What is Tricompartmental Osteoarthritis: Causes, Symptoms, Treatment, Diagnosis

What is Tricompartmental Osteoarthritis?

There are four major bones of the body that meet at the knee. These are the tibia, fibula, patella, and femur. The point where these bones meet at the knee creates the three compartments that the knee has. These three compartments are referred to as patellofemoral compartment where the patella and femur meet, medial femorotibial compartment, and the lateral tibiofemoral compartment. It is quite common for arthritis to develop at any one of these compartments. However, an individual is said to have Tricompartmental Osteoarthritis if all the three compartments of the knee get affected by arthritis. This results in significant degenerative changes occurring throughout the knee causing pain, inflammation, and restricted range of motion of the knee.[1]

Tricompartmental Osteoarthritis is the most severe form of osteoarthritis. According to various studies, there are approximately more than 25 million people who are dealing with osteoarthritis in the United States. With time as the condition progresses, there is a complete breakdown of the cartilage and eventually the joint. This makes mobility extremely challenging due to pain and discomfort. The knee becomes extremely stiff to an extent that even straightening it is quite painful. The joint also gets filled up with fluid which is medically termed as effusion.[1]

What is Tricompartmental Osteoarthritis?

Tricompartmental Osteoarthritis is a gradually worsening condition and requires aggressive treatment and significant lifestyle changes and physical therapy to restore normalcy in the functioning of the knee.[1]

What Causes Tricompartmental Osteoarthritis?

Overuse and wear and tear of the joints over time is the primary cause of any form of osteoarthritis, including Tricompartmental Osteoarthritis. The wear and tear of the joints is medically termed as degeneration. While, this is a common process of aging, it can always be accelerated by a trauma, injury, or an infection to a joint. If the injury or infection is severe then all three compartments of the knee can get affected causing Tricompartmental Osteoarthritis.[1]

There are however some risk factors which increase the likelihood of an individual developing Tricompartmental Osteoarthritis. These risk factors include age. This is a pertinent risk factor when it comes to Tricompartmental Osteoarthritis. As individual ages, there is significant wear and tear of the joints, especially of the knee with use. This implies that the joints of an individual who is 60 years of age will be weaker and more prone to degenerative conditions like osteoarthritis than an individual who is much younger. This calls for people above the age of 50 to stay active and keep the joints mobile and strong to delay the process of degeneration.[1]

Obesity is yet another common risk factor for Tricompartmental Osteoarthritis. An obese individual will put extra weight on the knees with movement. This excessive strain on the knees results in accelerated degeneration making the individual predisposed to Tricompartmental Osteoarthritis. Thus for obese individuals, shedding off the extra weight by healthy means can significantly decrease the symptoms of Tricompartmental Osteoarthritis and even delay the process of degeneration.[1]

There are also certain genetic factors which increase the risk of an individual developing Tricompartmental Osteoarthritis. An individual with a family history of a direct relative with osteoarthritis is at greater risk for developing this condition than others. Some studies suggest that there is gender prevalence to the development of Tricompartmental Osteoarthritis. The studies suggest that females are more at risk for developing this condition although why this happens is not quite clear. It also suggests that Tricompartmental Osteoarthritis is more prevalent in menopausal females than females who are in the reproductive age group.[1]

The researchers believe that estrogen which is a sex hormone in females has a role to play in the degeneration of the joints. Repetitive stress on the joints due to occupation or sporting activities also accelerates degeneration of the joints causing Tricompartmental Osteoarthritis. This is seen in people who are involved in manual labor such as at construction sites, heavy lifting and pushing, or athletes who are involved with running and sprinting. People born with abnormalities of the bones or cartilage also are at risk for developing Tricompartmental Osteoarthritis later on in the future.[1]

What are the Symptoms of Tricompartmental Osteoarthritis?

Tricompartmental Osteoarthritis results in degeneration of the cartilage that protects the bones of the knee joint from rubbing against each other. As and when this degeneration gets worse the affected individual starts experiencing symptoms. The symptoms tend to worsen as the degeneration progresses. Some of the symptoms of Tricompartmental Osteoarthritis include severe pain in the knee along with inflammation. There will also be visual swelling of the knee as there is gradual pooling of fluid within the knee joint.[1]

The joint becomes extremely stiff to an extent that individual cannot straighten the knee completely without pain or discomfort. This is especially worse after the individual has been sitting for some period of time and tries to stand up. There will also be periodic locking of the knee where the individual will not be able to even move the knee in any way. There will also be periods where the individual may lose balance and fall due to the knee giving way.[1]

The overall gait also gets affected as a result of the knee becoming weak and not being able to support the weight of the body. It the individual will start walking with more of a bow-legged gait. The symptoms get worse as the condition progresses with any attempts at exercising or using the knee becoming more painful [1].

How is Tricompartmental Osteoarthritis Diagnosed?

