Sandhigata vata is the commonest form of articular disorder. It is a type of vata vyadhi which mainly occurs in vridhavastha due to Dhatukshaya, which limits everyday activities such as walking, dressing, bathing etc, thus making patient disabled/ handicapped. It being a vatavyadhi, located in marmasthi sandhi and its occurrence in old age makes it kashtasadhya. Vata dosha plays a main role in the disease. Shula pradhana vedana is the cardinal feature of the disease associated with sandhishotha, vatapurna druthi sparsha, lack of movements of the joints or painful movements of the joints. Janu sandhigata vata can be correlated to Osteoarthritis of the knee joint. This is an age related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in youngers people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness1.

This study is on a female patient aged about 59 years suffering from severe pain and stiffness of the both knee, (left knee more than right). Patient had shown Orthopaedician for the same, and was advised for surgery in 2011. She did not undergo surgery and underwent Ayurvedic treatment for the Osteoarthritis of knee in the same year. Post Ayurvedic treatment she was able to walk, perform her daily activities without any difficulties till 2016. Finally in 2016, (her age 64 old), while walking she slipped in park, and then suddenly developed severe pain, swelling and restricted movement of the knee joint. All the conservative line of treatment failed to reverse the condition. So patient underwent Total Knee Replacement on 23/12/16.
So Ayurvedic treatment postponed her total knee replacement surgery for about 5 years. With this postponement, she would be able to avoid revision Total Knee Replacement surgery in future.
KEYWORDS: Osteoarthritis of knee, TKR, Ayurvedic treatment, Replacement surgery.

Ayurveda is a science of life, is based on the concept of Dosha Siddhanta. The Doshas are Vata , Pitta & Kapha. The equilibrium of these three Doshas called as health and their disturbance is called as disease. Based on the milestones of life, Kapha is predominant in childhood, Pitta in young age and Vata during old age. With the advancement of age Vata Dosha increases in an individual. This increasing Vata triggers and accelerates Dhatu kshaya (depletion of tissues) and bala kshaya (reduction of strength). Hence with advancing age man becomes prone to several diseases including degenerative disorders. Sandhigata Vata manifests when the deranged Vata lodges in joints. When this condition manifests in the janu sandhi (knee joint), it is called as janu sanshigata vata(osteoarthritis of knee).
In vridhavastha all dhatus undergo kshaya, thus leading to vata prakopa and making the individual prone to many diseases. Among them, Sandhigata vata stands top in the list. The incidence of Osteoarthritis in India is a high as 12%. It is estimated that approximately four out of 100 people are affected by it. Osteoarthritis is the most common articular disorder which begins asymptomatically in the 2nd and 3rd decades and is extremely common by the age 70. Almost all persons by the age of 40 have some pathologic change in weight bearing joints2, 25% female & 16% males have symptomatic Osteoarthritis.
Each and every system of medicine has its own limitation in managing this disease. They can provide either conservative or surgical treatment and are highly symptomatic and with troublesome side effects. Whereas such type of conditions can be better treated by the management and procedures mentioned in the Ayurvedic classics. So with the help of Ayurveda line of management, one can postpone the Total Knee Replacement Surgery.

During routine clinical practice in a clinic 5years back, 59 years old female patient came to take Ayurvedic treatment for Osteoarthritis of knee. She had already taken conservative treatment in modern system of medicine with physiotherapy and they had advised for knee Replacement surgery. As patient dint want to undergo surgery, opted for Ayurvedic treatment. On examination, severe tenderness positive in the articular margin, painful movement of the knee, and mild swelling was present over the knee. X ray showed reduction in the joint space with marginal osteophytes & deformity. Patient was advised Ayurvedic conservative line of management and quadriceps strengthening exercises. Patient gradually started improving in her conditions like reduction of pain, swelling and restoring moments of joints within 3 months. Patient was maintained without medication with only walking and exercises for 2year. After that patient underwent Ayurvedic treatment like, janubasthi, patrapinda sweda and kala basthi etc for 15days as inpatient. She went to Germany for 6months after treatment, and despite the cold climate in Germany patient was comfortable doing all the activity without pain. Patient was on regular follow-up every 6 months. In 2016 while walking in a park, she slipped and though there was no traumatic injury noted, had severe pain and swelling in her left knee with painful movement of the knee. Condition did not respond to with Ayurvedic and modern conservative management. So finally she had to undergo Total Knee Replacement Surgery on 23/12/16. Now she can do her daily activity without any support, and with 90 degree knee bending.

