Osteoarthritis of the knee joint

Knee pain is the most common manifestation of osteoarthritis of the knee joint.This disease affects millions of people around the world.But endoprosthesis is not always required!There are new effective treatments for knee degenerative processes that address both the causes and the symptoms.The most important thing for every patient is to know the causes and symptoms of the disease and the treatment options.

Where does knee pain come from?

Degenerative knee disease (arthrosis, degenerative changes, osteoarthritis) is a condition of chronic inflammation of the joint.Although age is the main risk factor, unfortunately the disease can affect people at a very young age.As a result of inflammation, cartilage, as well as ligaments, meniscus and other joint structures are damaged.However, it is the loss of cartilage tissue that most determines the complication of the development of arthrosis.The natural shock absorber between the bones, i.e. cartilage, weakens.When this happens, the bones within the joint move closer together (loss of cartilage thickness) and rub against each other.Due to the loss of cartilage thickness, the exposed nerve fiber ends are irritated with every movement.The friction causes pain, swelling (visible on ultrasound and sometimes even with the naked eye), stiffness, reduced mobility, and later the formation of bone spurs called osteophytes (visible on X-ray and ultrasound).The basis of this disease is chronic inflammation that destroys cartilage.Skillful management of inflammation, cartilage regeneration, and maintenance of joint biomechanical properties (rehabilitation) play a crucial role in combating progressive disease.

Who is affected by the degenerative joint disease osteoarthritis?

Joint arthrosis is the most common type of intra-articular inflammation.Although the disease can occur even among young people, the risk increases after the age of 45.Numerous studies show that osteoarthritis of the knee joint is one of the most common.Research also shows that women are more prone to osteoarthritis.

Causes of knee arthrosis

The most common cause of knee osteoarthritis is age.Almost all of us experience some degree of degenerative changes at some age.However, there are a number of factors that significantly increase the risk of osteoarthritis even at a younger age:

• Age- as age increases, the ability of cartilage tissue to regenerate decreases.At the same time, the number of cycles of the joint increases, micro-overloads accumulate, sometimes serious injuries occur.
• Excess weight- Excessive body weight increases the load on the knee joint.Every extra kilogram puts another 3-4 kg on your knees.Abnormal adipose tissue produces substances that enter the bloodstream and damage the joints.
• Atherosclerosis(poor blood supply to subchondral bone, bone infarction)
• Diabetes
• Hormonal disorders– Losing 5 kg of weight has been proven to reduce pain by up to 50%.
• Hereditary factor- Genetic factors play an important role in the development of osteoarthritis.The occurrence of arthrosis or rheumatic disease in parents significantly increases the risk of the disease in the patient.The wrong axis of the limb ("curvature") can also be inherited, which leads to excessive loading of the knee joint and the development of degenerative changes.This happens in case of valgus or varus deformation of the knee.
• Sex- Women over 55 years of age get sick more often than men of the same age.Hormonal factors affect.
• Injuries and overload- As a rule, injuries depend on the type of activity a person does.People who work while kneeling, squatting, or lifting heavy objects are more likely to develop degenerative changes due to frequent and improper loading and pressure on joint surfaces.
• Sports- professional athletes, especially in sports such as football, tennis, basketball or sprinting, have a high risk of developing osteoarthritis of the knee joint.A large group of our patients are also people who do recreational sports, but often very intensively.Among them, runners have the most problems with their knees (and feet).This means that athletes must take every precaution to avoid injury and overuse.A lot can be achieved with relatively simple means.It is important to remember to do regular and moderate strengthening exercises and stretching exercises.In fact, it is the weak muscles around the knee that reduce knee stability and lead to faster cartilage wear and degenerative changes.Improperly trained muscles contract easily, putting excessive strain on tendons, entheses (places where they attach to bones) and ligaments.In this way, the biomechanics of the damaged joint accelerates the "wearing" of its elements.Training, then recovery, diet, sometimes nutritional supplements and intra-articular injections of special drugs (hyaluronic acid, platelet-rich plasma PRP) should be regulated.
• Other reasons– People with rheumatoid arthritis, the second most common type of joint inflammation, are more likely to develop osteoarthritis.These patients first of all require proper treatment of the underlying disease by a rheumatologist, as well as complex multi-orthopedic procedures.In addition, people with certain metabolic disorders (such as those caused by excess iron or growth hormone) or connective tissue disorders (such as hypermobility of constitutional joints) are also at risk for osteoarthritis.Blood in the joint is very damaging to the cartilage, so hemophilia can lead to serious damage and the need for joint replacement.

