Before and After Knee Replacement in Osteoarthritis: Sandhigat Vaat and Ayurvedic Approach Explained

Dinesh Vats[1]. Shobha Bharti[2]

1. Introduction

Introduction

Osteoarthritis (OA) is one of the most common degenerative joint disorders, characterized by the gradual wear and tear of articular cartilage that cushions the ends of bones. As this protective layer deteriorates, the bones begin to rub against each other, leading to pain, stiffness, swelling, and restricted mobility. The condition primarily affects weight-bearing joints, especially the knees, hips, and spine.

Among these, knee osteoarthritis is a leading cause of disability and impaired quality of life in the elderly. Patients often experience progressive joint deformity and loss of function, making even simple daily activities—like walking, climbing stairs, or sitting cross-legged—difficult.

When conservative management fails, Total Knee Replacement (TKR) becomes a valuable surgical option to restore mobility and relieve pain. In this article, we present before and after X-ray images of TKR to visually demonstrate the structural transformation that surgery can achieve.

Beyond modern orthopedics, Ayurveda offers a comprehensive understanding of Osteoarthritis under the term Sandhigat Vaat—a Vata-dominant disorder resulting from degeneration in joints. This article explores both perspectives: the modern medical view of osteoarthritis and TKR, and the Ayurvedic concept of Sandhigat Vaat, including its classical references, shlokas, and holistic management through Panchakarma, herbal formulations, and lifestyle guidance.

Understanding Osteoarthritis (OA)

🔹 What is Osteoarthritis?

Osteoarthritis (OA) is a chronic degenerative joint disorder in which the smooth articular cartilage gradually wears down, leading to friction between bones. Over time, this results in pain, stiffness, reduced mobility, and structural changes within the joint.It most commonly affects weight-bearing joints such as the knees, hips, and spine.

🔹 Causes and Risk Factors

OA develops due to a combination of mechanical stress, aging, and biological changes. Major risk factors include:

• Aging – natural degeneration of cartilage with time

• Obesity – increases load on weight-bearing joints

• Sedentary lifestyle – weak muscles fail to support joints

• Previous joint injury or surgery

• Genetic predisposition

• Occupational stress, frequent squatting, heavy lifting

🔹 Symptoms

Patients with OA commonly experience:

• Pain during movement, especially while walking or climbing stairs

• Morning stiffness, usually lasting less than 30 minutes

• Swelling or joint effusion

• Reduced range of motion

• Joint deformity in advanced stages

• Crepitus — a crackling or grinding sensation during movement

🔹 Diagnosis of Osteoarthritis

1. Clinical Examination

• Pain on joint movement

• Reduced range of motion

• Crepitus

• Tenderness along joint line

• Visible deformity (varus/valgus)

• Muscle weakness (especially quadriceps)

2. X-Ray Findings

Characteristic radiological signs include:

• Joint space narrowing (medial or lateral compartment)

• Osteophytes (bony outgrowths)

• Subchondral sclerosis (increased bone density below cartilage)

• Subchondral cysts

• Angular deformity (varus/valgus visible on long-leg views)

  Kellgren–Lawrence Grading of Osteoarthritis (X-Ray)

Grade	Visual Cue	X-Ray Features	Interpretation
🔵 Grade 0 Normal	✅ No abnormality	• Normal joint space • No osteophytes • No sclerosis	Healthy joint
🟢 Grade 1 Doubtful OA	🔍 Very early changes	• Minute osteophytes (doubtful) • Possible mild narrowing	Very early OA; often asymptomatic
🟡 Grade 2 Mild OA	⚠️ Early degeneration	• Definite osteophytes • Clear joint space narrowing • Early subchondral sclerosis	Mild OA; pain during movement
🟠 Grade 3 Moderate OA	📉 Noticeable structural change	• Multiple osteophytes • Moderate narrowing • Prominent sclerosis • Bone contour irregularity	Moderate OA; crepitus, stiffness, gait difficulty
🔴 Grade 4 Severe OA	❗ Advanced degeneration	• Large osteophytes • Severe or complete joint space loss • Marked sclerosis • Bony deformity / varus–valgus • Possible bone-on-bone contact	Advanced OA; TKR usually indicated

. Before and After TKR – A Visual Transformation

Total Knee Replacement (TKR) is performed when advanced osteoarthritis causes severe pain, deformity, and loss of daily function.The X-ray images below clearly show how knee structure changes before and after surgery.