The diagnosis of Tricompartmental Osteoarthritis begins with history taking and a thorough physical examination of the affected extremity. During history taking, the physician will ask questions as to the duration of the symptoms, the activities that the individual can or cannot perform due to pain in the knee. The physician may also inquire about whether individual hears cracking or a popping sound when using the knee and whether there are problems with using the extremity first thing after getting up in the morning.[1]

During physical examination, the physician will carefully observe the knee to look for any signs of swelling or inflammation around the knee. He or she will also look for any area of abnormal coolness around the knee. Once Tricompartmental Osteoarthritis is suspected, the physician will order radiological images in the form of an x-ray, MRI, and CT scan of the knee. These studies will clearly show whether the cartilage over the knee joint has worn away completely or whether there are any bone spurs or effusion present in the knee.[1]

This will more or less confirm the diagnosis of Tricompartmental Osteoarthritis. However, it should be noted that Tricompartmental Osteoarthritis is challenging to diagnose in its earlier stages; however, as the condition advances it becomes easier to diagnose this condition.[1]

How is Tricompartmental Osteoarthritis Treated?

Unfortunately, as of now, there is no permanent cure for Tricompartmental Osteoarthritis. The reason behind this is the cartilage once damaged and degenerated cannot regenerate on its own due to lack of blood supply and cannot be replaced. The treatment is basically aimed at controlling the symptoms and improving quality of life of the patient. The treatment approach for Tricompartmental Osteoarthritis depends on the severity of the condition and the extent to which the cartilage has been damaged. This is normally done by way of medications, physical therapy, and at times surgery.[1]

The patient suffering from Tricompartmental Osteoarthritis will be asked to apply ice alternating with heat to the affected knee for 15-20 minutes two to three times a day to calm down the swelling and inflammation. Elevating the leg above the level of the heart during sleeping also helps in reducing the swelling. The Tricompartmental Osteoarthritis patient will be given NSAIDs for pain relief in the form of Tylenol or ibuprofen. In case if these medications are ineffective, then the patient may be prescribed much stronger medications in the form of a COX-2 inhibitor.[1]

If medications are ineffective in providing relief to the Tricompartmental Osteoarthritis patient, the physician may opt to inject corticosteroids directly into the joint for pain relief and decreasing swelling, pain, and inflammation. Other than this, the patient will be asked to make certain lifestyle changes to help with the symptoms of Tricompartmental Osteoarthritis. Patient will be asked to avoid activities which may put strain on the affected knee and make the condition worse. The Tricompartmental Osteoarthritis patient will be asked to focus more on low impact exercises like swimming or cycling rather than doing high impact exercises like lifting weights.[1]

Low impact exercises strengthen the joints and decrease the effect of the degenerated cartilage. There are also certain devices that can be used as a mode of treatment for Tricompartmental Osteoarthritis. These devices reduce the pressure put on the affected knee and include cane, walker, or wearing shoes with wedged soles. An individual can also use a brace for the knee in order to protect the knee from any undue stress. Of late, the use of Hyalgan injections has proven to be quite effective in controlling the symptoms of Tricompartmental Osteoarthritis.[1]

Surgery is reserved for patients who have advanced Tricompartmental Osteoarthritis and their quality of life is extremely poor as a result of this condition. Surgery is also the preferred route for patients in whom other modes of treatment including injections and therapy have proven to be ineffective. Surgery for Tricompartmental Osteoarthritis of the knee is quite complicated and includes either a total knee replacement or total knee arthroplasty.[1]

In a knee replacement, the damaged knee is removed in its entirety and is replaced by an artificial knee made of metal or plastic. The surgery has a prolonged recovery period and requires aggressive physical therapy postsurgery to regain normal functioning of the knee.[1]

In conclusion, Tricompartmental Osteoarthritis occurs when all the three compartments of the knee get affected with arthritis. The symptoms of this condition are more severe and encompass the entire knee when compared to osteoarthritis of a single compartment. An individual with Tricompartmental Osteoarthritis will find it extremely tough to move the knee or carry out normal activities of daily living due to pain, stiffness, and restricted range of motion of the knee. As of now, there is no cure for Tricompartmental Osteoarthritis as the cartilage that protects the knee cannot be replaced once it has completely degenerated.[1]

However, there is research going on and researchers are carrying out various trials to look at the feasibility and safety of transplanting a healthy cartilage from some other part of the body into the knee joint. This they believe will help in reducing the symptoms and improve the quality of life of an individual with Tricompartmental Osteoarthritis. As of now, application of heart and ice, low impact exercises, corticosteroid injections, and lifestyle changes form the core treatment of Tricompartmental Osteoarthritis.[1]

In extremely advanced cases where the individual has an extremely poor quality of life and other modes of treatment have been proven to be ineffective surgery is recommended for treatment. Total knee replacement and total knee arthroplasty are the two procedures that are done for cases of advanced Tricompartmental Osteoarthritis. These are complicated surgeries with prolonged recovery times but in majority of the cases postsurgery the individual does get almost complete relief from symptoms of Tricompartmental Osteoarthritis.[1]

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