Osteoarthritis is a common chronic degenerative osteoarthropathy, a chronic aging of the joints, commonly known as “bone spurs”. It is most common in middle-aged and elderly people, and is more common in women than men. About 40 million people in the United States suffer from arthritis, of which osteoarthritis accounts for 43%, and 90% of women and 80% of men over the age of 65 suffer from osteoarthritis. Among men over age 50 in the United States, osteoarthritis is the second leading cause of work incapacity after ischemic heart disease and can cause up to 53% of workforce loss. Osteoarthritis is the leading cause of pain and disability in the elderly, and it seriously affects the daily work and life of middle-aged and elderly people. According to the World Health Organization (WHO), osteoarthritis is the fourth most prevalent disease among women and the eighth most prevalent disease among men. A domestic survey shows that among people over 60 years old, 5.6% of men and 15% of women have osteoarthritis, and 21.5% of men and 42.8% of women are found to have osteoarthritis on X-ray. With the aging of the population, China has also entered into an aging country, and the incidence of osteoarthritis is increasing day by day, which will inevitably increase the national medical investment and increase the economic burden of families and even society. At present, due to the lack of medical knowledge in China, people’s knowledge of osteoarthritis is only at a very superficial level, and they are not aware of the serious consequences caused by osteoarthritis, which often results in minor illnesses not being treated and becoming serious illnesses, losing a good time to treat osteoarthritis and increasing the burden on families and society. For this reason, the World Health Organization has designated October 12 each year as World Osteoarthritis Day to raise awareness of osteoarthritis and to facilitate early and aggressive treatment of osteoarthritis. Osteoarthritis of the knee is one of the most prevalent forms of osteoarthritis, also known as osteoarthrosis, degenerative arthritis, proliferative arthritis, hypertrophic arthritis, and age-related arthritis. Its pathogenesis is multifactorial. The etiology of this disease is not well defined, but is closely related to age, gender, occupation, trauma, underlying disease, immune response, free radicals, and increased intraosseous pressure. After the age of 45, the ovarian function of women decreases and the level of estrogen decreases, which weakens the metabolism of articular cartilage and makes it easy for degenerative changes to occur. In addition, long-term heavy physical labor, special occupational groups, such as miners, porters, athletes, dance acrobats, etc. are a good prevalence of knee osteoarthritis; with the increasing improvement in living standards, obesity is also a non-negligible factor causing knee osteoarthritis, so weight loss not only avoids the occurrence of a variety of internal diseases, but also reduces the burden on the knee joint, reduces the wear and tear of the knee joint, and postpones or even avoid the occurrence of osteoarthritis. In addition to this, articular cartilage damage gradually increases with age due to various causes of damage. After articular cartilage degeneration, the water content decreases and the elasticity decreases, making it less resistant to impact and wear and tear. Cartilage damage can aggravate the degeneration of cartilage joints, leading to different degrees of cartilage damage, thus forming a vicious circle and further aggravating the symptoms. The pathological change is a joint lesion caused by degenerative changes in articular cartilage, mainly osteophytes, and the inflammation of synovium is a secondary lesion. [What are the manifestations of osteoarthritis of the knee in middle-aged and elderly people? Most patients who go to the hospital will say that they have soreness and discomfort in the knee joint, which is aggravated by activity or exertion, inconvenience in going up and down stairs, squatting and standing up, inability to walk long distances, stiffness in the knee joint after getting up or after sitting for a long time, inflexibility in the knee joint flexion and extension activities, a feeling of friction or even a popping or rubbing sound, and even swelling around the knee joint in patients with a long course of the disease. This means that fluid has developed in the knee joint cavity. When an X-ray of the knee is taken, the report often indicates “degeneration of the knee joint (aging of the knee