Q: What is osteoarthritis?
A: Osteoarthritis, also known as osteoarthrosis, is mainly characterized by degenerative changes in joint cartilage and secondary osteophytes around the joint (often called “bone spurs”), and is more common in middle-aged and elderly people, especially women. The specific causes of the disease have not been fully explained, but obesity, heavy physical activity, excessive exercise, inappropriate exercise, advanced age, and genetic factors are all risk factors for the development of the disease. Multiple joints throughout the body can be involved, mainly the knee, hip, small finger joints, shoulder joints, and small joints of the spine. In China, osteoarthritis of the knee joint is the most common.
Q: What is articular cartilage?
It is the thin white brittle bone that we usually eat when we eat chicken and duck. The human body is a machine that after decades of operation, some of the cartilage in the joints is worn out. Unlike bone, cartilage is difficult to regenerate once it wears out (bone can be regenerated, even if an old man in his nineties breaks a bone, it can grow back). Without the protection of cartilage, the bones grind against the bones when walking, and the periosteum and surrounding synovial membrane are rich in nerves, so it is very painful. In the long run, the knee joint will be deformed and become O-legged or X-legged.
Q: Why does the articular cartilage degenerate?
This is due to mechanical factors, i.e., long-term repeated wear and tear, and obesity, excessive exercise, etc., will accelerate the wear and tear, at first manifested as focal softening, cartilage surface roughness, and gradually lose normal elasticity, followed by small pieces of detachment, irregular small depressions or lines of small grooves, mostly in the more loaded parts, then further appear tiny cracks or even erosion, ulcers, large pieces of cartilage detachment can lead to subchondral bone plate On the other hand, it is related to the individual’s physical condition, with older or obese women more likely to get osteoarthritis. From a micro-etiological point of view, the main mechanisms that have been identified are: dysregulation of cartilage matrix synthesis and catabolism, loss of cartilage cushioning due to damage to the subchondral plate, and focal intra-articular inflammation.
Q: What are the manifestations of having osteoarthritis of the knee?
Some people experience constant dull pain in the knee joint, some have swollen joints, and others experience sudden, severe pain when moving around, and a “weak leg”. Joint pain is usually worse with activity and less with rest. Joint pain is initially episodic, often triggered by cold, overexertion or minor sprains. Some people only have an initial attack once every year or two, but as the disease progresses, the attacks become more frequent and eventually become persistent pain.
If a joint remains stationary in a certain position for a long time, for example, after sitting for several hours, the joint starts to feel stiff when it gets up and moves, feeling like it is frozen or stuck, and accompanied by pain.
Most people also have difficulty squatting. Over the years, joint deformation may occur, most often in the form of “O-leggedness”.
Q: How should I treat osteoarthritis?
A: Early osteoarthritis should be treated conservatively to effectively reduce symptoms and slow down the progression of the disease. First, pay attention to the protection of joint cartilage, try to avoid strenuous, excessive and weight-bearing activities, such as repeated squatting, climbing stairs, walking long distances, lifting heavy objects, climbing mountains, etc. Obese people should control their weight. At the same time, strengthen the muscle strength around the joint: for example, lying flat on the bed to practice leg lifts, straighten the leg, hook the foot, raise one leg to about 45 ° to 60 ° (feet from the bed about 40 ~ 50 cm), adhere to 10 ~ 15 seconds and then put down, alternating between the two legs, do 3 ~ 4 each time, do several times a day in the morning and evening, as a way to strengthen the quadriceps muscle strength. If the joint pain is obvious, you can take oral anti-inflammatory and analgesic drugs, plasters and ointments, and joint cavity drug injections are also feasible. If the joint swelling is significant, high frequency physical therapy may be used. In addition, drugs that nourish cartilage are also indicated for early to mid-stage osteoarthritis.
However, if the osteoarthritis is advanced, the cartilage is so severely worn that conservative treatment is no longer effective. Surgery is the only way to relieve the pain and suffering of the disease.
Q: What kind of surgery is done for severe osteoarthritis of the knee?
This surgery is called knee arthroplasty, which simply means that a thin layer of cartilage that has broken down is removed and replaced with an artificial one, and a wear-resistant spacer made of special plastic is added in between. For example, if you have a table and the table top becomes pockmarked, instead of throwing away the whole table and replacing it with a new one, we remove the broken table top and replace it with a new one, leaving all the other parts intact. In some patients with special conditions, where the cartilage is more severely worn on just one side of the joint, we can choose unicondylar surface plication to obtain the same result with less trauma.
Q: How long is the hospital stay and can I move around like a normal person after the surgery?
Generally speaking, you will be hospitalized for 5 to 7 days, and you can walk on the floor and go to the toilet two or three days after the surgery, and after two or three months of rehabilitation training, you will be able to move around as normal. After two to three months of rehabilitation, you will be able to walk up and down the stairs, do housework, take a walk, ride a bicycle, swim, dance, travel, etc. You can fully meet the activity requirements of middle-aged and elderly people.
Q: Is the surgery risky?
As long as the surgical technique is excellent, there is no post-operative infection and scientific and effective rehabilitation training is carried out, the surgical results are very good. At the same time, the risk of surgery has a lot to do with the patient’s own physical condition. High blood pressure, diabetes and coronary heart disease can tolerate the surgery if they are well controlled.
Q: How long will the artificial joint last?
As long as it is not infected or broken, it can last for more than 15-20 years, and according to the literature, some have lasted up to 40 years. However, for elderly people with severe osteoarthritis, the sooner they have this surgery, the sooner they can enjoy the benefits of the disease.