As the saying goes, the legs get old before the person gets old, where old refers to the gradual appearance and aggravation of leg pain, joint deformation and stiffness, and restricted movement as a person ages, which seriously affects the quality of life of the elderly. There are many causes of leg pain, including diseases of the joints themselves, lumbar spine diseases, vascular and nerve diseases, etc., but the most important cause is osteoarthritis. The following is a vernacular version of the common problems in the diagnosis and treatment of osteoarthritis in the elderly.
I. Which is the right diagnosis when different doctors give different diagnoses for the same disease?
Different doctors may give different diagnoses for osteoarthritis of the knee joint due to joint pain, such as osteophytes, bone spurs, degenerative arthritis, senile arthritis, synovitis, etc. These names are customary or folk vernacular, and all of them have some reasonable components, but they are for the same disease. For example, after the invention of radiography, some patients with knee pain were found to have bone spurs or osteophytes in their photos, so this was considered the cause of the disease; therefore, the disease is mostly seen in the elderly and is related to aging or degeneration, so there is the name of degenerative or age-related arthritis; some patients are accompanied by joint effusion, and the joint fluid is related to synovial inflammation, so it is called synovitis, but there are many causes of synovitis. The current international term is “osteoarthritis”. Imagine the common word bun, there will be multiple local names, such as bun, steamed bun, etc.
How is osteoarthritis formed?
The main reason for the formation of osteoarthritis is “wear and tear”. Normal joints are similar to bearings, with smooth, wear-resistant friction surfaces and no nerves, so they move freely and without pain, and can be used for decades without breaking down. When the friction surface wears out, it does not grow into its original shape and becomes a bone spur, which has nerves and becomes painful when it rubs, stimulating the surrounding tissue and producing swelling and fluid. Similar examples, such as the violent friction of the hand to produce blisters, long periods of friction into calluses. In addition, diseases of the knee joint such as rheumatoid, trauma, etc. will accelerate the wear and tear of the joint surface.
Third, what daily activities affect the development of osteoarthritis?
The development of osteoarthritis is progressive and will not stop, just as people cannot return to old age; wearing shoes with a certain degree of flexibility, such as travel shoes, walking shoes and eating foods rich in mucopolysaccharides, such as jelly, can help protect the joint surface; some daily activities can accelerate the wear and tear of the joints and should be avoided, such as high heels, obesity, stair climbing, etc.; inappropriate Exercise is more wear and tear on the joint surface and should be prohibited.
Fourth, what is the appropriate exercise method?
There is a famous “Wolfe’s law”, the term “function determines the form”, the vernacular called “use into the waste”, meaning that the use of more strong, do not use the atrophy, but can not In this regard, the greater the intensity of the exercise, the better, it must be limited, excessive exercise will only accelerate wear and tear, aggravating the condition. Some ignorant people will advise the elderly to climb stairs, hills, and overflex the knee joints, which is wrong. The basic principles of reasonable exercise are: 1, painless exercise, especially not when the joint pain exercise, when the best method is less activity or inactivity; 2, different from person to person, different from disease; 3, gradual. Suitable exercise methods are: swimming and cycling (three-wheeled safer), these activities do not increase the weight of the joint, but also exercise muscle strength and body function; walking is also a relatively good exercise method.
V. Is Chinese medicine more effective than Western medicine in treating osteoarthritis?
Drugs can only relieve pain and cannot reverse joint surface wear, so they are only used for a short period of time when joint pain is evident. Long-term use of these drugs can produce serious side effects, such as gastrointestinal bleeding and perforation, drug-related hepatitis, and drug-related nephritis, the consequences of which are more serious than osteoarthritis itself. It’s just that Western medicine is more detailed and more accurate; while Chinese medicine is confusing, the good and the bad, the long-term use of toxic side effects research is limited, and there are false advertising lull, it is easy to make people fall for it, can not be used blindly.
Six, what is the purpose of physiotherapy?
The main role of physical therapy is to relieve pain, make people comfortable, and can not reverse the wear and tear of the joint surface, it is appropriate to carry out at home is more appropriate; if you endure the pain and suffering out of physical therapy, often outweighs the loss. Those who blow up the magic of physical therapy in fact and ordinary physical therapy mechanism is the same, but the money spent out more.
Seven, what is the purpose of closed treatment?
Knee joint closure therapy is also called intra-articular injection drug therapy, divided into two categories. One type is intra-articular injection of adrenocorticotropic hormone plus local anesthetics, mainly used for joint synovial inflammation is obvious, there is swelling and fluid, the purpose is to relieve pain, reduce fluid, because there is a risk of inducing infection, should not be used repeatedly; the other type is intra-articular injection of sodium vitreous acid, has the effect of lubricating the joint surface. Intra-articular injection therapy is effective in the early stage of osteoarthritis, similar to the maintenance of the machine; it is not effective in the late stage when the joint surface is severely damaged by wear, which is similar to the overhaul or replacement of parts of the machine.
In what cases is minimally invasive arthroscopic treatment available?
Osteoarthritis of the knee joint is sometimes combined with intra-articular free body, that is to say, there are broken bones in the knee joint, which affects the joint activity, at this time, removing the broken bones through arthroscopy can improve some of the symptoms, similar to removing the stones in the shoe; once the joint surface is severely worn and destroyed, simply removing the broken bones will not help. Imagine if the sole is worn out and you have to walk on all kinds of roads, what is the best way?
Under what circumstances do I need an artificial knee joint replacement?
If the sole of a shoe is worn out, it can be replaced with a new shoe or sole, and if the bearing is broken, it can be replaced, so the best way to replace a worn out knee surface is to replace the joint surface. For a specific individual, it depends on the understanding and requirements for quality of life whether the joint surface is replaced or not. If elderly patients suffering from osteoarthritis of the knee expect to have a good quality of life, such as not depending on others to live independently, travel, their own recreational activities, etc., they first need a pain-free knee joint, pain-free is the first element of a happy life, and this is when artificial knee replacement is necessary, which is the intrinsic motivation for the development of this method in Western developed countries.
X. What are the options available for a low quality of life?
The options are to use crutches, walk less or not walk at all, ask someone to take care of you, take pain medication, and suffer from pain. In the drama “Mu Guiying hangs her head”, the emperor rewarded She Lao Taijun with a dragon head walking stick, which was nominally used to beat the emperor and the ministers, but in fact it was because She Lao Taijun had knee pain and could not be cured, so the emperor gave her the walking stick to help her walk.
XI. How to understand the risk of surgery?
The most serious surgical risks are post-operative infection of the artificial knee joint and fatal pulmonary embolism, with the former occurring at about one percent and the latter at about one thousandth. If you decide to have surgery, you will have to face and bear the risks of surgery. Just like when you go out and take a car or an airplane, car accidents and air crashes are risks that you must face, but for convenience and speed, most people choose to take the risk; but if you want to have a good quality of life with no or little pain in your knee for the rest of your life, are you willing to take the risk of knee replacement? You can’t expect your doctor to give you a 100% safety guarantee, and both doctors and patients must realize that the only guarantee is the teaching of the sages of China more than 2,000 years ago: “Do your best and listen to God’s will”.