I. What is osteoarthritis? You may often see older people walking with a hobbled gait, knee pain when going up and down stairs, or even an “O” shaped leg. In fact, this is all due to osteoarthritis. Osteoarthritis, commonly known as “long bone spurs”, “osteophytes”, is a group of diseases caused by a variety of causes of damage to the integrity of joint cartilage and related symptoms and signs. The underlying cause is the destruction of articular cartilage and the inability of chondrocytes to synthesize normal hyaluronic acid and the escape of short-chain proteoglycan polymers from the collagen meshwork, resulting in softening of the cartilage matrix and loss of elasticity and strength, as well as sclerosis or cystic degeneration of the subchondral bone and formation of bone fragments. This results in pain and motor impairment, leading to severe limb disability. In conclusion, although osteoarthritis starts from the articular cartilage, it affects the entire joint structure, including the subchondral bone, ligaments, synovial membrane, joint capsule and extra-articular muscles, and eventually results in joint deformity and loss of function due to total loss of articular cartilage. The incidence of osteoarthritis is high in the elderly: the incidence of the disease is closely related to age. 2, more female patients, especially after menopause; in the 45 to 55-year-old population, the frequency of men and women is comparable, while after the age of 55, there are significantly more female patients, and overall, women are more likely to suffer from osteoarthritis than men. 3, obese people are vulnerable to osteoarthritis: epidemiological studies have found that obesity has a certain impact on the occurrence of osteoarthritis of the knee. In addition to the mechanical factors caused by obesity, but also with the obese systemic metabolic factors. The stress and direction of the knee joint depends on the force line of the limb, body shape, muscle strength and their interactions. The incidence of knee osteoarthritis in obese women is four times higher than that in normal weight women. In addition, there is a correlation between the distribution of fat and the occurrence of osteoarthritis when obese, that is, patients with more fat in the waist are prone to hip and knee osteoarthritis, while the fat in the hip and thigh rarely causes osteoarthritis.4. Racial factors can also cause the onset of osteoarthritis, with a high incidence of hip osteoarthritis in Westerners and a high incidence of knee osteoarthritis in Easterners.5. Some special occupational personnel The main cause of osteoarthritis is the long-term wear and tear of joint cartilage caused by high-intensity stress or injury. 6, joint injury is also an important factor causing osteoarthritis: such as joint instability caused by ligament damage around the joint, meniscal injury or intra-articular fracture. In addition, genetic changes, nutritional disorders of articular cartilage, metabolic abnormalities, neurological abnormalities and changes in the biomechanical environment of the joint can trigger osteoarthritis. If you wear high-heeled shoes with a sharp heel or wide heel, walking increases the usual stress on the knee joint and changes the stress point of the knee joint, which can also easily cause osteoarthritis. Third, what are the symptoms of osteoarthritis? Osteoarthritis can occur in joints throughout the body, showing pain, swelling, friction sounds, deformation and limited movement of the corresponding joint. However, the incidence of osteoarthritis of the knee is the highest. Approximately 41% of patients with osteoarthritis have osteoarthritis of the knee. This is because the knee is a joint that is heavily loaded, active, and susceptible to trauma, strain, and wind and cold stimulation. Hip osteoarthritis accounts for 19%. Osteoarthritis joint pain is characterized by excessive activity and can be reduced with rest. Osteoarthritis of the knee joint also causes the affected limb squatting, up and down stairs and other obstacles, and inversion and flexion contracture deformity can occur in severe cases, and finally joint disability. The actual osteoarthritis is a result of the fact that the joint is not damaged, such as avoiding repeated impacts or torsions on the joint, minimizing frequent high altitude exercise, taking Vit A, Vit C, Vit E, and Vit D, etc., all have a preventive effect on osteoarthritis. V. Can osteoarthritis be treated? At present, medicine has no ability to reverse the course of osteoarthritis, and the condition of most patients will continue to develop and deteriorate. Therefore, the vast majority of patients need to be treated. The basic goals of conservative treatment are to relieve symptoms, improve function, delay the process and correct deformities, and improve the patient’s quality of life. In advanced stages, the use of artificial joint replacement surgery is the fundamental solution to osteoarthritis. Sixth, can I exercise if I have osteoarthritis? Proper exercise can prevent, slow down and slow down the process of osteoarthritis. These include: swimming, walking, cycling, supine straight leg raises or resistance training and non-weight bearing joint flexion and extension activities. Improper over-exercise can aggravate osteoarthritis. Harmful exercises are those that