Osteoarthritis of the knee is a chronic joint disease characterized by destruction of joint cartilage and secondary osteophytic lesions. It is also known as osteoarthrosis, degenerative arthritis, proliferative arthritis, age-related arthritis, and hypertrophic arthritis.
What are the symptoms of patients with osteoarthritis of the knee?
Osteoarthritis can be divided into two main categories: primary and secondary. Primary osteoarthritis occurs mostly after middle age, while secondary osteoarthritis can also occur in younger people. Secondary osteoarthritis refers to osteoarthritis that occurs after a known osteoarthritic disease is not controlled or not detected, such as an intra-articular fracture that results in an uneven joint surface and secondary damage to the articular cartilage, thus osteoarthritis can also occur in young people. There are many causes of secondary osteoarthritis, but the most common type of osteoarthritis in young people is traumatic osteoarthritis following trauma.
Osteoarthritis of the knee can be unilateral or bilateral, and is more common in women, who are often overweight. Symptoms appear after entering middle age. Feeling soreness and discomfort in the knee when walking from a sitting position and disappearing after walking for a period of time is a clinical manifestation of early knee osteoarthritis. As the disease progresses, it is found that activity does not relieve the pain and there is some difficulty in going up and down stairs, squatting and getting up from a seat, requiring a hand on the knee to support it.
There was also some swelling of the knee joint after more walking, and in some cases the knee was so swollen that some yellowish fluid could be drawn out. Due to the thickening of the synovial membrane and joint capsule, there may be a ringing sound when moving. In the end, knee deformities such as knee flexion contracture, “O” or “X” shaped legs, and even walking with crutches may occur.
What are the treatments for osteoarthritis of the knee?
I. General treatment and self-care
To date, no medication has been able to completely control its development or cure it. Some of the so-called effective drugs that boast of dissolving or eliminating the “bone spurs” are purely illusory. However, osteoarthritis is not an incurable disease and can be treated well with modern medicine.
First of all, the affected joints should be protected, so that they can get sufficient rest, do not overuse, should avoid making weight-bearing sports exercise, such as: climbing mountains, climbing stairs, long-distance walking, etc.. Prevention and treatment of osteoporosis, obese patients should actively reduce weight. Avoid mechanical injuries and use canes, crutches or other assistive devices to reduce the load on the involved joints. Appropriate exercise is beneficial to maintain and improve joint movement and enhance the muscle strength of the affected joint, commonly used are increased joint mobility training, quadriceps muscle strength enhancement exercise, etc.
Physiotherapy
Physiotherapy plays an important role in the treatment of osteoarthritis, especially for those who cannot relieve symptoms or tolerate drugs. In the acute stage, the main focus is on pain relief, swelling and improving function; in the chronic stage, the main focus is on enhancing local blood circulation and improving joint function.
Third, drug treatment
Oral non-steroidal anti-inflammatory drugs are often effective in relieving pain and reducing synovial swelling. Oral glucosamine drugs have a certain effect on promoting cartilage repair. Local injection of glucocorticoids is effective for limited tendonitis or aseptic inflammation of soft tissue secondary to periarticular joint. Intra-articular injection of hyaluronic acid is also effective in relieving symptoms and protecting articular cartilage.
Fourth, surgical treatment
There are mainly arthroscopic treatment, osteotomy, artificial joint replacement, etc.
What is arthroscopic surgery? What are its advantages?
Arthroscopy is a minimally invasive joint surgery that has been developed in recent years. It is performed by making two to three incision holes of about 5mm around the joint, inserting a metal tube with an illuminated lens into the joint cavity, magnifying the image on a monitor inside the joint, and observing the lesions inside the joint, so it is more accurate than observing the lesions inside the joint with the naked eye after the joint has been cut open, and at the same time inserting instruments for examination or surgery through another small incision hole, and performing a comprehensive examination and The procedure is performed under television surveillance. In layman’s terms, it is an examination and surgery at the same time, and the examination and treatment are performed simultaneously.
Because the arthroscope can see almost all parts of the joint, it is more comprehensive than cutting the joint; because the image is magnified, it is more accurate than cutting the joint; because the incision is small, there is less trauma, less scarring, faster recovery, and fewer complications. Most patients can go down to the ground the day after surgery and can be discharged three days after surgery. Arthroscopy confirms the diagnosis of difficult joint conditions and often achieves immediate results for injuries that have plagued patients for years.
What is the principle of arthroscopic treatment for osteoarthritis of the knee?
Arthroscopy is a new and advanced orthopedic technology that has been developed in recent years. The application of arthroscopy allows for the observation and diagnosis of diseases within the joint, and more importantly, the application of various arthroscopic instruments under arthroscopic surveillance allows for the treatment of a variety of pathologies within or around the joint.