🔹 Preoperative X-ray (Before TKR)

Image 1. Preoperative AP and lateral X-ray views of both knees showing severe medial joint space narrowing, osteophyte formation, and advanced osteoarthritis before total knee replacement.

Key radiological findings in the before-surgery images:

1. Severe Joint Space Narrowing

• Almost complete loss of medial joint space in both knees.

• Bone is rubbing against bone (bone-on-bone contact).

2. Large Osteophytes

• Prominent bony spurs around:

  • Medial femoral condyle

  • Tibial plateau

  • Patellofemoral joint

These osteophytes indicate advanced degenerative osteoarthritis.

3. Varus Deformity

• The lower limbs show bowing inward (Varus alignment).

• The mechanical axis has shifted medially.

• Weight-bearing X-rays highlight the severity of deformity.

4. Subchondral Sclerosis & Irregular Joint Margins

• Hardening/thickening of bone under the cartilage.

• Irregular, rough joint surfaces indicating chronic wear and tear.

5. Clinical Correlation

• Severe pain during walking and standing

• Morning stiffness

• Restricted movement

• Difficulty with stairs and daily activities

These findings together represent Kellgren–Lawrence Grade 4 Osteoarthritis.

Image 2.Full-length standing lower limb alignment X-ray demonstrating bilateral varus deformity, knee joint degeneration, and mechanical axis deviation prior to total knee replacement surgery.

🔹 Postoperative X-ray (After TKR)

The postoperative X-rays display a successful Total Knee Replacement on both sides.

1. Well-positioned Prosthesis

• Stable femoral and tibial components

• Clear, symmetrical joint space created by the implant

• No signs of loosening or malalignment

2. Restored Alignment

• The varus deformity is corrected

• Mechanical axis restored to normal

• Weight distribution across the knee is even

3. Patellar Tracking Appears Normal

• Smooth articulation in the patellofemoral compartment

• Proper orientation of the prosthetic surfaces

4. Surgical Fixation

• Screws and components are placed appropriately

• Post-op soft tissue shadows indicate healthy healing

  

  Image 3. Postoperative AP and lateral X-ray views of both knees after total knee replacement, showing well-positioned femoral and tibial components, restored alignment, and stable fixation.

🔹 Patient Outcome After TKR

✔ Pain Relief

Most patients experience dramatic reduction in pain within weeks of surgery.

✔ Improved Joint Function

• Better bending

• Smooth walking

• Ability to climb stairs

• Longer standing ability

✔ Improved Quality of Life

Patients can return to:

• Routine household activities

• Long-distance walking

• Social and recreational movement

✔ Importance of Physiotherapy

Physiotherapy plays a crucial role:

• Quadriceps strengthening

• Gait training

• Flexion–extension exercises

• Balance improvement

Regular physiotherapy accelerates recovery and ensures long-term success of the implant.

Concept of Sandhigat Vaat (Ayurvedic Correlation of Osteoarthritis)

1. Definition and Correlation

🔹 Sandhigat Vaat is described in Ayurveda as a Vatavyadhi where aggravated Vata gets lodged in the Sandhi (joint), causing degeneration, pain, cracking sounds, and stiffness.🔹 It is closely correlated with Osteoarthritis (OA) in modern medicine.

Classical Reference

वातपूर्णदृतिस्पर्शः शोथः सन्धिगतेऽनिले।

प्रसारणाकुञ्चनयोः प्रवृत्तिश्च सवेदना॥📜 Charaka Samhita Chikitsa Sthana 28/37

Translation:When aggravated Vata lodges in the joints, they feel as if filled with air, become swollen, painful, and movements like flexion or extension become painful.

Clinical meaning:Reflects classic OA features: pain, swelling, stiffness, crepitus, and restricted motion.

