Introduction
Osteoarthritis of the knee is a disease that is mainly caused by degenerative changes in the bones and cartilage of the knee joint. It is most commonly seen in middle-aged and elderly people, especially in women who are fat, and the symptoms gradually worsen with age. With the ageing of the population and the development of transportation, sports and tourism, the number of patients with osteoarthritis of the knee is gradually increasing. The basic lesion is progressive knee cartilage loss and degenerative changes in the joint edges and subchondral bone, accompanied by a mild inflammatory response, also known as degenerative knee osteoarthritis and osteoarthrosis of the knee. It seriously affects the quality of life of middle-aged and elderly people and is attracting more and more attention (the picture below shows the structure of the knee joint) Huiliang Shen, Department of Orthopedics, Xuanwu Hospital, Capital Medical University
The picture below shows the knee joint of a patient with osteoarthritis. We can see that the cartilage surface of the knee joint is very badly worn.
Causes
1. Age factor The knee joint carries the most weight in the human body. As the knee capsule atrophies, degenerates and fibroses with age, the joint becomes stiff and inflexible, and the synovial fluid secretion is abnormal, causing the chondrocytes to be undernourished, the water content in the cartilage decreases, and the mucopolysaccharide, the main component of cartilage, decreases. In order to adapt to the needs of the knee joint bearing force, the edge of the articular cartilage has osteophytes, that is, the occurrence of osteoarthritis in the elderly.
2, endocrine factors Patients with endocrine disorders, the knee joint is subject to long-term minor trauma that is not easily noticed, excessive inappropriate exercise, etc., are caused by the knee joint load, transmission to the disorder, causing degenerative changes in the knee joint cartilage, secondary to osteoarthritis of the knee joint.
3, obesity factors This disease is related to weight overload, menopausal women weight gain can contribute to the occurrence of osteoarthritis.
4, trauma fracture, dislocation, meniscus or ligament injury in the knee joint can cause instability of the knee joint, is the cause of secondary osteoarthritis of the knee.
5, Inflammation Knee septic arthritis and tuberculosis, rheumatoid arthritis, etc., even if the inflammation subsides, the joint cartilage surface is damaged to varying degrees, such as the joint still maintains a considerable degree of mobility, most secondary to osteoarthritis.
6. Joint anomalies such as inversion and valgus deformity of the knee joint, large osteoarthrosis, and multiple epiphyseal dysplasia can be secondary to this disease.
Clinical manifestations
Knee pain: the most common symptom of the disease, early pain is mild, mostly occurs during activity, relieved after rest, and later can be accompanied by pain at rest, and can be accompanied by nocturnal pain. Knee pain is obvious when going up and down stairs, more prominent when going downstairs, difficulty in squatting, and a babbling sound in the knee joint when moving. The pain may increase with overexertion.
Some patients may also have morning stiffness, which lasts less than 30 minutes and is relieved by activity and is limited.
Knee swelling and difficulty in movement In severe cases, it is difficult to walk and affects daily life. Sometimes the joint feels like it is stumbling, but improves with activity. When you stand up from a sitting position, you may also feel that the movement of your leg is inhibited, and the muscle strength around the knee joint will become weaker. Symptoms are worse on rainy days. Difficulty with movement is the end result of the development of most patients with osteoarthritis. As the disease worsens, it may range from a mild early onset of inability to move in the morning or after sitting for a long time to joint deformity, a significant decrease in range of motion, and joint swelling with effusion. On examination, joint enlargement, tenderness, rattling, deformity and dysfunction can be seen.
The figure below shows a comparison between a normal knee joint and a diseased knee joint
Tips: If you are older than 45 years old and begin to experience the more typical manifestations described above, or if you experience joint soreness, pain, and sometimes swelling, aggravated by cloudy weather, cold, or overexertion, difficulty going down stairs, and weakness in the legs that persists without relief, then you should consider seeking medical attention, as these are early symptoms of osteoarthritis.
Treatment
Most osteoarthritis of the knee develops slowly and with aggressive treatment can improve joint function, with a very small number developing dysfunction. During an acute attack of osteoarthritis, the primary treatment is rest, with attention to reducing the stress and activity of the affected joint. Avoiding and reducing the wear and tear of the articular cartilage. Therefore, appropriate restriction of the affected joint activity is beneficial to reduce pain and prevent aggravation of the disease. However, complete bed rest is not recommended.
