Osteoarthritis is a chronic, progressive, degenerative, and secondary proliferative joint disease associated with a variety of factors, and is a systemic disease. In Europe and the United States, osteoarthritis is more common in the medullary joint, while in China it is more common in the middle-aged and elderly, more in men than in women, and more common in the heavily weight-bearing knee joint. Osteoarthritis of the knee is not just a simple aging process, but its pathogenesis is very complex. This article discusses the clinical staging of osteoarthritis of the knee and the corresponding stepwise treatment.
Clinical staging:
There are five stages of osteoarthritis of the knee according to the clinical manifestations and imaging radiographs and relevant test data
(1) Early stage knee symptoms are aggravated after climbing or heavy activities, and there may be slight swelling and pain after heavy daily activities, and often no obvious abnormal changes are seen on X-ray.
In the early and middle stages, the knee joint is repeatedly swollen and painful, and the function of flexion and squatting is limited, which is aggravated when going up and down stairs. If the knee is gripped and flexed, a slight abrasive sensation can be detected,
X-rays show a slight change in the medial and lateral joint space of the knee or no abnormality.
In the middle stage, the mobility of the knee joint is still normal, but it is difficult to stand up and walk in the morning or after sitting for a long time, and the pain is obvious. Repeated swelling of the joint, unequal height of the medial and lateral joint gaps, and labral hyperplasia of the joint rim can be seen on x-ray.
In the middle and late stage, the knee joint is swollen for a long time, and the extension activity is obviously limited.
In some cases, the knee is swollen and stiff, with loss of extension function, and some people have valgus or inversion of the knee. Some people may have osteoporosis under the femur and tibial plateau.
Treatment methods:
1.Early treatment.
Reduce excessive walking, avoid strenuous exercise, obese people reduce body mass to protect joint cartilage, local pain relief creams, hot compresses, magnetic therapy, irradiation, etc. can be used. Pulsed electromagnetic field, millimeter wave, ultrasound, laser, ultra-short wave infrared and other physical therapy can also be used, these treatments are effective for osteoarthritis, with pulsed electromagnetic field and ultrasound being the most effective. Use drugs that inhibit the synthesis of articular cartilage, such as aspirin, anti-inflammatory pain, and botrytisone, with caution.
2.Early to mid-term treatment.
Oral loxoprofen sodium plus glucosamine, which has no obvious effect on cartilage synthesis, depending on the patient’s specific situation, can choose to promote the synthesis of articular cartilage, such as bivalirudin, ampicillin, sulindac, diclofenac sodium, etc. In order to protect the articular cartilage and quickly relieve pain, can also choose intra-articular injection in the knee cavity in the inner or outer side of the skeletal ligament, close to the lower edge of the skeleton as the entry point, choose a 9-gauge needle, the direction of the back up, no The needle should be pushed in a posterior-superior direction with no resistance, and injected with sodium glacial acid without changing the needle. Dexamethasone or tretinoin may be added for more severe symptoms. For patients with combined internal and external collateral ligamentitis of the knee, we can stagger the time and add painful injection, lidocaine, sodium bicarbonate, vitamin B1, B12, prednisone acetate.
3.Intermediate treatment.
Patients are required to take X-ray film, and CT, MR or puncture biopsy should be added if it cannot be confirmed, to exclude other diseases such as gout, chemical off, tumor, tuberculosis and other contraindications such as diabetes and cardiac insufficiency. The joint cavity is irrigated by the closed infusion method, the joint cavity is routinely disinfected and toweled, aseptically operated under local anesthesia, and both sides of the skeletal ligament are selected as the entry points. The transfusion strip and drainage bag were placed in a low position to drain the fluid from the cavity. After the first bag is finished, continue with compound salvia injection, and before the end of flushing, use a syringe to draw out the residual fluid in the cavity, and flush and inject once every two weeks, two to three times.
4.Middle and late stage treatment.
① Arthroscopic debridement This method has the characteristics of less trauma, less complications and faster postoperative recovery. In addition to joint lavage, this method can also be used to perform procedures such as synovial membrane, bone flab and free body removal, articular surface revision, subchondral bone drilling, meniscal revision and release of extra-articular support bands. Open arthroscopic debridement is an option because of severe swelling of the joint, unrelieved pain after the initial arthroscopic surgery, or mechanical locking symptoms of varying degrees, or persistent joint effusion, and poor results of arthroscopic debridement.
Proximal tibial osteotomy is performed to correct the abnormal loading stress on the coronal surface of the knee due to the abnormal tibiofemoral axis,
This can prevent or delay the pathological changes of osteoarthritis of the knee and relieve the symptoms. Currently, most plates, screws, and riding staples are used. However, we believe that the postoperative efficacy is not statistically significant regardless of the internal fixation material used.
5.Late treatment.
①Arthroplasty is suitable for young and strong people who are engaged in manual labor, who suffer from severe osteoarthritis of the unilateral knee or who have failed knee arthroplasty, but the patient loses joint movement after surgery, so it has been used less recently.
Total knee replacement is an option for patients of appropriate age who have significant narrowing of the joint space between the two compartments. Artificial knee arthroplasty is primarily indicated for patients over 45 years of age with severe knee pain that has been poorly treated conservatively or by other surgical methods, without serious organic lesions or foci of infection. The procedure provides the patient with a mobile and stable joint and corrects deformities. In recent years, as some patients have become more conscious of their quality of life and the public has become more aware, more and more people are choosing to undergo total knee replacement techniques or surface replacement.