2. Pathogenesis (Samprapti)

🔸 Aging, excessive strain, irregular diet, and dryness lead to Vata prakopa.🔸 Aggravated Vata depletes Shleshaka Kapha (natural lubricating fluid), resulting in:

• Pain (Sandhishool)

• Swelling (Sandhishotha)

• Degeneration

• Stiffness and crunching sounds

Classical References

हन्ति संधिगतः संधिन शूलशोफौ करोति च॥📜 Sushruta Samhita Nidana Sthana 1/28

Aggravated Vata destroys joint integrity, causing pain and swelling.

हन्ति संधिगतः संधिन शूलाटापौ करोति च॥📜 Madhava Nidana 22/21

Vata in joints leads to pain (shoola) and burning sensation (atap).

Interpretation:All classics describe Vata aggravation → degeneration → OA-like pathology.

3. Symptoms According to Ayurveda

• Sandhishool – Joint pain

• Sandhishotha – Mild swelling

• Prasaran & Akunjan Vedana – Pain during movement

• Atishabda – Crepitus

• Sandhi Shithilata – Looseness/instability

(These match modern OA symptoms and can be explained integratively.)

4. Chikitsa Siddhanta (Treatment Principles)

Therapeutic Goals:

1. Vata Shamana – pacify aggravated Vata

2. Sandhi Poshana – nourish the joints

Core Principles:

• Snehana (oleation)

• Swedana (fomentation)

• Mridu Virechana (mild purgation)

• Basti (medicated enema – the best therapy for Vata disorders)

Local Therapies:

• Janu Basti

• Pinda Potli Sweda

• Dhara

• Upanaha Sweda

5. Classical Reference for Treatment

कुर्यात् संधिगते वाते दहस्नेहोपनहं।

इन्द्रवारुणिकामूलं मागधीगुडसंयुक्तं।

भक्ष्येत् कर्षमात्रं तत् संधिवातं व्यपोहति॥ 📜 Bhavaprakasha Madhya Khanda 24/259

Translation:In Sandhigata Vata, therapies like fomentation (Daha), oleation (Sneha), and poultice (Upanaha Sweda) are beneficial.A preparation of Indravaruni root, Pippali, and jaggery helps alleviate Sandhivata.

Meaning:Classical texts advocate both external and internal therapies for effective relief.

6. Ayurvedic Treatment Modalities

🔹 Panchakarma Therapies

• Abhyanga with Mahanarayan Taila or Ksheerbala Taila

• Swedana to relieve stiffness

• Basti (especially Ksheer Basti or Matra Basti)

• Janu Basti — highly effective for knee OA

🔹 Internal Medications

• Yograj Guggulu, Mahayograj Guggulu

• Dashmool Kwath, Rasna Saptak Kwath

• Shunthi Churna with warm milk

• For severe pain: Simhanad Guggulu, Punarnavadi Kwath

🔹 Diet and Lifestyle

• Prefer warm, oily, nourishing foods

• Avoid dry, cold, sour, and spicy items

• Gentle exercise like walking, yoga

• Regular oil massage and adequate rest

7. Role of Ayurveda Before and After TKR

Before TKR

• Slows degeneration

• Reduces inflammation

• Helps maintain joint space

• Improves mobility and pain control

After TKR

• Aids faster recovery

• Reduces stiffness

• Supports strengthening and mobility

• Prevents degeneration in other weight-bearing joints

Rasayana support: Ashwagandha, Shatavari, Guggulu, Triphala Rasayana.

8. Conclusion

Ayurveda explains Osteoarthritis as Sandhigat Vaat, a condition driven by Vata imbalance leading to degeneration.An integrative approach—combining modern treatments like TKR with Ayurvedic therapies—provides holistic management, better function, and improved long-term quality of life.

About Authors:

1. 
   

   👤 Dr. Dinesh Vats

   BAMS, Founder of Vatsaayush and drvats.com Dr. Dinesh Vats is an Ayurvedic physician and the founder of Vatsaayush and drVats.com. He focuses on integrative health, oncology, and public health, connecting classical Ayurvedic wisdom with modern challenges to promote holistic healthcare and community well-being.

   2. 👤 Dr. Shobha Bharti

   BAMS, Trainee in General Medicine Dr. Shobha Bharti is an Ayurvedic doctor currently undergoing a two-year clinical training under Dr. Vats. She is passionate about blending Ayurvedic concepts with contemporary medical approaches for holistic patient care.