If conservative treatment fails, surgery (also called alloplasty) is indicated to replace the joint with an artificial knee endoprosthesis.

Symptoms of arthrosis of the knee joint

This disease develops differently depending on the severity, age, physical activity and other trends, but the most common symptoms are:

• pain in the knee joint that increases with activity and decreases with rest.It is caused by the opening of the free nerve endings of the subchondral bone of the damaged cartilage
• knee swelling
• feeling of heat in the joint
• knee stiffness, especially in the morning or after prolonged inactivity, such as sitting at the office or watching TV
• A decrease in the range of motion of the knee joint (ROM. - Range of Motion), for example, makes it difficult to get up from a chair or get out of a car.He has difficulty going up and down stairs, and later even walking.
• creaking, crunching or creaking noises in the knee, especially from sudden movement of the knee joint
• many people also say that weather changes affect pain levels and joint function.

How to determine knee arthrosis?

The diagnosis of knee arthrosis is primarily based on a description of the patient's medical history, an accurate description of the existing symptoms, and an orthopedic examination.In a conversation with your doctor, you should focus on what causes the pain to increase and what relieves it.You should also find out if anyone in the family has a history of osteoarthritis or rheumatoid arthritis.

Your orthopedic surgeon may recommend additional tests, including:

• x-ray, shows the severity of bone lesions, including: narrowing of the joint space, osteophytes (bone plugs), subchondral sclerosis, sharpening of intercondylar shells, abnormal limb axis.
• Ultrasound- click here to learn more.
• MPT- magnetic resonance imaging - most often done when X-ray and ultrasound do not show a clear cause of pain in the joint.
• Blood test- to eliminate other causes of diseases such as rheumatoid diseases, Lyme disease (borreliosis).

Methods of treatment of arthrosis of the knee joint

In recent years, the development of orthopedics has opened up new opportunities for extremely effective treatment of knee arthrosis.With the application of modern methods and treatment with growth factors (GPS = PRP, Platelet-Rich Plasma), it is increasingly possible to delay or even cancel the stage of replacement surgery (knee replacement).These methods use the body's natural ability to prevent arthrosis and strengthen articular cartilage.

The most important goals of knee osteoarthritis treatment are pain relief and restoration of range of motion along with mobility.The treatment plan should be selected individually.In addition, treatment usually includes a combination of the steps described below.

Conservative treatment (non-surgical)

• Loss of body weight.Even losing a few pounds can significantly reduce knee pain.
• Exercises.Strengthening and stretching the muscles around the knee provides greater stability, proper biomechanics and reduced pain.
• Analgesics and anti-inflammatory drugs.There are many drugs on the market that help reduce pain and inflammation (called NSAIDs - non-steroidal anti-inflammatory drugs).But remember: You cannot use painkillers for more than 10 days without consulting your doctor.Taking them for a longer period of time increases the likelihood of side effects.The most important of them are:
• bleeding from the upper gastrointestinal tract (stomach and duodenum) - especially in the United States, where NSAIDs are high and physician availability is low, and bleeding is a common cause of death,
• peptic ulcer of the stomach and duodenum (destruction of the gastric mucosa by hydrochloric acid in the gastric juice),
• gastritis of the stomach and duodenum,
• decreased blood clotting (possible bleeding),
• kidney failure,
• bone marrow destruction.

Therefore, it is very important to use other methods that do not cause systemic side effects.