joint), narrowing of the joint space (wear and tear of the cartilage surfaces of the joint), formation of bone fragments (osteophytes, commonly known as “bone spurs”), and joint free bodies (commonly known as “joint rats”). “The doctor will make a conclusion of “osteoarthritis of the knee” by combining clinical manifestations and X-ray findings. In the early stages of the disease, the patient’s pain is mainly paroxysmal, easily appearing after exertion or weather changes, and the initial symptoms usually do not affect the patient’s daily life. When osteoarthritis develops in the later stages, it can cause deformities of the knee joint, such as an “O” or “X” shaped leg. When osteoarthritis is advanced, it can cause deformity of the knee joint, such as “O” leg or “X” leg, and X-ray examination shows severe internal and external deformity of the knee joint and loss of joint space, especially in obese people, thus seriously affecting the working life of patients. [Diagnosis] For osteoarthritis of the knee joint, there are strict clinical diagnostic criteria: ① knee pain on most days of the month; ② ringing during joint activity; ③ morning stiffness ≤ 30 minutes; ④ age ≥ 38 years; ⑤ osteoarthritis of the knee joint with popping; ⑥ osteoarthritis of the knee joint without ringing. The diagnosis of osteoarthritis of the knee can be made if ①②③④ or ①②③⑤ or ①⑥ are met. In addition, there are clinical diagnosis + X-ray diagnostic criteria: ① knee pain on most days for a month; ② bony bulge at the edge of the joint on X-ray; ③ osteoarthritic synovial fluid (clear, viscous, leukocytes <2< span="">×106/L); ④ no synovial fluid check, age ≥40 years; ⑤ morning stiffness ≤30 minutes; ⑥ ringing during joint activity. The diagnosis is clear if ①② or ①③⑤⑥ or ①④⑤⑥ are met. [The etiology, clinical manifestations, and diagnosis of osteoarthritis of the knee have just been described in detail, but is all knee pain osteoarthritis? In fact, it is not that simple. Clinically, there are many diseases that tend to be very similar to the clinical manifestations of osteoarthritis, and even professional physicians are sometimes prone to deviations in diagnosis and treatment. However, the following diseases need to be differentiated from osteoarthritis of the knee in terms of clinical manifestations, but their contents are very specialized and require professional orthopedic surgeons to make accurate judgments: 1. Patellar chondromalacia: more frequent in women, the greater the activity of the knee joint, the more obvious the pain, and there is hyperextension pain and walking weakness. There is pressure pain on the anterior, inferior, medial, lateral and N fossa of the knee. When the knee is extended with pressure on the patella, friction and pain can be palpated. Patellar grinding test is positive. 2, knee ligament injury: most have obvious history of trauma, need to carry out drawer test sound test, lateral squeeze test to clarify whether there is corresponding ligament injury, if necessary, also need to carry out magnetic resonance imaging (MRI) examination to clarify whether there is knee ligament injury. 3, knee meniscus injury: most have a history of trauma, a small number of congenital disc meniscus injury, no obvious trauma, post-injury joint pain, swelling, popping and interlocking phenomenon, knee gap pressure pain. In the chronic phase, quadriceps atrophy is particularly evident in the medial quadriceps. If necessary, magnetic resonance examination is also required. CT examination is not helpful for the diagnosis of meniscal injury. 4, lumbar disc protrusion lumbar spinal stenosis: because the protruding disc compresses the nerve root or protrudes causing spinal stenosis, it is easy to cause pain around the knee joint, numbness, muscle weakness, inconvenience, even intermittent claudication and other symptoms, if necessary, MRI, CT and other examinations to clarify, which requires a professional orthopedic surgeon to make an accurate diagnosis, and is also a disease that can easily cause misdiagnosis in clinical practice. 