What is osteoarthrosis of the knee and how should it be treated? Knee pain is very common clinically, from the classification of the situation seen in the clinic, first of all, we must exclude traumatic knee pain (that is, knee pain produced by various traumatic injuries such as excessive exercise, bruises, etc.), and then exclude some rheumatoid rheumatoid, infectious knee arthritis, etc. (all uncommon), the rest is basically osteoarthritis. Knee osteoarthritis refers to a degenerative disease in which primary or secondary degeneration and structural disorders occur in the cartilage of the knee joint surface, accompanied by subchondral bone proliferation and cartilage exfoliation, resulting in gradual destruction of the joint, deformity, and eventually knee dysfunction, and with the gradual aging of our society, the incidence of this will remain high. This is why patients always come to the clinic with the following complaints: knee pain without obvious trauma, initially light, with occasional episodes of pain, slowly worsening and becoming constant pain, and pain that is obvious after exertion and when going up and down stairs. In the morning, the joint feels a little stiff, and it gets better after moving around, but the pain worsens again after walking more. You can hear or feel a popping sound and a feeling of friction when you move your knee. The joint may even become deformed, making it difficult to do squatting movements. The knee joint is almost the most complex joint in the human body, it silently bears the weight of the body and the greater load brought by sports. What we need to know is that the knee joint has three articulating surfaces, which are like machine bearings that grind and slide against each other to produce the relative joint, and of course there are ligaments attached between and around the articulating surfaces, which on the one hand limit the range of motion, and on the other hand protect the knee joint from injury by stabilizing and cushioning it; there are two menisci between the upper and lower articulating surfaces, and this structure is just like the previously mentioned This structure is similar to the analogy of the “cushion” of the intervertebral disc, but there are differences, so you can understand it first. The gap between the joint surfaces is called the joint cavity, and there is a small amount of joint fluid in the joint cavity, which plays the role of lubrication, reducing the wear and tear of the articular cartilage surface, and nourishing the articular cartilage, just like we apply oil to the bicycle chain to reduce the wear and tear of the chain and gears, but when there is inflammation and pain, or joint degeneration, the joint fluid will increase or decrease, and the composition will change, but it will not play a protective role. Therefore, when the knee joint has too much inflammatory fluid, it should be punctured and extracted, and when the joint degenerates, the joint fluid can be injected into some lubricant such as sodium vitrate. Understanding the structure of the knee joint, it is easy to understand the pathogenesis of osteoarthritis of the knee joint: long-term poor walking posture, unreasonable strenuous exercise, excessive weight and high load on the knee joint for a long time, long-term work with weight and force, squatting for a long time, etc., will lead to wear and tear of the articular cartilage surface of the knee joint and injury to the surrounding ligamentous tissue, perhaps these strains are not usually perceptible because The body’s ability to compensate will repair and maintain. However, as we age, or as the strain increases beyond the limit of repair, it will slowly lead to disease. The surface of the joint surface is cartilage structure, just like the layer of “brittle bone” on the surface of the cylinder bone, as the wear and tear increases, the surface of the “brittle bone” is worn away, revealing the “brittle bone” under the bone cortex. The bone cortex, which is rough compared to the cartilage surface, and the joint surface will intensify each other’s wear and tear after grinding. At this time, the body’s repair capacity reaches its limit, it will do something “irrational” (in fact, it is also a protective response), the human body will be on the friction of the bone surface to re-grow bone, then the formation of bone proliferation, that is, the proverbial “bone spurs ” Why is osteophyte growth a protective response and a compensatory disease rather than a disease? The reason is that as the joint surface wears beyond the repair limit, the joint surface becomes uneven, and the body will try to make it “flat”, so that the bone will grow in the place of cartilage defects to replace it, but sometimes there will be too much replacement, and the protruding piece is like a “bone spur”. At this point, the wear and tear is further increased, and as time goes by, the body believes that the main role of the joint at this point is not to move, but to stabilize and reduce friction on the joint surface, thus reducing pain, so the upper and lower joint surfaces are not as important as the direct “anastomosis”, so the situation described above occurs. In the later stages of osteoarthritis of the knee, it is very difficult to bend. It is more important to find the cause of the spur, to correct it, to prevent it, to reduce the formation of spurs, and to slow down the disease process. Even if the bone spur is eliminated, the cause of the disease will not be removed, and the spur will grow back in a short time. What should I do if I have a bone spur? At present, the more recognized at home and abroad is the step treatment method, of course, before formal treatment is recommended to go to the hospital, physical examination, X-ray, CT, MR, clear diagnosis, exclude other tumors, tuberculosis, fractures, infections, meniscal damage, ligament damage and other diseases, clear degree of joint degeneration. The first step, if it is the first occurrence, the pain and discomfort is very intense, and the knee joint is not swollen, we should pay attention to rest and can take the general treatment. The first step is to raise awareness of the disease, to carry out appropriate exercise, to lose weight if you are overweight, it is recommended to take the exercise method of swimming instead of running, the latter is more loaded on the knee joint, if you can’t swim, you can refer to the later special muscle training method around the knee joint. In short, the core purpose is to prevent excessive joint movement and excessive weight bearing and to avoid mechanical injury. At the same time, you can do physical therapy, pain can be strong oral anti-inflammatory pain medication, such as indomethacin, diclofenac, ibuprofen, clonoxicam, etc., a line, the principle of taking medication lumbar disc herniation that has been told. It is very important to pay attention to the protection of the knee joint, exercise and prevention of reoccurrences once the symptoms appear, which is more important than the treatment, so it is emphasized several times. The first is pain medication, which can be divided into non-steroidal anti-inflammatory analgesics, the general analgesics mentioned above, and the better selective COX-II inhibitors, mainly the previously mentioned celecoxib, and further anesthetic|analgesics, central|neurological|systemic|analgesics, etc. The second specific drug is glucosamine sulfate. Patients always come to Shu Shu and ask if this is useful for knee osteoarthritis. I have checked the relevant literature and found that glucosamine is actually a component of cartilage and has the effect of repairing damaged cartilage cells, but its route of administration is oral, so there are doubts about the extent to which it reaches the cartilage surface of the knee, and it is generally not recommended. So should I use it or not? In a word: better than nothing, better than nothing. We also commonly use closed needle joint cavity injections clinically, the pain relief effect is also very good, but not long-term use. The third step, if the joint deformity, pain seriously affect the quality of life, conservative treatment is not effective, you have to surgery, arthroscopic surgery or open surgery or even artificial joint replacement technology has been very mature. Finally, let’s talk about exercise modalities and prevention. The core purpose is to prevent excessive joint movement and excessive weight, to avoid or reduce mechanical damage, to slow down the process of joint degeneration, or, as the saying goes, good maintenance, long life, less failure. There is one more thing to add, but it is also the most important: what are the most damaging forms of exercise for the knee joint? Climbing, too much going up and down stairs (especially downstairs), strenuous running, jumping and sports that do these actions such as basketball and soccer. It is recommended that after a certain age, because the repair ability of the human knee joint gradually decreases, the exercise style should gradually become calm, swimming, walking and cycling are recommended.