First, what is osteoarthrosis of the knee? Osteoarthropathy of the knee, that is, osteoarthritis of the knee, is a chronic joint disease characterized by degeneration and destruction of articular cartilage and osteomalacia, also known as proliferative knee osteoarthritis and senile knee osteoarthritis. Clinically, it is most common in middle-aged and old-aged people, and is more common in women than in men. Pathology is characterized by focal degenerative changes of articular cartilage, dense subchondral bone (sclerosis), marginal osteochondral osteophyte formation and joint deformity. Disease Overview Osteoarthritis is a chronic joint disease whose main changes are degenerative changes in the articular cartilage surface and secondary osteophytes. The main manifestations are joint pain and inflexibility. X-ray shows narrowing of the joint space, dense subchondral bone, fracture of bone trabeculae, sclerosis and cystic changes. There is lip-like hyperplasia at the edge of the joint. In the later stage, the bone ends are deformed and the joint surface is uneven. Intra-articular cartilage is spalled and bone fragments into the joint, forming intra-articular free bodies. Osteoarthritis, also known as degenerative arthritis, is not an inflammatory disease, but is mainly degenerative, a premature aging of the joints, especially the articular cartilage. Osteoarthritis represents the aging of the joints and is therefore called senile arthritis. Osteoarthritis in a broad sense also includes some other aseptic arthritis disorders. Third, the causes of osteoarthritis of the knee joint 1, chronic strain: long-term poor posture, weight-bearing force, overweight, resulting in knee joint articular cartilage hyperplasia, destruction, soft tissue damage. 2, obesity: weight gain and the onset of osteoarthritis of the knee is directly proportional. Obesity is also an aggravating factor. Weight loss of obese people can reduce the incidence of osteoarthritis of the knee. 3, bone density: when the cartilage under the bone trabeculae thin, stiff, its tolerance to withstand the pressure will be reduced, therefore, in osteoporosis the chances of osteoarthritis will increase. 4, trauma and force tolerance: frequent knee injuries, such as fractures, cartilage, ligament damage. Abnormal state of the joint, such as after patellar osteotomy when the joint is in an unstable state, when the joint is subjected to muscle imbalance and coupled with localized pressure, degenerative changes in the cartilage will occur. Normal joints and activities and even after strenuous exercise is not osteoarthritis. 5, other factors: such as age, gender, etc., the disease is more common in women, and more often in older women. What are the clinical manifestations of osteoarthropathy of the knee? 1, the onset of slow, mostly seen in middle-aged and elderly obese women, often have a history of exertion. 2, knee joint pain aggravated by activities, characterized by pain for paroxysmal at the beginning, and then persistent, exertion and more at night, up and down the stairs pain is obvious. 3.Knee joint activities are limited, or even limp. Very few patients may have interlocking phenomenon or knee joint effusion. 4, joint activities can have popping, friction sound, some patients joint swelling, joint deformity can be seen over time. 5.Knee joint pain is a common complaint of patients with this disease. Early symptoms of pain when going up and down the stairs, especially when going downstairs, unilateral or bilateral alternating, is the joint swelling, mostly due to bony hypertrophy, can also have joint cavity effusion. Synovial hypertrophy is rare. In severe cases, there is knee inversion deformity. Fifth, the diagnosis of knee osteoarthritis 1, repeated strain or trauma history. 2, knee joint pain and stiffness, more obvious when getting up in the morning, reduced after activities, aggravated when there are many activities, and relieved after rest. 3, late pain persists, joint activity is obviously limited, quadriceps atrophy, joint effusion, and even deformity and intra-articular free body. 4.Friction sound can be detected during knee flexion and extension activities. 5, Knee joint positive and lateral X-ray, showing the patella, femoral condyle, tibial plateau joint margins were lip-like osteophytes, tibial condylar eminence became sharp, the joint space becomes narrow, subchondral bone is dense, sometimes see intra-articular free body. What kind of patients with osteoarthropathy of the knee can have knee replacement? Artificial knee replacement is to replace the diseased knee joint partially or completely by artificial joint parts through surgery, which is to remove the worn and damaged joint surface and implant the artificial joint, so as to restore the normal and smooth joint surface. Patients opting for surgical treatment should meet several criteria: (1) Moderate to severe persistent pain in the knee caused by osteoarthritis or arthritis of the knee. (2) Substantial improvement not achieved with long-term conservative treatment (more than 6 months of nonsteroidal anti-inflammatory drug therapy). (3) Arthritis-induced knee