S. Lahkar, M.B.,B.S., M.S. (Orth.),
Department of Orthopaedic Surgery, Assam Medical College, Dibrugarh - 786 002 (Assam).

Osteoarthrosis of knee is more common than of any other joint. There is primary degenerative change in the articular cartilage with subsequent new bone formation at the articular cartilage with subsequent new bone formation at the articular margins. Osteoarthrosis can involve the whole joint or it may remain localised to only one part of the joint. Accordingly osteoarthrosis of knee ma be classified as — Medical moncompartmental when the disease is localised to the articulation between medial tibio-femoral condyles, Laterla mono-compartmental when the disease is localised to the articulation between lateral tibio-femoral condyles, Patello-femoral when osteoarthrosis involves only patello-femoral articulation, Bi-compartmental which indicates osteoarthrosis involving both the compartment so fo the tibio-femoral joint and Pan-articular when osteoarthrosis affects the entire tibio-femoral articulation together with patello-femoral joint. The aetiology of primary osteoarthrosis is not exactly known. It is believed that –

In some patients osteoarthrosis of knee may be seen due to some local causes, e.g.– following intra-articular fracture of knee joint, rheumatoid arthritis, haemophilia, pigmented villonodular synovitis, chronic synovits of traumatic or idiopathic orgin.

The onset of the condition is very slow and insidious. One of the earlies symptoms is stiffness of knee after a period of rest which wears off with exercise and movement. The cause of stiffness may be due to decreased muscle power; alteration in the collagen content of the joint capsule resulting in increased physical resistance in the capsule; decrease in the viscosity of the synovial fluid, degenerative changes in the medial meniscus and resulting abrasive injury to the opposing articular cartilage. All these can cause increase in the physical resistance within the joint.

Pain appears gradually and increases as the disease process advances. Patient may complain of difficulty in mounting stairs due to pain. But more commonly patient complains of difficulty in getting up from the squatting position due to pain. The origin of pain is owing to friction between the incongruous articular surfaces, altered vascularity soft tissue changes in and around the affected joint resulting in capsular oedema and distension, cellular invasion with subsequent fibrosis and later on formation of osteophyte.

Patient may complain of instability and insecurity of the affected joint.

Pain is the predominent symptom in osteoarthrosis of the knee and often the only symptom (Smillie, 1980). Pain may cause difficulty in getting up from the squatting position.

For relief of pain one may have to give drugs for long duration. So a drug which is safe, effective and without toxic effects is very much essential. Various drugs used for this purpose such as - Salicylates, Phenylbutazone, Indomethacin. Dextropropoxyphene, Naproxen etc., are all useful but often present with toxic manifestations or serious untoward side effects.

Rumalaya tablets, an indigenous presentation of the The Himalaya Drug Co., is reported to be effective in different types of joint pain without any toxic effects. The present study was undertaken to see the response of Rumalaya talbets in osteoarthrosis of knee joint.

Each Rumalaya tablet contains—

Prepared in the juices and decoctions of Vitex negundo, Tinospora cordifolia, Ocimum sanctum, Eclipta alba, Withania somnifera, Zingiber officinate, Dashamoola.

Fifty-six patients suffering from osteoarthrosis of knee without any known local cause for the onset of the disease were selected for the study. All the patients were selected from the Out-pateint Department of Assam Medical College Hospital, Dibrugarh. There were 34 males and 22 females, ranging in age from 35 years to 68 years (Table – I).

Total number of joints involved by osteoarthrosis were 88; 24 patients with unilateral involvement and 32 patients with bilateral involvement.

Routine history taking and data regarding previous treatment received by the patient where available were collected. Erythrocyte sedimentation rate, Haemoglobin percentage, Total and Differential leucocytic count, Complete urine examination, Stool examination for occult blood were carried out before and after the end of the trial in all cases. Radiological examinations of the affecte joints were done before starting the treatment.

All these cases were regularly observed, clinically examined and improvements were followed up regularly. Eight patients were lost to follow up study (4 with bilateral involvement of knee).

All cases were given Quadriceps exercise and Rumalaya tablets; 2 tablets three times daily. The dosage was reduced to 1 tablet three times daily when patient showed some improvement and was discontinued when they were asymptomatic for 4-6 weeks. Duration of treatment varied from 4 weeks to 2 months in 32 cases and 2 months in 32 cases and 2 months to 6 months in the remaining 16 cases.

The results were recorded as follows:

It is seen that Rumalaya therapy with Quadriceps exercise gives excellent result in patient suffering from osteoarthrosis of knee. Rumalaya tablets can be given fro longer duration without any untoward reactions which are commonly observed with Salicylates, Phenylbutazone, Oxyphenbutazone, Indomethacin, Dextropropoxyphene, Naproxen etc. From this study it is seen that pain in osteoarthrosis of knee is a common symptom and one can use Rumalaya tablets for long duration; they are effective and safe and without any toxicity.

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