Drug treatment Drug treatment Drug treatment Drug treatment
(1) Anti-pain and anti-inflammatory drugs
(2) Joint cartilage protection drugs
(3) Anti-inflammatory drugs
(4) Joint lubricants
(5) Osteoporosis treatment drugs
Diet
(1) Eat foods high in calcium to ensure the normal needs of bone metabolism. It is advisable to eat more milk, eggs, soy products, vegetables and fruits, and take calcium supplements when necessary.
(2) Overweight people should control their diet and reduce their weight to help reduce the weight of the joints.
(3) Increase the intake of multivitamins, such as vitamins A, B, B1, B12, C and D, etc.
(4) Physical therapy that can be considered in conjunction.
Surgical treatment mainly includes arthroscopy and knee replacement surgery.
Arthroscopic surgery is less invasive and involves only two small holes in the joint surface and joint cleaning with special instruments.
In the advanced stages of arthritis, when the joint has lost its function, artificial joint replacement surgery has become the ideal procedure because of its ability to relieve pain and restore function to the joint. The procedure has evolved over the past century and is now well established and widely available worldwide.
Many patients have a great deal of fear about joint replacement, but in fact, joint replacement is not a scary procedure. The procedure has been performed for nearly 100 years and the surgical technique has become very mature. With advances in artificial joint materials and newer medical philosophies, joint replacement surgery now takes just over an hour, and patients experience minimal pain and recover very quickly after surgery.
The following two pictures are the diagrams of knee arthroplasty. Through these two pictures, we can clearly see that total knee arthroplasty is the placement of a prosthesis on the surface of the joint to replace our own joint for friction, thus eliminating pain and increasing mobility.
Our department has mastered all the techniques related to total knee arthroplasty, and the surgery has yielded good results. The following picture shows Mr. Liu, a patient who had bilateral knee replacement in our department. The most important thing is that the knee joint does not hurt anymore and he can take care of himself.
The following points should be noted for the prevention of osteoarthritis of the knee in middle-aged and elderly people.
1. Try to avoid being obese to prevent aggravating the knee joint, and once you are overweight, you should actively lose weight and control your weight. 2. Pay attention to the posture of walking and labor, do not twist the body to walk and work. Avoid squatting for a long time, because the weight of the knee joint when squatting is 3-6 times its own weight, squatting at work (such as car mechanics, sand turners) is best changed to a low sitting position (sitting on a small bench), sitting and standing for a long time, but also often change positions to prevent the knee joint fixed a posture and too much force. 3. Do not wear high heels when walking long distances, but wear thick-soled and flexible soft-soled shoes to reduce the impact on the knee joint and avoid wear and tear on the knee joint. 4. When participating in physical exercise, prepare for the activity by gently stretching the knee joint and allowing the knee joint to fully move before participating in strenuous exercise. When practicing leg press, do not lift your leg too high to prevent excessive strain on the knee joint. When practicing taijiquan, do not squat too low, and do not play several sets in a row to prevent injury to the knee joint from being overburdened. 5. When riding a bicycle, adjust the height of the seat to sit on the seat with both feet in the pedals, both legs can be straight or slightly bent for appropriate, the seat is too high, too low or riding uphill when pedaling hard, have a negative impact on the knee joint, should be overcome. 6. When the knee joint is cold, the blood vessels constrict and blood circulation becomes poor, which often makes the pain worse. 7. People with osteoarthritis of the knee should try to walk up and down stairs, climb less, stand less, and lift less heavy objects to avoid overloading the knee joint and aggravating the disease. 8. People with osteoarthritis of the knee should avoid excessive fatigue of the knee joint, but also carry out appropriate functional exercises to increase the stability of the knee joint and prevent muscle atrophy of the leg, which not only relieves joint pain, but also prevents the progress of the disease, do not think that only rest and inactivity can protect the diseased knee joint. According to research, people with knee osteoarthritis, swimming and walking are the best exercises that do not increase the weight-bearing capacity of the knee joint, but also allow the muscles and ligaments around the knee joint to be exercised. Secondly, sit-ups, push-ups, bridge arches and the repeated practice of raising and lowering the two retreats on the supine bed, imitating pedaling a bicycle, are the best exercises for patients. 9. In terms of diet, you should eat more food containing protein, calcium, collagen, isoflavones, such as milk, dairy products, soybeans, soy products, eggs, fish and shrimp, kelp, black fungus, chicken feet, pig’s feet, leg of lamb, beef tendons, etc. These can not only replenish protein, calcium, prevent osteoporosis, but also grow cartilage and joint lubricating fluid, and also replenish estrogen, so that bones and joints can better carry out calcium metabolism and reduce the symptoms of arthritis.