dysfunction, inability to work or sleep due to joint pain, inability to walk for more than 3 blocks due to joint pain. (4) X-ray changes with destruction of the knee joint. For example, when degenerative arthritis reaches an advanced stage, apart from joint pain, the patient will also have joint deformation (pinnacle), difficulty in bending the knee, difficulty in walking, inability to walk up and down the stairs, and inability to do kneeling or squatting movements. In some cases, the joints may make an abnormal sound when they move. Sometimes there is swelling of the joint, which indicates a buildup of fluid in the joint cavity (an increase in joint fluid), which can cause discomfort and mobility problems for the patient. Radiographic examination of the knee joint may show the following changes: bone spurs, narrowing of the joint space, hardening and whitening of the bones under the joint, and deformation of the joint. In the most serious cases, the joint space disappears completely and the whole joint is adherent and immobile. If the patient has the above symptoms, artificial knee replacement can be considered. In addition, for rheumatoid arthritis and ankylosing spondylitis with advanced knee joint lesions, other non-infectious arthritis-induced knee joint lesions accompanied by pain and dysfunction, infectious arthritis with residual joint destruction (without active infection), and tumors involving the knee joint surface that cannot be reconstructed after resection to obtain good joint function are all feasible cases of artificial knee replacement. Postoperative efficacy of artificial total knee replacement Artificial total knee replacement has become a routine surgery with mature technology and is increasingly accepted by the majority of patients. As long as the surgical indications are strictly mastered, and the operation is carried out by an experienced surgeon together with reasonable postoperative functional exercises, patients’ satisfaction can be achieved. According to our past experience, patients can walk on the ground within one week after surgery with reasonable application of antibiotics and drugs to prevent deep vein embolism of the lower limb, and encourage patients to perform isometric contraction of the quadriceps muscle and early postoperative continuous passive motion (CPM) exercise of the affected knee, and with the disappearance of postoperative pain and the functional exercise of the affected limb, the patient’s gait will also return to normal. For some patients with bilateral osteoarthritis of the knee, since one side of the knee can bear most of the body weight after the replacement, the other side of the joint without surgical treatment will be less painful than before. Therefore, for patients with osteoarthritis of the knee, if they meet the indications for joint replacement, there is no need to be afraid of surgery, and they should go to a large hospital with a high level of comprehensive care and have surgery performed by an experienced surgeon, in order to relieve pain as soon as possible and improve their quality of life. The following are the preoperative and postoperative radiographs of several typical patients treated in our clinic: Example 1: Preoperative and postoperative This patient is a 55-year-old woman, with osteoarthritis of the left knee joint as seen in the preoperative radiographs, with no gap on the medial side, and the patient is in severe pain, with a deformity of internal rotation of the left knee joint, which makes it impossible for her to walk normally. After left total knee arthroplasty, the patient was able to walk on the ground within one week and recovered well. Example 2: Preoperative Postoperative This patient is a 53-year-old woman. Preoperative X-ray showed severe osteomalacia in both knees, with a large number of bony encumbrances formed in the inter-articular area and behind the joints, and the patellofemoral joint surfaces were also heavily hyperplastic, with a narrow joint space and severe destruction of the articular cartilage. The patient was in pain in both knees and was unable to sleep, had difficulty in flexion and extension of the knees, and had difficulty in walking. The patient was admitted to the hospital and underwent bilateral total knee arthroplasty at the same time. One week after the operation, the patient went down to the ground, the pain symptoms gradually disappeared, and she could walk normally. Example 3: Preoperative and postoperative This patient is a 74-year-old woman. Preoperative X-ray showed severe osteomalacia of the left knee joint margin, loss of the medial joint space, severe destruction of the articular cartilage, sclerosis of the articular surface, and deformity of the left knee joint inversion, and the patient suffered from pain and impaired mobility of both knees. The patient was admitted to the hospital and underwent left total knee arthroplasty. After the surgery, active and passive functional exercises were performed on the left knee, and the patient went down to the ground one week later, and the pain symptoms gradually disappeared, and the activity of the left knee was normal.