increase joint torsion or overload the joint surfaces: activities such as climbing, stair climbing or squatting and standing. VII. What are the oral medications used to treat osteoarthritis? Since the 1990s, international research on the treatment of osteoarthritis has begun to focus on the treatment of osteoarthritis, and the therapeutic drugs are divided into two categories of drugs to improve the symptoms and change the condition. For patients with early or mid-stage osteoarthritis, drug therapy has the advantages of being readily available, simple, reliable and easy to maintain compared to other methods, and is worth promoting in this area, which has not yet received widespread attention in China. Pharmacological treatment includes the following: anti-inflammatory and analgesic drugs: acetaminophen is preferred abroad, which is effective in relieving pain, has fewer adverse effects and is less expensive. Usually the total amount of 1 day does not exceed 3g, but long-term high dose use has been reported to cause liver or kidney damage. If these drugs are not effective in relieving pain or are associated with knee effusion, other drugs should be used. Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs have anti-inflammatory, analgesic and antipyretic effects and are the most commonly used drugs for the treatment of osteoarthritis. However, some of them, such as aspirin, salicylic acid, pautazone, indomethacin and naproxen, have an inhibitory effect on the synthesis of proteoglycan in the articular cartilage matrix, which is detrimental to osteoarthritis and should not be chosen, at least not for long-term use. Other drugs such as diclofenac, meloxicam, nabumetone, etodolac, sulforaphane and acimicin have no adverse effect on the synthesis of cartilage matrix proteoglycans, and even have a role in promoting synthesis, and are suitable for use. Opioids: In patients with moderate to severe osteoarthritis of the knee, opioids are used as a last resort when the above medications fail to relieve pain. Codeine and tramadol are often used. They are effective, but the adverse effects of these drugs, such as nausea, vomiting, diarrhea and excessive sweating, as well as a certain degree of tolerance and potential dependence, are worthy of attention. Glucosamine: Glucosamine has both anti-inflammatory and pain-relieving properties, as well as a slow-acting effect on the development of knee osteoarthritis, and is considered to be the first drug or slow-acting agent to modify the condition of osteoarthritis. In vitro experiments have also confirmed its good effect on cartilage metabolism, and it is also referred to as a chondroprotective agent. Long-term treatment with glucosamine can stop the progression of osteoarthritis of the knee. Diacerein: This drug can inhibit the activity of metalloproteinases and stabilize the lysosomal membrane to exert anti-inflammatory and protective effects on articular cartilage, thus improving the course of osteoarthritis. Trials have shown that it can significantly improve the patient’s symptoms, and its adverse effects are only transient diarrhea. Can intra-articular injections be used to treat osteoarthritis? There are two main types of drugs that can be injected into the joint cavity, one is hormonal drugs and the other is hyaluronic acid preparations. Hormonal drugs: Although they can temporarily reduce pain, repeated intra-articular injections of hormonal drugs can degenerate the joint and lead to “corticosteroid arthropathy”. Hormones also inhibit the synthesis of normal joint cartilage matrix and increase the likelihood of infection. Therefore, hormone injections should only be given once for patients with joint oozing and severe pain. Hyaluronic acid preparations: The high viscosity of the synovial fluid in the joint cavity provides an almost frictionless surface for joint movement and is therefore very beneficial for normal joint function. In osteoarthritis, hyaluronic acid is destroyed, the viscosity of the synovial fluid is reduced, lubrication is lost and the smooth movement of the joint surface is lost, resulting in further joint destruction. Intra-articular hyaluronic acid supplementation is beneficial in relieving joint pain, increasing mobility, eliminating synovial inflammation and delaying disease progression. These drugs are mainly used for osteoarthritis of the knee and are indicated for those who do not respond well to conventional therapy or who cannot tolerate treatment with analgesics or non-steroidal anti-inflammatory drugs. Treatment of osteoarthritis should focus on early diagnosis, early treatment and a long course of treatment. In other words, prevention and comprehensive treatment should be started when the patient is symptomatic and the articular cartilage has not yet become obvious, the joint space has not yet narrowed and the bone redundancy has not yet reached the obvious level, and long-term follow-up. What surgeries are available to treat osteoarthritis? The most common procedures for treating osteoarthritis include arthroscopic debridement, high tibial osteotomy, joint fusion and artificial joint replacement. Arthroscopic debridement: Arthroscopic debridement is performed to remove or repair cartilage fragments, meniscus fragments, and bone fragments that cause mechanical impairment of the joint, and