In recent days in the clinic to see a few patients with osteoarthritis of the knee, are in an advanced stage, need to perform knee replacement, it is very sorry, refer to a popular science article, write to learn together!
I. Concept
Osteoarthritis is a common chronic joint disease, also known as osteoarthrosis, degenerative arthritis, etc.. It is characterized by primary or secondary degenerative changes in the articular cartilage, as well as osteophytes.
The cause of the disease is not clear, and its occurrence is related to age, obesity, inflammation, trauma and genetic factors. The prevalence of the disease is more common in middle-aged and elderly patients, more women than men, and the prevalence can reach 50% in people over 60 years of age and 80% in those aged 75 years. OA is more likely to occur in joints with high load and activity, such as the knee, spine (cervical and lumbar spine), hip, ankle, hand and other joints.
Second, the performance
1, joint pain and pressure pain: initially mild or moderate intermittent hidden pain, better at rest, increased after activity, pain
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 obvious when accompanied by joint swelling.
2. Joint stiffness: stiffness and tightness of the joint when waking up in the morning, which can be relieved after activity. The duration of joint stiffness is usually short, often a few minutes to ten minutes, and rarely exceeds 30 minutes.
3.Joint enlargement: Hand joint enlargement and deformation are obvious, some knee joints may also cause joint enlargement due to the formation of bone redundancy or joint effusion.
4. Bone rubbing sound (sensation): Due to the destruction of joint cartilage and uneven joint surface, bone rubbing sound (sensation) appears when the joint moves, mostly in the knee joint.
5, joint weakness, activity disorders: joint pain, decreased mobility, muscle atrophy, soft tissue contracture can cause joint
Weakness, soft legs or joint locking when walking, inability to fully straighten or impaired movement.
6. X-ray examination: asymmetric joint space narrowing, subchondral bone sclerosis and/or cystic changes, joint edge proliferation and bone redundancy or with
The joint margins may be enlarged and the bones may become superfluous or there may be different degrees of joint effusion, and some of the joints may have free bodies or joint deformation.
Treatment
(a) Non-pharmacological treatment: It is the basis of pharmacological treatment and surgical treatment. For patients with osteoarthritis who are first diagnosed and do not have severe symptoms, non-pharmacological treatment is the preferred treatment modality to reduce pain, improve function and enable patients to have a good understanding of the nature and prognosis of the disease.
1. Patient education
Patients should be made to understand that not everyone over 40 or 50 years of age will suffer from this disease. In addition to ageing, trauma, obesity, inflammation, genetics, endocrine abnormalities, poor biomechanics and other factors are related to the occurrence and development of the disease. Therefore, educating patients to eliminate or avoid causative factors, such as proper rest, weight loss, avoiding mechanical injuries, using canes, crutches or other assistive devices to reduce the load on the affected joints, and performing relevant muscle exercises to increase joint stability, are all beneficial to the recovery and control of the disease.
2.Physiotherapy
Physiotherapy plays an important role in the treatment of osteoarthritis, especially for those who cannot relieve the symptoms with medication or cannot tolerate it. In the acute stage, pain relief, swelling and improvement of function are the main focus; in the chronic stage, enhancing local blood circulation and improving joint function are the main focus. Traditional treatment such as acupuncture, massage and tui-na can have certain effect.
3.Medical sports
Appropriate exercise is beneficial for maintaining and improving joint movement and enhancing muscle strength of the affected joints, which can be divided into the following three categories.
(1) Exercises to maintain maximum joint mobility: the patient should take the initiative to perform them, gradually, more than 3 times a day.
(2) Exercises to increase muscle strength: static exercise or isometric exercise is an easy and effective exercise to increase muscle strength.
(3) Exercises to increase endurance: outdoor exercises such as walking and swimming are suitable for patients with osteoarthritis and can enhance their endurance, ability to perform daily activities, and eliminate depression and anxiety. Different patients should focus on different exercises, such as cervical and lumbar spine osteoarthritis, frequent neck and waist rotation, flexion and extension exercises, hand osteoarthritis often for grasping, grip exercise, etc.
(4) Patients suffering from knee or hip osteoarthritis should avoid weight-bearing exercise, such as: climbing mountains, stairs, long-distance walking, etc.
(2) Drug treatment
1, analgesics and non-steroidal anti-inflammatory drugs
The elderly are prone to adverse reactions to non-steroidal anti-inflammatory drugs, especially attention should be paid to the side effects of the gastrointestinal tract and kidneys. It is recommended to take them after one hour after meal or apply Cilazol, 200 mg once by mouth, once or twice a day.
2.Glucocorticoids
Systemic use of glucocorticosteroids is absolutely unnecessary for osteoarthritis. A small amount of local closure is possible and should not be used repeatedly. It is not recommended to use intra-articular injection of glucocorticosteroids at will, and it is opposed to repeated use for many times, generally no more than 3 to 4 times a year.
3.Chondroprotective agents
At present, there are some so-called “chondroprotective agents” in the past, which are now renamed as disease-modifying drugs, including aminoglucan polysulfate, aminoglucan polypeptide complex, hyaluronic acid, glucosamine sulfate, etc. Some of these agents are aminoglucan in cartilage. Some of these agents are the basic components of aminoglucan in cartilage, which is the main raw material for synthesis of aminoglucan by chondrocytes, some can inhibit various protease activities in cartilage, and some can increase cartilage differentiation or stimulate chondrocyte growth. These agents are still in the exploratory research stage and should not be recommended for routine application to patients. Hyaluronic acid is the main component of joint fluid, also seen in articular cartilage. Intra-articular injection of hyaluronic acid has a certain effect on relieving symptoms and protecting articular cartilage, and is routinely injected once a week in an outpatient clinic for five weeks as a course of treatment, with attention to aseptic operation.
(iii) Surgical treatment
Including arthroscopic surgery, osteotomy, joint fixation, artificial joint replacement, etc.
Artificial joint replacement should be used for: (1) those who have severe pain and are not treated with various treatments; (2) those who have dysfunction and affect their daily life. Because artificial joints have a certain lifespan limit, and increasing the number of operations increases the difficulty and reduces the success rate, they are generally used for people over 60 years of age. Of course, as technology advances, the age limit may be reduced. The United States every year for the knee, hip osteoarthritis patients to perform artificial joint surgery 100,000 cases. As the standard of living of our people improves, it is believed that more patients with severe osteoarthritis will choose artificial joint replacement. Joint replacement surgery is the last salvage surgery, the current surgical techniques and prosthesis design have achieved more satisfactory treatment results, but there are traumatic, high surgical requirements, relatively long recovery time, expensive, once the failure of the consequences are severe, the patient and family economic and mental aspects are a serious test, so joint replacement should be careful! Be sure to go to the regular hospital orthopedics treatment!
Finally, I wish you a speedy recovery!