I. Osteoarthritis of the knee joint
Clinical typing includes: free body type, synovial type, meniscal type, cartilage damage type, and mixed type.
Second, osteoarthritis of the knee joint, the general use of a stepwise treatment plan.
The first step is simple conservative treatment, including physical therapy, wearing knee brace, external and oral medication, etc.
The second step is conservative treatment with intra-articular drug injections, such as intra-articular sodium glutamate or hormone injections, to nourish and lubricate the joint cartilage.
The third step is arthroscopic surgery to preserve the joint, which is a minimally invasive procedure to clean up the broken cartilage, meniscus, free bodies and some of the symptomatic bones to improve joint function. This is accompanied by 1-2 courses of postoperative intra-articular sodium vitreous acid injections.
The fourth step is artificial joint replacement surgery, which removes the degenerated joint surface and replaces it with an artificial one, thus restoring the function of the knee joint and reaching the goal of complete radical treatment.
For secondary osteoarthritis, early surgery should be performed to correct factors such as poor force lines that cause osteoarthritis to occur.
In general, for patients with mild symptoms and a short course of disease, we recommend simple conservative treatment first, and if the results are not satisfactory, then they need to gradually “step up” to further treatment. For some patients with typical ratty (free body) or meniscal osteoarthritis, we recommend direct arthroscopic debridement surgery. For some patients with severe symptoms and significant narrowing of the joint space on X-ray, we recommend direct artificial knee replacement surgery.
III. Intra-articular injection
Intra-articular injections with sodium vitreous acid should be given once a week for 3-5 times as a course of treatment, and the next course of treatment can be repeated after an interruption of 3 months. For patients without diabetes mellitus, compound betamethasone can be added to the first injection.
IV. Topical medication
Diclofenac sodium ethylenediamine emulsion can be applied topically to the painful location around the knee and dried with a hair dryer in warm air for 5 minutes after application, 2-5 times a day, which can significantly improve the therapeutic effect.
V. Osteotomy orthopedic treatment of chondromalacia patellae
Patellar tenderness (patellofemoral osteoarthritis) can be a part of knee osteoarthritis, which manifests as pain in front of the knee when squatting, and in severe cases will affect going up and down steps, and can even affect walking on flat ground.
Patellar tenderness is often secondary to patellar malposition (tilt or subluxation) and can be alleviated by surgical orthopedic correction of the patella’s position. Therefore, for patients with chondromalacia patella, a CT scan at 30 degrees of knee flexion can be considered first, and if there is a significant tilt or subluxation of the patella, surgery can be recommended.
VI. High tibial osteotomy for internal knee valgus
Orthopedic surgery is most appropriate for internal derangement of the knee accompanied by early osteoarthritis.
VII. Arthroscopic clean-up surgery for osteoarthritis of the knee
Arthroscopic surgery is mainly applied to patients with obvious physical symptoms (such as don’t card, playing soft leg, etc.), and the main objectives are
1. Knee joint flushing. To remove disease-causing factors from the joint cavity and to clean up bone and cartilage debris produced by joint wear and tear.
2. Synovectomy. It is mainly applied to patients with recurrent joint effusion.
3.Articular cartilage revision to remove the cartilage that may detach.
4.Meniscus repair.
5.Free body removal.
6.Selective osteotomy. It is suitable for the bone superfluous that has direct influence on flexion and extension or the bone superfluous whose activity is close to detachment.
7.Intercondylar fossa molding. For cases where the intercondylar fossa is narrow due to hyperplasia.
Precautions for arthroscopic surgery for osteoarthritis of the knee.
1, preoperative nuclear magnetic examination of the knee joint is sought to have a full grasp of the preoperative situation of non-bony structures in the joint.
2. Knee replacement surgery may still be required eventually.
3. Arthroscopic surgery often requires 3-6 months of rehabilitation and careful rehab to restore the balance of the intra-articular environment of the knee joint.
4. Intra-articular injection of sodium vitreous acid or hormones is often required.
VIII. Artificial knee joint replacement surgery
Artificial knee replacement surgery is a radical surgery for osteoarthritis of the knee joint, and is indicated for severe osteoarthritis with significant pain symptoms.
Rehabilitation considerations for osteoarthritis of the knee
1. Combine work and rest, moderate exercise and sports.
Exercise and exercise must be moderate, according to their own feelings and appropriate adjustments, not overworked. Avoid excessive stair climbing, mountain climbing, squatting exercise. And pay attention to weight control, overweight is bound to cause wear and tear to the knee joint.
2. Protect yourself from the cold.
You can wear knee pads. Cold knee joint can lead to osteoarthritis symptoms aggravated, especially synovitis response will be aggravated. Wear fall pants early in the fall when it is cool, and take them off late in the spring when it is warm.
3. Long-term intermittent use of cartilage-nourishing drugs.
You can take long-term and intermittent cartilage-nourishing drugs, such as glucosamine, chondroitin sulfate, etc. For non-steroidal anti-inflammatory and analgesic drugs (such as Fentanyl, Fotarine, etc.), you can take them intermittently during the painful time, but it is not beneficial to take them for a long time.
Exercises for osteoarthritis of the knee joint
1, quadriceps (anterior thigh muscles) strength exercise method.
At the beginning, sit with the knee flexed, or supine position with the knee padded. Straighten the knee joint and keep it straight for 5 seconds and then relax, let the knee joint flex on its own, and count the 1st time in your mind; then straighten the knee joint again and keep it straight for 5 seconds, then relax and let the knee joint flex on its own, and count the 2nd time in your mind; …… until you exercise 10 times and then rest. The total number of exercises per day varies depending on the individual, generally 250-300 times. When you feel this exercise is easier, you can tie a 1 – 2 pounds of sandbags at the ankle.
2, the national rope muscle (rear thigh muscles) strength exercise method.
At the beginning, prone position will be straight knee joint. The knee will be bent hard, and maintain the state of hard bending for 5 seconds after relaxation, so that the knee straight, the heart silent count for the first time; then again the knee will be bent hard, and maintain the state of hard bending for 5 seconds after relaxation, so that the knee straight, the heart silent count for the second time; …… until the exercise 10 times after rest. The total number of exercises per day varies according to individual circumstances, generally 250-300 times. When you feel that this exercise is easier, you can fix a leather band at the foot of the bed, hook the ankle to the band and exercise the flexion knee joint.
3, the lower limb muscle isometric contraction exercise method.
The “lower limb muscle isometric contraction” is to make all the muscles of the lower limb tense, but the lower limb joints are not contracted by muscle extension and flexion activities. This exercise method is generally used in the early post-operative period, and generally does not lead to increased pain and bleeding.
4. Passive knee extension exercise method.
Supine position, heel pads, so that the lower limb relaxed, so that the knee joint as far as possible completely straight.
In the prone position, the upper part of the knee is padded, so that the lower limb is relaxed and drops naturally, so that the knee joint is completely straightened as much as possible.
5. Active knee flexion exercise method.
Supine position, try to bend the knee joint, so that the heel is close to the hip.
6.Passive knee flexion exercise method.
Supine position, the thighs will be high, so that the lower extremities relaxed, so that the lower leg in the role of gravity under the natural sag.
Supine position, with a bandage to pull the ankle, hands pulled up to the head end, so that the knee joint flexion.
Sit on the edge of the bed with the thighs at the edge of the bed, so that the lower extremities are relaxed and the lower legs drop naturally under the effect of gravity.
Stand with your hands on the head of the bed and gradually squat down to flex the knee.