Osteoarthritis, also known as osteoarthrosis and degenerative arthritis, is a degeneration of the articular cartilage covering the joint surfaces, resulting in a series of clinical symptoms. Many people think that osteoarthritis is a disease of the bones, but this is a misconception, because it is a disease of the cartilage, not the bones. The disease starts in the cartilage, not the bone.
So what are the symptoms of osteoarthritis? The symptoms of osteoarthritis are not always present after the cartilage in the joints has degenerated, but only some of the symptoms of arthritis are present. Most commonly, there is joint pain and limitation of joint extension and flexion, and this pain and limitation of function worsens with increased exercise loads. When the disease progresses further, the degenerated cartilage peels off like aging paint on a wall and falls into the joint cavity in a free state, which is the source of free bodies in the joint cavity. This is the source of free body in the joint cavity. Free body is the body’s garbage, which not only hinders the movement of the joint, but also causes more wear and tear on the joint cartilage as the joint moves. If a patient with osteoarthritis has a stuck joint, i.e., the joint cannot be extended or bent and is “frozen”, and there is a significant increase in pain, the clinical consideration is that there is free body in the joint and surgery should be performed.
People with osteoarthritis
Osteoarthritis is a very common disease, and the incidence of osteoarthritis in China is more than 9%. The onset of osteoarthritis is closely related to age. 60% of people over the age of 60 have osteoarthritis, and 80% of people over the age of 70 have osteoarthritis, so some people jokingly say that osteoarthritis is the ‘disease of the second half of life’. With the aging of our society’s population, the incidence of osteoarthritis is bound to increase. In addition to being age-related, osteoarthritis is also ‘more feminine than masculine’ – women are more susceptible to the disease than men, especially obese postmenopausal women, who are more likely to suffer from osteoarthritis of the knee.
This is mainly due to the decrease in estrogen levels after menopause, and the weight load that adds to the burden on the knee joint, in addition to being related to fat metabolism. Therefore, the people who are associated with osteoarthritis are the elderly, women, and obese people. However, osteoarthritis is not exclusive to the elderly. Some people who have exercised excessively for a long time also develop early degeneration of the joints, such as gymnasts, wrestlers, and weightlifters, who have engaged in strenuous exercise for a long time, resulting in degenerative changes or damage to the cartilage.
There are still many problems with the understanding of osteoarthritis, which leads to misconceptions about health care.
Misconception one.
Osteophytes are osteoarthritis. In fact, joint degeneration is a natural phenomenon in the human physiological aging process, and osteophytes are just imaging manifestations of joint degeneration. Having osteophytes does not indicate the presence of osteoarthritis, as some osteophytes are not accompanied by any symptoms. It is true that “osteophytes are usually present in patients with osteoarthritis”, but it is not valid to infer that “osteophytes are osteoarthritis”.
Misconception 2.
”The only way to cure osteoarthritis is to remove the hyperplastic bone”. In the clinic, we often see patients come in worried and ask: How can I get rid of the hyperplastic bone? The goal of treatment for patients with osteoarthritis is to relieve pain, improve joint function, and control disease progression, and does not force surgical removal of the hyperplastic bone.
Misconception three.
”If your joints are inflexible, you should exercise more”. This is a common misconception that exists among the majority of elderly patients. Exercise is right, but you have to pay attention to the way. With osteoarthritis if you do not exercise, it may lead to muscle atrophy, physical decline, osteoporosis, etc.. However, excessive exercise of joints such as climbing, squatting and standing can aggravate joint damage and be detrimental to symptom relief. Therefore, more suitable exercise programs for the elderly include swimming, walking and tai chi, that is, more upper body exercises. In short, excessive and strenuous joint exercises can only increase the burden on the joints, making the painful symptoms worse and the dysfunction more obvious.
Arthroscopic surgery is one of the ways to treat osteoarthritis
So, what approach should be taken for patients with osteoarthritis? Different measures should be taken according to different conditions and ages. In general, physical therapy is available for early stage patients, or appropriate rest is also possible. There are more methods of physical therapy, mainly through the local thermal effect to promote the inflammation to subside and improve the symptoms, such as infrared and spectrum instrument irradiation, local hot compress, Chinese medicine fumigation, etc. The efficacy varies from person to person. If the pain is obvious, oral or topical non-steroidal anti-inflammatory and analgesic drugs, such as anti-inflammatory pain, can be added, and intra-articular injection of sodium hyaluronate can be used at the same time, which can play the role of joint lubrication and protection of joint cartilage. If the above-mentioned non-surgical treatment does not bring about relief, arthroscopic joint irrigation and cleaning surgery is required. If the osteoarthritis is so severe that cleaning and flushing are not expected to help, then artificial joint replacement surgery may be considered. Artificial joint replacement surgery has been performed since the 1930s and is now a very mature technique.
Patients with osteoarthritis should have a low-fat, low-calorie diet, mainly light, and obese people should pay attention to weight loss. In addition, some vitamin C and D supplements are good for the bone joints.
To completely prevent osteoarthritis may seem like a difficult thing to do now. However, establishing good lifestyle habits can help reduce the occurrence of the disease, for example, maintaining proper body weight, preventing joint injuries, and reducing exercises that increase the load on the joints.
What other diseases can arthroscopy treat
The first arthroscope was designed by Japanese scholars on the basis of cystoscopy and was first used to observe knee tuberculosis. It has been developed for nearly 90 years, and the current equipment and techniques are quite mature, especially in the diagnosis and treatment of knee diseases.