Total knee replacement surgery is performed,
 When there is severe knee pain or stiffness that limits the everyday activities, including walking, climbing stairs, and getting in and out of chairs.
 One finds it hard to walk more than a few blocks without significant pain and may need to use a cane or walker.
 Moderate to severe knee pain while resting, either day or night. Chronic knee inflammation and swelling that does not improve with rest or medication.
 Knee deformity a bowing in or out of the knee.
 Failure to substantially improve with other conservative treatments3.
Knee Prosthesis / implant
Knee replacements eventually wear out. Unfortunately, an artificial knee is not as durable as one’s own knee. Because the knee replacement implants are made of metal and plastic, over time, these materials begin to wear, just like the rubber on the car tires.
In 1960s and 1970s, most believed that total knee implants would last about 10 years. This was one of the reasons that knee replacement procedures were confined to older patients. As time passed, it became apparent that the great majority of knee implants would last approximately 20 years and even longer. Improvements in surgical techniques, materials, implant designs and fixations have escalated over the past two decades resulting in an increased durability of knee implants well beyond even 20 years4.
According to the manufacture of prosthesis there are two varieties, Indian prosthesis and western prosthesis. Durability of the implant is in accordance to the manufacturer. The Indian prosthesis is valid for 8 to 10 years and western / imported prosthesis is valid for 10 to 12 years. This should be kept in mind before doing the surgery. Considering this case, if Total Knee Replacement surgery was done in 2011, then she would have had to undergo revision replacement surgery in 2022 that is at the age of 71 years. Now that her age is 64 year, and surgery is done with imported prosthesis, it will be valid till she will be 76 years or even more. Here, if we compare her activity at ages 71 and 76, at 76 years less activity is done and that will promote prosthesis to be valid for longer, and can prevent revision replacement surgery for life time. So if we postpone Total Knee Replacement surgery as much as possible it will help to avoid revision replacement surgery.
In this case with Ayurvedic line of treatment for Osteoarthritis of Knee we could postpone the surgery for about 5 years, and also might be able to prevent revision replacement surgery for life time. Thus, Ayurvedic treatment has an important role in postponement of Total Knee Replacement surgery.

Janu sandhigata vata (Osteoarthritis of Knee) is an old age degenerative disorder, which is kashtasadhya. Osteoarthritis of knee affects the structure of the joint including articular cartilage, ligaments etc, which alters the functional aspect of the joints with deformity that cannot be reversed. Structural deformity can be corrected by surgery only, so in this case Total Knee Replacement surgery was indicated, but looking at age of the patient and durability of Knee prosthesis, the Surgery was postponed for about 5 years with Ayurvedic treatment. Thus proving beyond doubt that Ayurvedic treatments play an important role in the postponement of Total Knee Replacement Surgery and preventing Revision replacement surgery for life time.

1. Orthoinfo, The American Academy of Orthopaedic Surgeons, Total Knee Replacement, page2/11.

2. Ch.321.15th edition 1987. Harrison’s Principles of Internal Medicine.

3. Orthoinfo, The American Academy of Orthopaedic Surgeons, Total Knee Replacement, page4/11.

4. Durability of Knee Implants: How Long Do Knee Replacements Last?, BoneSmart, Knee Replacement & Hip Replacement Patient Advocacy & Online Community.