5. Subpatellar fat pad injury: history of trauma, strain or cold in the knee. The pain of the knee joint, even more so when going down stairs, is aggravated by the pain in the knee hyperextension position, the pressure pain of the infrapatellar fat pad is obvious, the knee hyperextension test is positive, the patellar tendon relaxation pressure pain test is positive. x-ray lateral knee film, the texture of the fat pad scaffold is seen to be thickened, a few of them are seen to be calcified shadows of the fat pad. [The aim of treatment is to relieve pain, stop and delay the progression of the disease, and improve the patient’s quality of life. The treatment plan varies according to the individual patient and the degree of osteoarthritis degeneration. General treatment (1) Physical therapy includes warmth, heat, physiotherapy, acupuncture, etc. If Chinese medicine is used, standardized treatment should be given in a regular hospital. (2) Avoid wear and tear of the knee joint, avoid prolonged standing, squatting, kneeling and other postures, canes, walkers and other assistance activities, obese patients should be moderate weight loss. Strengthening coordinated muscle movements and enhancing quadriceps exercises can reduce painful joint symptoms, and reasonable exercise to maintain joint range of motion. Treatment of osteoarthritis is generally divided into three stages. The first stage is based on conservative treatment, with oral Chinese medicine, anti-inflammatory and pain-relieving drugs, and intra-articular injection of joint lubricating drugs such as sodium hyaluronate. In the second stage, when conservative treatment is ineffective, arthroscopic surgery is actively performed; in the third stage, when the destruction of articular cartilage is more serious, the gap is severely narrowed, and the joint is obviously deformed, artificial knee arthroplasty is recommended. Drug treatment ① NSAIDs are the most commonly used class of osteoarthritis treatment drugs, their effect is to reduce pain and swelling, and improve the movement of the joint. However, they are prone to complications such as gastrointestinal diseases, liver and kidney diseases, etc. Clinically, they are commonly used, including mobicol and celebrex. Before using the drug, you should refer to the instruction manual, pay attention to the dosage and adverse drug reactions, etc. For some patients, the above methods of treatment cannot be used. Other pain relievers Acetaminophen has a good pain-relieving effect on osteoarthritis, and is still widely used abroad at low cost, while it is relatively little used in China. If the above methods are not effective in relieving the symptoms, tramadol and other treatments can be given. The drug is well tolerated and has little addiction, and attention should be paid to adverse reactions. Local treatment Glucocorticoids can relieve pain and reduce exudation, which is often called “closed injection”, and the effect can last for several weeks to months. Intra-articular injections of hyaluronic acid, including the domestically produced Serpentine and imported Synvic, can relieve pain and lubricate the joint cavity, and the dose is usually 2ml (1 stick) once a week for 5 weeks. Improvement in joint function was reported in 77% of patients after treatment and lasted for an average of 8 months. After a second course of treatment, further improvement in joint function was observed in 87% of cases. Arthroscopic treatment Arthroscopic treatment may be considered when drug therapy is not effective. Arthroscopy is used in the early to mid stage of osteoarthritis of the knee and is now a very mature technique. In China, arthroscopic surgery has been performed in the early years to clarify the degeneration of articular cartilage, determine the extent of meniscal damage, flush the joint cavity, remove free bodies, and remove synovial growths. Arthroscopic treatment is safe, effective, requires small incisions (generally two incisions of about 0.5-1 cm each at the front of the knee), short operation time (within 20-30 minutes for skilled surgeons), quick recovery, short hospital stay, and relatively low surgical risk, which most patients are happy to tolerate. Artificial knee replacement If the above-mentioned methods do not work and the patient still complains of significant knee pain, restricted movement, joint space narrowing, or severe knee deformity, and if clear contraindications to surgery are excluded, artificial knee replacement can be used under the guidance of a physician to completely treat osteoarthritis of the knee if the patient’s general condition allows and if he or she has certain financial conditions, thus improve the quality of life of the patient. In conclusion, the process of treating osteoarthritis of the knee is a long way to go and requires patients to have a certain amount of medical knowledge, health care knowledge, and standardized and reasonable clinical treatment under the guidance of a physician to better improve the quality of life of the patient and reduce the burden on the family and society.