Osteoarthritis of the knee is a common chronic joint disease in knee surgery, characterized by high prevalence, wide range of lesions, and severe functional impairment in the late stage. percent.
Osteoarthritis of the knee is divided into two types: primary and secondary
1. Primary
In osteoarthritis without a clear history of trauma, joint degeneration is due to joint
The degeneration of the joint is caused by self degeneration, heredity, body fat, ageing and other factors. Most commonly seen in middle-aged and elderly patients, the lesions are widely involved.
(1) Age, sex and race, and advanced age are the most obvious risk factors, and are higher in blacks than in whites.
(2) Genetic factors, studies have shown that osteoarthritis of the knee is a combination of intrinsic genetic factors and extrinsic environmental factors.
(2) Genetic factors, research has shown that osteoarthritis of the knee is the result of a combination of intrinsic genetic factors and extrinsic environment.
(3) Bone density. People with high bone density are more likely to develop osteoarthritis.
Increased bone mass is positively associated with the development of osteoarthritis.
(4) Obesity, clinical studies have confirmed that the incidence of knee osteoarthritis is higher in obese people than in normal weight patients.
The incidence of knee osteoarthritis is higher in obese people than in normal weight patients. A survey in the United States indicated that a 20% weight loss in knee osteoarthritis was associated with a 50% reduction in knee pain, and that weight loss reduced the incidence of knee osteoarthritis by 25%-50%.
(5) Joint instability, as age or disease affects the nervous system
With age or disease, the nervous system’s ability to control the muscles and sensation around the joint decreases, and the muscle strength around the joint also decreases, resulting in joint instability, and arthritis can easily occur in unstable knees.
(6) Nutritional deficiencies, studies have shown that if the intake of vitamin D is lower than 1/3 of normal
is lower than 1/3 of normal, the risk of osteoarthritis and joint pain in the knee joint is increased by 3 times.
2. Secondary
There is usually a clear history of trauma, resulting in cartilage damage, joint inflammation and ligament
or joint capsule injury, secondary to early traumatic arthritis into osteoarthritis, mostly in young and middle-aged patients with limited cartilage damage.
The course of the disease changes: degenerative lesions of articular cartilage and secondary periarticular osteophytes, which may involve all joint structures including subchondral bone, ligaments, periosteum, joint capsule and periarticular muscles in advanced stages.
II. Diagnosis.
The diagnosis of knee osteoarthritis is not difficult based on the patient’s symptoms, signs, and typical x-ray manifestations. To diagnose primary osteoarthritis, the first step is to rule out possible causes of secondary osteoarthritis, and the 1995 American College of Rheumatology revised diagnostic criteria for knee osteoarthritis as follows.
1. Knee pain most of the time in the last 1 month;
2. X-rays show bony vertebrae at the joint edges;
3. Laboratory tests of joint fluid are consistent with osteoarthritis;
4, Age greater than or equal to 40 years;
5. Morning stiffness less than 30 minutes;
6, frictional sound when moving the knee joint;
Confirmation criteria.
1+2
1+3+5+6
1+4+5+6
III. Treatment
Non-pharmacological treatment, pharmacological treatment, surgical treatment
The specific treatment should be chosen according to the age of the patient and the degree of the disease.
The aim of treatment for early osteoarthritis is to relieve pain and slow down the development of the disease, and non-invasive treatment methods should be used as much as possible.
In advanced osteoarthritis, the goal of treatment is to relieve or eliminate pain, increase the range of motion of the joint, and restore joint stability.
The aim of treatment for advanced osteoarthritis is to relieve or eliminate pain, increase the range of motion of the joint and rebuild joint stability.
1. Non-pharmacological treatment.
Psychoeducation
Because of the long duration of osteoarthritis and the impact of symptoms on work and life, patients often have a high ideological burden and high expectations for the treatment effect. Therefore, an important element in non-pharmacological treatment is psychological education for patients, so that they can have a good understanding of the nature and prognosis of the disease and reach a consensus with the competent physician.
(1) The aim of treatment of osteoarthritis is to relieve the pain and slow down the progression of the disease;
(2) There is no treatment modality that can reverse and stop the course of osteoarthritis.
(3) Early and proper treatment can significantly eliminate symptoms and improve joint function so that pain does not affect the patient’s quality of life.
(4) Treatment of osteoarthritis must emphasize early, standardized, and adequate course of treatment.
(5) Patients with advanced osteoarthritis should be actively treated surgically to avoid serious deformities of the joints.
Lifestyle
In addition to psychological education, patient education also includes education on lifestyle and functional exercise modalities. The core idea is to appropriately reduce the burden on weight-bearing joints and to perform reasonable functional exercises. The former can reduce the pressure on the joint surface, and the latter can improve the ability of the joint surface to withstand the pressure. The measures to reduce the burden are
(1), pay attention to rest, avoid running, jumping and squatting for a long time, and avoid climbing stairs and hills for a long time or frequently.
(2), through control of diet and aerobic exercise such as swimming, bicycling, walking on flat ground and other measures to reduce weight.
Functional exercise mode
Reasonable functional exercise refers to non-weight-bearing functional training to maintain maximum joint mobility, enhance muscle strength around the joint and increase joint stability, especially for the elderly, quadriceps exercise is very important for the treatment of osteoarthritis of the knee joint. Studies have confirmed that exercises to increase knee range of motion are based on isotonic contractions and need to be performed without resistance, otherwise they may aggravate the lesion of the affected joint. Activities to increase muscle strength are based on isometric contractions and need to be performed with muscle resistance exercises while keeping the joint position fixed.
2.Physiotherapy
The main function is to increase local blood circulation, reduce inflammatory reaction, and release muscle spasm
Hot compress, massage, traction, acupuncture
Mobility support
The load on the joint surface in the weight-bearing state is about four times the body weight. Therefore, the use of canes, crutches and walkers when walking for patients with osteoarthritis of the knee not only increases the support and reduces the weight of the affected joint, but also improves the patient’s balance.
Changing the line of negative gravity, orthopedic brace
3.Drug treatment
At present, there is no drug that can reverse and stop the course of osteoarthritis, but drugs have obvious efficacy in eliminating symptoms.
(1)Drugs for symptom control
NSAIDS, non-steroidal anti-inflammatory drugs
Tramadol
(2)Drugs to improve the condition and chondroprotective agents
Glucosamine sulfate
Glucosamine hydrochloride
(3), intra-articular injection drugs
Glucocorticoid, sodium hyaluronate
Role of sodium hyaluronate: The high viscosity of the synovial fluid in the joint cavity provides an almost frictionless surface for joint movement and is therefore very beneficial to normal joint function. Intra-articular injection of sodium hyaluronate can form a mucus-like protective film on the surface of articular cartilage and, at the same time, restore the normal viscous properties of synovial fluid that have been altered by the disease process, so as to lubricate joints, protect articular cartilage and inhibit inflammatory reactions.
4.Surgical treatment
When the patient has more serious persistent pain and obvious joint movement disorders, conservative treatment is ineffective, affecting work and life, surgical treatment can be considered. For patients with early osteoarthritis, arthroscopic joint debridement can be performed with good results. In advanced cases of deformity or persistent pain, periarticular osteotomy, joint fusion and artificial joint replacement can be chosen according to the patient’s specific situation.
Arthroscopy
Arthroscopic debris, synovial debris, and enzymatic degradation are removed from the joint cavity and the synovial membrane embedded in the cartilage surface is removed.
Indications for arthroscopic knee debridement: Patients with early knee osteoarthritis in whom at least 3 months of regular conservative treatment has failed; normal knee stability and range of motion.