I. Overview
Osteoarthritis (OA) refers to joint cartilage degeneration, degeneration and destruction, fibrosis, cracking, ulceration, loss of cartilage, subchondral bone sclerosis or cystic changes, joint edge osteophytes, synovial hyperplasia, joint capsule contracture, ligament laxity or contracture, muscle atrophy and weakness, etc., resulting in clinical joint pain, swelling, deformity, and limitation of movement as the main It is a joint disease characterized by joint pain, swelling, deformity and limitation of movement. It is more common in middle-aged and elderly patients, more women than men, and the prevalence can reach 50% in people over 60 years old and 80% in people over 75 years old. OA is more common in joints that are heavily loaded and active, such as the knee.
Osteoarthritis can be divided into two categories: primary and secondary. Primary OA occurs mostly in the middle-aged and elderly, with age, obesity, inflammation, strain, degeneration, physical and genetic factors. Secondary OA can occur in young adults, mostly secondary to trauma, inflammation, congenital diseases, etc.
Symptoms of osteoarthritis are.
① Joint pain and pressure pain: the initial stage is mild or moderate intermittent vague pain, better at rest, aggravated after activity, pain is often related to weather changes. In the late stage, there may be persistent pain or nocturnal pain. There is localized pressure pain in the joint, which is especially noticeable when there is swelling in the joint, and the knee is often predominantly medial.
② Joint stiffness: stiffness and tightness in the morning when waking up, also called morning stiffness, may be relieved after activity. The joint stiffness is aggravated when the air pressure decreases or the air humidity increases on rainy days, and the duration is usually short, often a few minutes to ten minutes, but rarely more than 30 minutes.
(3) Enlargement of the joint. Medial swelling and inversion deformity of the knee joint are often present, and joint effusion may also cause overall joint enlargement.
Bone rubbing sound (sensation): Due to the destruction of articular cartilage and uneven joint surface, bone rubbing sound (sensation) occurs when the joint moves, most often in the knee joint.
⑤ Joint weakness and movement disorders. Joint pain, decreased mobility, muscle atrophy, and soft tissue contracture can cause joint weakness, soft legs or joint locking when walking, inability to fully straighten or impaired movement. Female patients have difficulty squatting and getting up, affecting urination and defecation and making life very inconvenient. In the advanced stage, the knee joint has severe pain, inversion deformity, inability to flex, and almost inability to walk.
Knee OA diagnostic criteria:
1. Recurrent knee pain within the last 1 month;
2. X-ray (standing or weight-bearing) shows narrowing of the joint space, subchondral bone sclerosis and/or cystic degeneration, and bone redundancy at the joint edge;
3.Joint fluid (at least 2 times) is clear and viscous, WBC <2000/ml;
4, middle-aged and elderly patients (≥40 years old);
5, morning stiffness ≤ 3 minutes;
6, bone friction sound (feeling) during activity.
Second, conservative treatment
The purpose of OA treatment is to reduce or eliminate pain, prevent joint deformity, improve or restore joint function, and improve quality of life. The overall principle of conservative treatment is a combination of non-pharmacological and pharmacological treatment, and the patient’s own situation, such as age, gender, weight, their own risk factors, the location and degree of lesions, etc. to choose an individualized and appropriate treatment plan. If conservative treatment is ineffective, surgery will be performed in advanced pain.
Non-pharmacologic treatment: Publicize and popularize the general knowledge of osteoarthritis, reduce unreasonable overload exercise, avoid long time running, jumping, squatting, avoid bad posture, maintain a reasonable diet, reduce weight, aerobic functional exercise (such as swimming, bicycling, etc.), functional training of joint mobility, muscle training, etc. Can be combined with physical therapy such as heat therapy, hydrotherapy, ultrasound, acupuncture, massage, etc. Canes, crutches, walkers, etc. can be used, and corresponding orthopedic braces or orthopedic shoes can be used for deformities.
Drug therapy: If non-drug therapy is ineffective or inefficient, or if the patient does not have time to do physical therapy, drug therapy can be chosen. Topical medications include non-steroidal anti-inflammatory drugs (NSAIDs) emulsions, creams, patches, herbal plasters, etc. Oral medications include various non-steroidal anti-inflammatory drugs (NSAIDs) that are irritating to the gastrointestinal tract, Vigorix and herbal medicines.
Joint cavity injection drugs.
① If oral medication is not effective, joint cavity injections of sodium hyaluronate-based viscoelastic supplements can be combined. Sodium hyaluronate, the main component of synovial fluid, is one of the components of the cartilage matrix. It plays a lubricating role in the joint cavity to reduce friction between tissues, and at the same time plays an elastic role to cushion the effect of stress on joint cartilage and perform its proper physiological function;
②Glucocorticoids, intra-articular injection of glucocorticoids is feasible for those with severe OA or those who cannot tolerate NSAIDs drug treatment for 4 to 6 weeks, persistent pain and obvious inflammation. Generally, the maximum number of injections per year should not exceed 3 to 4 times.
Third, surgical treatment
1.Arthroscopic joint cleaning: treatment: remove the free body, remove the direct damage to the articular cartilage, clean up the damaged cartilage and meniscus to reduce irritation; perform appropriate microfracture surgery on the exposed subchondral bone of the joint. Postoperative outcomes were satisfactory in 85% of patients and unsatisfactory in 15% of patients. In patients with satisfactory outcomes, the duration of treatment may last only 6 months to 2.5 years, with a very small number being maintained for a long period of time and with hospitalization costs of $8,000 or more. Unsatisfactory efficacy is generally manifested by no improvement of symptoms after arthroscopic surgery compared with that before surgery, and a few patients have worse symptoms after surgery than before surgery.
2, open osteotomy: mainly for patients with abnormal joint force line, through osteotomy to correct the abnormal force of joint cartilage, currently mainly used for young people’s “O” leg or “X” leg correction.
3, joint fusion: joint fusion seriously affects the quality of life of patients, and is only used for joint replacement infection failure.
4.Artificial joint replacement: It is suitable for patients with severe limitation of joint flexion and extension, deformity, and inability to take care of themselves in the late stage.
If the condition of the patient with osteoarthritis meets the following six conditions at the same time, the patient can undergo total knee replacement.
①Age 60 years or older, joint replacement can be considered in the following cases: painful flat walking, painful knee joints in going up and down stairs, weak legs, inability to exert force, inability to stir down, with swelling, which has affected daily life and necessary activities, and ineffective after treatment with Chinese and Western medicine (see osteoarthritis treatment guidelines).
②The medial or lateral joint space of the knee joint is significantly narrowed, indicating damage to the articular cartilage and meniscus.
The knee joint has an “O” or “X” shaped leg, i.e., a deformity such as internal or external knee rotation. If the disease continues to develop, wear and tear will further aggravate the deformity, increasing the complexity of the joint replacement and affecting the surgical outcome.
④The flexion and extension activities of the knee joint are significantly limited due to the joint spur, which has begun to affect daily life and work.
⑤ Severe bone formation and MRI (magnetic resonance imaging) of severe degenerative meniscal damage, osteochondral destruction, and subchondral cystic changes in the joint are seen on x-ray.