At present, the majority of knee disorders are suitable for arthroscopic surgery, such as: unexplained joint swelling, various synovitis, mild to moderate traumatic osteoarthritis, senile degenerative osteoarthritis, intra-articular free bodies, meniscal injuries, cruciate ligament injuries, acute joint sprains, patellar subluxation, and so on. In recent years, arthroscopically guided closed reduction and internal fixation of intra-articular fractures has been developed, which not only reduces surgical trauma, but also can accurately reset the fracture and restore the flatness of the joint surface with the magnification of the arthroscope, which is conducive to the maximum recovery of joint function.
For the surgeon, the arthroscope can observe almost all structures in the cavity, which is more comprehensive than the traditional surgical incision; and because the image is magnified, it is also more accurate and detailed than the traditional incision. For the patient, recovery is quick and complications are minimal because of the small incision, trauma and scarring. Some patients are able to move around after anesthesia, which can be very beneficial for them to gain confidence in overcoming the disease.
With so many benefits, can arthroscopic technology completely replace arthroscopic surgery? The answer is no.
Arthroscopic technology is not a panacea, and there are still some diseases of the bone and joint that can only be solved by cutting into the joint. For example, very serious osteoarthrosis requires total knee replacement, and severe knee tuberculosis requires an incision and fusion. Also, even when arthroscopic surgery is performed, the joint may still need to be cut for a variety of reasons, and a combination of the two will solve the problem completely. Therefore, the surgeon will tell the patient preoperatively, “Do arthroscopic surgery, but the possibility of performing an incisional joint surgery cannot be completely ruled out.”
Indications.
Arthroscopy can be used to diagnose and treat a variety of knee disorders; for example, meniscal injuries, cruciate ligament ruptures, articular cartilage injuries, intra-articular free bodies (also called joint rats), and various chronic synovitis. Most sports injuries that cause knee swelling, pain, instability or strangulation that are ineffective with conservative treatment can be further diagnosed and treated with arthroscopy.
Contraindications.
Systemic or localized infectious diseases, such as fever due to infection, long boils on the skin near the knee joint. Severe hypertension, heart disease, diabetes, or other serious medical conditions in which the patient cannot tolerate anesthesia and surgery.
Surgical procedure.
After administering anesthesia, the patient is placed on his or her back on the operating table, and after strict sterilization, the procedure is ready to begin. A tourniquet is used to block blood flow to the lower extremity at the base of the thigh during surgery to reduce bleeding during surgery. Usually three small incisions of 1 cm in length are made in the anterior part of the knee joint. One of them inserts an inlet tube to inject sterile saline into the knee joint continuously to swell the joint cavity and facilitate the surgical operation; at the same time, it is able to reduce bleeding. The other two incisions insert an arthroscopic camera, which displays the real-time images on a monitor so that the surgeon can see what is going on inside the joint by viewing the monitor screen. The other incision allows for the insertion of various arthroscopic instruments to perform various surgical operations. For example, the structures inside the joint are explored with a probing hook, the diseased synovium is removed with an electric planer, the damaged meniscus is removed with a basket clamp, the free body is removed with a grasping clamp, and the cruciate ligament is reconstructed with the aid of a special positioner. The surgery is usually completed within 1 1/2 hours. After the surgery is completed, 3 small incisions are sutured and the lower extremity is wrapped with cotton pads under pressure to reduce swelling of the joint. The sutures are removed 1 week after surgery, leaving only three small 1 cm scars.
Complications.
As with any surgery, there are some complications associated with arthroscopic surgery. Examples include postoperative infection, neurovascular damage to the posterior knee, joint adhesions, and venous thrombosis of the lower extremity. However, the overall incidence is very low.
Rehabilitation.
The ankle should be moved the day after surgery with the affected limb slightly elevated to promote blood return. Muscle strength exercises of the lower limbs can be performed on the second day after surgery; you can walk on the ground, and depending on the condition, the affected limb can be fully weight-bearing, partially weight-bearing or non-weight-bearing when walking. Meniscectomy and free body removal surgery can be discharged in about 3 – 4 days; cruciate ligament reconstruction surgery and synovectomy surgery usually require 7 – 10 days of hospitalization due to more complicated postoperative rehabilitation.
Suitable for arthroscopic surgery.
1, meniscectomy, trimming, shaping, suture repair, absorbable meniscal nail (arrow) fixation repair, meniscal transplantation (homogeneous allogeneic meniscus with meniscal prosthesis transplantation) after meniscus injury.
2, joint inflammation such as septic arthritis cleaning and flushing drainage, tuberculosis lesion cleaning, osteoarthritis lesion cleaning and lavage.
3.Cleaning of lesions of synovial lesions (rheumatoid, gout, pigmented villous nodular synovitis, synovial chondromatosis, synovial embedding, etc.).
4.Repair and reconstruction of cruciate ligament injury.
5.Cartilage injury lesion cleaning, drilling decompression, drilling microfracture technique repair, cartilage transplantation.
6.Patellar fracture, tibial plateau fracture, type III tibial tuberosity avulsion fracture, intercondylar spine avulsion fracture repositioning and fixation under arthroscopic surveillance.
7.Recurrent patellar dislocation microscopic release of the lateral support band and medial tightening.
8.Intra-articular free body removal.
9.Scopic release of knee joint adhesions.
10.Microscopic removal of intra-articular soft tissue tumors and meniscal cysts.
11.Acute knee injury including joint cavity hematoma removal, meniscal interlock early examination and surgery.