to remove synovitis-causing inflammatory factors through intraoperative high-dose joint irrigation. Arthroscopic debridement reduces symptoms by eliminating mechanical barriers and inflammatory factors. Planing of the degenerated cartilage and meniscus does not lead to their repair, so the purpose of the procedure is not to hope for new cartilage regeneration (rather it may accelerate the degeneration). Rather, it is intended only to relieve symptoms; it does not alter the pathological changes or course of osteoarthritis. It will not have any effect on cartilage dysfunction caused by already existing articular cartilage damage or abnormal cartilage metabolism. Arthroscopic cleanup may achieve better results in the relatively acute phase of symptom onset, and short-term improvement after arthroscopic surgery may be seen in patients with chronic progressive changes and in patients with osteoarthritis that has reached an advanced stage. High tibial osteotomy: The lower extremity force line is the line from the center of the femoral head through the knee joint to the center of the ankle joint. Normally, the lower extremity force line passes through the center of the knee joint and the body load is evenly distributed over the medial and lateral knee surfaces. Patients with osteoarthritis of the knee can develop internal knee valgus, where increased loading of the medial joint surface produces loss of articular cartilage and sclerosis of the subchondral bone. After high tibial osteotomy, the abnormal biomechanical axis is corrected, thus changing the abnormal tibial plateau weight-bearing surface, changing the joint load, achieving a reduction in intraosseous pressure, promoting the formation of a new joint surface, reducing pain and achieving disease relief. However, the condition for high tibial osteotomy is a unicompartmental lesion with no significant instability of the joint, at least 90 degrees of flexion and no significant flexion contracture. In contrast, purely unicompartmental lesions are relatively rare clinically, especially in the elderly. Besides, those who already have cartilage destruction, even after changing the force line, it will not solve the problem of cartilage destruction. So this method is also not a fundamental solution to the problem. In addition, this method will not only fail to solve the problem for elderly patients with advanced disease, but will also cause difficulties for future artificial joint replacement and increase the chance of infection in the next surgery. Arthroplasty: As you can see from the above treatments, any treatment will only temporarily reduce the symptoms, but the most effective treatment is arthroplasty. Artificial joints are one of the most important advances in the field of orthopaedic surgery in the 20th century, enabling patients who used to rely on crutches or even amputation to walk like normal people, greatly improving their quality of life. It has given hope to some patients with advanced osteoarthritis who have severe joint destruction, and some patients who have been bedridden for a long time have regained their standing and walking functions through surgery, partially or completely restoring their ability to take care of themselves. It is now widely used at home and abroad as a mature treatment method. At present, artificial joint replacement has become one of the main means of treating severe joint lesions and is regarded as one of the important milestones in the history of orthopaedic development in the 20th century. At present, there are about 1 million total hip replacements each year worldwide. In the United States, there are 120,000 cases of total knee replacement each year. In contrast, there are less than 10,000 total knee replacements per year in China’s population of 1.3 billion. The reason for this difference is not only the economic conditions, but also the lack of popular education and the fact that the majority of patients do not understand the benefits of artificial joint replacement, and many primary care doctors are not yet aware of the technology and master it. With the development of socio-economic and cultural health and the change of people’s concept, artificial joint replacement will become more common, so that more patients with osteoarthritis can be relieved of their pain, improve their function and enhance their quality of life in their later years. After joint replacement, pain will be significantly reduced and function will be significantly improved. Nowadays, about 90% of the artificial joints are still in use at the 10-15 years follow-up after the artificial joint replacement. Thus the life span of the artificial joint has improved significantly. And it is also possible to replace the artificial joint after it has loosened. In summary, various medications can be used for early osteoarthritis and they can reduce the symptoms for a period of time. However, because there are no effective measures to control the progression of osteoarthritis, osteoarthritis will continue to develop and worsen. The only effective treatment for the advanced stages of the disease is artificial joint replacement. Artificial joint replacement is now a very mature procedure that can relieve pain, improve function and enhance the quality of life in later life for patients with advanced osteoarthritis.