Treatment of osteoarthritis in middle-aged and elderly people

  Osteoarthritis is a joint disease that causes widespread pain, and surveys have shown that the prevalence of osteoarthritis in people over 55 years of age is 44% to 70%, and 10% of patients have functional limitations, which can be chronic and disabling in severe cases. China is entering the ranks of the world’s aging countries, and thus the incidence of osteoarthritis in the elderly continues to rise.  Treatment of osteoarthritis is divided into pharmacotherapy, non-pharmacotherapy and surgery: 1. Pharmacotherapy: mainly refers to the application of systemic and local analgesic drugs, such as non-steroidal anti-inflammatory analgesics fentanyl, furosemide and corresponding emulsions. However, these drugs have more side effects, especially gastrointestinal side effects, which limit the long-term application of these drugs. In recent years, xylazine drugs such as celebrex have also been used, which are specific COX-2 inhibitors with little gastrointestinal irritation. In addition, intra-articular injection of medical hyaluronic acid has a good effect on protecting the nutritional joint surface and relieving pain.  2, non-pharmacological treatment: chronic osteoarthritis for moderate physical exercise can improve functional energy, emphasizing the concept of rest for the affected joints, has been replaced by medical sports, however, physical exercise must be based on the specific circumstances of the patient, choose different treatment goals, within the range of motion of the diseased joint, by the patient automatically exercise, step by step. It can be divided into: exercise to increase joint mobility, exercise to enhance muscle strength around joints, and exercise to increase endurance, such as walking, bicycling or swimming, which can increase the patient’s oxygen capacity, improve cardiopulmonary function and sugar and fat metabolism to enhance endurance and physical fitness. For osteoarthritis of the lower extremities, walking aids can be used, simple ones such as walking sticks, which can reduce the load on the affected knee, and others such as walking frames and orthoses. In the chronic phase, physical therapy can improve joint function, while in the acute phase, it can help to relieve pain and swelling. Usually deep heat therapy is used, such as short wave, microwave, ultra short wave, ultrasound, etc. The use of pulsed electrical stimulation is also effective in relieving pain and improving function. In addition, the use of mineral spring therapy can also play a good effect on osteoarthritis.  3.Surgical treatment: For those who have severe joint pain that has not been treated with various treatments, or whose joint function is seriously impaired and affects their daily life, surgery is required to relieve pain and restore joint function.  Commonly used surgeries are: (1) Arthroscopic surgery: arthroscopic irrigation of the joint cavity, or both clean-up surgery, clean-up surgery includes shaving of hyperplastic synovial membrane, removal of stripped articular cartilage, repair of the joint surface, removal of bone redundancy, removal of intra-articular free bodies, drilling of cartilage defects, repair of ruptured meniscus, etc.  (2) Osteotomy: mostly used for orthopedic hip and knee osteoarthritis, through osteotomy to correct the force line and force distribution of the joint, to achieve the purpose of relieving pain and improving function, suitable for middle-aged and young patients under 60 years old.  (3) Artificial joint replacement: It is an important part of the surgical treatment of osteoarthritis. At present, hip, knee, shoulder, elbow, hand and foot joints can be replaced. Artificial total hip arthroplasty, one of the most widely used surgeries in clinical practice, is suitable for hip osteoarthritis over 60 years of age, with a more definite efficacy and an excellent postoperative follow-up rate of over 90%. Artificial knee surface replacement is suitable for severe knee degeneration. Knee unicondylar replacement, for osteoarthritis of the tibiofemoral compartment on one side, is less invasive because only the diseased joint surface is removed and fewer prostheses are implanted, although the technique is more demanding and requires precise positioning. Shoulder, elbow and wrist joints are non-weight-bearing joints and can be arthroplasty if necessary. Although artificial joint replacement is widely used, the indications must be strictly controlled in order to ensure a good outcome.  In recent years, there are some new techniques that are gradually moving from research to clinical application, such as autologous chondrocyte implantation, which has attracted widespread interest. The method is to use an arthroscope to take chondrocyte samples, then perform tissue culture for several weeks to expand the number of cells, inject the cultured chondrocytes into the articular cartilage defect, and cover it with a periosteal flap and suture it tightly. A more simplified sampling method has been reported in animal studies, in which bone marrow cells are aspirated and cultured to produce mesenchymal stem cells, which are chondrocyte precursors, and these cells are embedded in a biomatrix gel and then implanted into the cartilage defect to achieve cartilage repair.