• Corticosteroid injections are called steroid knee blocks.Steroids are powerful anti-inflammatory drugs and relieve pain.Unfortunately, they have very negative systemic effects (for example, hormonal disorders, diabetes) and local (irreversible damage to joint cartilage!).Therefore, this form of therapy should only be reserved for patients who are scheduled to undergo knee replacement surgery (arthroplasty) in the short term.
• Ultrasound intervention.Injection into the affected area with the appropriate drug under ultrasound control.A very effective form of therapy, but it requires high qualifications and experience from an orthopedic doctor.
• Hyaluronic acid injections, the so-called viscous supplements.Hyaluronic acid is injected into the knee joint and increases the viscosity of the synovial fluid and therefore its lubricating properties.It reduces friction between cartilage surfaces, knee pain, swelling and stiffness, often improving range of motion.
• Tablets with glucosamine, collagen, chondroitin.Although research has not proven their effectiveness, they are very common.
• Anti-inflammatory ointments.These ointments are used externally and can bring temporary relief.Their movement, but the skin, subcutaneous tissue, fascia, etc.The joint is significantly limited by poor penetration through the barrier.Sprays ensure better penetration of the drug.
• Stabilizers and orthoses of the knee joint.It is mainly indicated for damage to the anterior cruciate ligament (ACL) or other ligaments.They help maintain better stability of the knee joint, thereby preventing further damage to the cartilage and meniscus.
• Physiotherapy.It is a very important part of the therapeutic process.Strengthening and stretching exercises are often necessary.Massage and manual therapy performed by an experienced physiotherapist are most important.Physical therapy (eg, cryotherapy, ultrasound, iontophoresis, or TENS currents) is supportive.Acupuncture, which is already used in daily hospital practice in Germany, may also have an effect.Your physical therapist will teach you ways to improve muscle strength and joint flexibility at home.It should also show you how to perform basic exercises every day without putting too much strain on your knees.

Surgical treatment

The operation has several advantages as well as disadvantages.With the right qualifications for surgery (correct assessment of the damaged structures and the possibility of their recovery), significant improvement can be achieved quickly.Every operation carries risks, so it is performed only when the degree of damage to the intra-articular structures is severe and conservative treatment methods do not give a positive result.The most common procedures for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy- minimally invasive endoscopic procedure.It provides safe restoration of most intra-articular structures.A camera and instruments are inserted longitudinally into the knee through two small (a few millimeters) skin incisions in the front of the knee.This procedure is often performed on athletes (complex reconstructions of ligaments, cartilages, meniscus sutures) and relatively young patients (usually under 60 years old) with the initial stage of arthrosis.In the first case, it is possible to return to professional sports in a short period of time, in the second case, the discomfort decreases and the patient is transferred in time or the need for endoprosthetics is eliminated.
• Osteotomy- the procedure of "cutting" the bone, correcting the axis of the limb and joining the bones.In this way, the painful part of the knee, the most medial part, is relieved (it is the most damaged part).An osteotomy is often recommended for a knee fracture (such as a proximal tibia fracture) that has not been properly treated.The success of such an operation mainly depends on the correct classification of the patient and the correct performance of the procedure itself.The advantage is the time change in the need for endoprosthetics, the disadvantage is the need for long-term immobilization in plaster to allow the bone to heal.
• Knee replacement(alloplasty, endoprosthetic) is a major surgical operation in which the ends of the joint bones are properly cut, then the metal parts of the prosthesis are placed over them (called bone cement or only mechanically).New articular surfaces form the so-called liners: they are made of polyethylene, ceramic or metal.Replacement of part of the knee (medial) or the entire knee joint may be required.The goal of the operation is to restore greater mobility and relieve pain.In most cases, this is the case.But this is a big and difficult operation for which the patient should be well prepared.Complications, although rare, can be very serious (including bone infections, implant loosening, thromboembolic complications).Therefore, knee replacement should be reserved for people over 55 years of age with severe osteoarthritis in whom appropriate and intensive conservative treatment has not yielded the expected results.This operation is contraindicated in the elderly, after cardiac or respiratory failure, hormonal disorders (mainly related to the thyroid gland), stroke or other serious internal diseases.Intensive conservative treatment is offered to these patients.However, according to statistics, despite some risks, the overall results of endoprosthesis implantation surgeries in recent years are very good.

Therefore, the importance of early diagnosis and regular contact with a podiatrist should be emphasized.The best alternative growth factor treatments to surgery are PRP, viscosupplementation and individually selected professional rehabilitation.In my practice, I monitor the progress of osteoarthritis and choose the appropriate treatment together with high-quality radiologists, rheumatologists and physiotherapists.