerged. They have shortened the duration of hospital stay, have reduced the complications and are now widely practised.

Preventing Arthritis Epidemic:

In the next 10 years, knee arthritis is expected to emerge as the fourth most common cause of physical disability in the country after paralysis, stroke, and accidents. However, prevention is always better than cure. As far as possible, one must avoid over-working the knee joint. Thus, the elderly especially should use Western-style toilets. They should avoid sitting cross-legged and sit on chairs.

Besides, obesity and vitamin D deficiency are other preventable causes of developing or retarding the progress of arthritis. Cutting down the intake of processed foods and opting for fresh fruits and vegetables provides a rich source of anti-oxidants. They limit age-related degenerative processes and help fight infections. Regular moderate exercise also keeps the joints healthy. Static quadriceps exercise, cycling and swimming are the three best exercises for early-stage patients of knee arthritis.

Additionally, Calcium-Vit D3 supplementation should be provided to all post-menopause women. They are more prone to developing osteoporosis since the protective effects of oestrogens are lost after menopause.

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