There are a lot of patients of phleboarthroses that others specialists are not able to pick up. These patients as well as their doctors are not convinced that the knee joint arthroses is due to chronic venous disease. In almost all the cases it is superficial venous reflux that adds to the pathology around the knee. It is a pity that other specialists even orthopedics are not aware of this condition. Nutrition of every structure around the knee joint suffers when there is venous congestion. Also one must understand any egress from the bone marrow is through veins and this component also suffers so there is an external and internal congestion. Knee joint stability relies upon soft tissues. All soft tissues get nutrition by diffusion. When there is venous insufficiency there is congestion. This causes malnourishment of tissues leading to delayed healing of normal wear and tear. The mobility decreases further adding to the congestion and patients put on weight. A vicious cycle sets in. At least phlebologists should be very much aware of this condition. Treating venous disease prolongs the life of the natural knee joint. Clinical diagnosis of phleboarthroses is most important aspect in planning the protocol for the treatment. Pain and swelling, in and around a knee joint at rest and on movement can be due to soft tissue and cartilage injury that is not allowed proper healing in presence of venous reflux. Always look for evidence of C0 or C1 disease that will lead you to make a diagnosis of C3 or C4 disease in most cases once the ultrasound is done. Once the venous reflux is treated then the knee joint milieu interior shifts towards being normal with decrease in pain and arthroses starts to settle down. The orthopaedic surgeon can enhance this healing by conservative measures. Even those, in whom the knee joint replacement does not settle down, it is very likely that there is superficial venous reflux and treating the venous reflux will help better recovery from a less than happy knee replacement. – Dr. Ambrish Raja