The most commonly performed arthroscopic procedure for the treatment of osteoarthritis is called arthroscopic joint debridement. Arthroscopic debris, synovial debris, and free bodies are removed from the joint cavity through the arthroscope, and the structures within the joint are examined and treated at the same time if meniscal or ligament damage is found.
The reason why arthroscopy can treat osteoarthritis is
(1) A large amount of irrigation in the joint during arthroscopy removes the inflammatory material that causes pain, swelling and other symptoms.
(ii) joint cleanup removes cartilage, synovial debris and free bodies, preventing them from becoming entrapped in the joint and accelerating the wear and tear of the joint surface.
(iii) Arthroplasty heals concomitant damage to the meniscus and ligaments, restores joint stability, and removes factors that cause further joint degeneration.
Arthroscopic arthroplasty is based on arthroscopic debridement to remove floating unstable cartilage and promote cartilage regeneration, and debridement of hyperplastic synovium, which can reduce inflammatory response.
Arthroscopic joint drilling and arthroscopic subchondral bone microfracture are based on the first two procedures, in which subchondral bone in the area of cartilage defect is drilled or chiseled to cause fine fracture, thus stimulating cell differentiation within the bone marrow to form fibrous cartilage to cover the area of cartilage defect, it must be stated that: the cartilage thus obtained is fibrous cartilage, not hyaline cartilage which is characteristic of normal articular cartilage, and compared with hyaline cartilage In contrast to transparent cartilage, fibrous cartilage is less wear-resistant and less resistant to tension, but is much better than cartilage defects and exposed subchondral bone.
Cartilage degeneration and wear is the cause of osteoarthritis and its most basic pathological changes, thus dealing with cartilage degeneration and defects is the most important and fundamental treatment to cure osteoarthritis, but due to the poor regeneration and repair ability of cartilage.
At present, the fundamental repair of articular cartilage defects is still a medical challenge. There have been experimental studies in which tissue engineering techniques were applied to regenerate cartilage, and then the regenerated cartilage was implanted into the joint through arthroscopy to repair the defective cartilage. It is believed that in the near future, osteoarthritis can be cured by arthroscopy and tissue engineering techniques without removing the joint surface and without the use of artificial joints.
Which patients with osteoarthritis of the knee are suitable for knee arthroscopy?
First of all, it should be noted that for patients with osteoarthritis, different ages, different degrees of pathological changes, and the severity of the patient’s symptoms are all factors that must be considered in the choice of treatment.
Simply put, in early osteoarthritis, conservative treatment is the main focus, with regular and timely medication, quadriceps functional training and other treatments as ordered by the physician. In advanced osteoarthritis, there is significant deformity, the joint space is narrowed or nearly gone, and symptoms continue unabated, then joint replacement surgery should be performed. In mid-stage osteoarthritis, the joint is sometimes swollen, often painful, with symptoms of strangulation, and to some extent affects life, then arthroscopic treatment is the best option.
Specific case selection is available as follows.
(1) Arthroscopic debridement is not indicated for any patient with osteoarthritis. Arthroscopic debridement can be helpful when conservative treatment has failed, but is not a substitute for conservative treatment, osteotomy, or arthroplasty. In younger patients, if the inversion deformity is progressively greater, osteotomy is still required and arthroscopic debridement does not delay definitive treatment. In older patients, if the joint is extensively damaged, an arthroplasty is still needed.
(2) Age: There is no age limit for arthroscopic surgery, but because of the precise effect of current artificial arthroplasty and its good cost-benefit ratio, artificial arthroplasty should be actively recommended for patients older than 60 years of age, although the symptoms and X-ray performance are not very serious; for patients younger than 55 years of age, arthroscopic debridement can be performed first to temporarily reduce the symptoms and delay the need for artificial arthroplasty. For patients younger than 55 years old, arthroscopic clearance can be performed first to temporarily reduce symptoms and delay the need for arthroplasty.
(3) Mechanical symptoms: If there are mechanical symptoms such as locking and jamming, especially interstitial locking, it indicates that there may be free bodies, meniscal damage or synovial folds in the joint, and these mechanical symptoms are suitable for removal by arthroscopic surgery, which not only can eliminate the symptoms, but also can prevent further aggravation of the degenerative process.
(4) Degree of degeneration on radiological examination: Arthroscopic cleanup is suitable for patients with essentially normal or mildly narrowed joint space, or clinical symptoms such as pain and fluid accumulation that do not correspond to radiological manifestations.
(5) Efficacy of conservative treatment: For patients with significant joint pain or swelling, the application of arthroscopic treatment is considered when regular conservative treatment is ineffective for more than 3 months.
(6) Internal and external rotation deformity and flexion contracture deformity: arthroscopy cannot correct the alignment deformity, internal and external rotation deformity should not exceed 10°, and joint stability must be good. The knee flexion contracture should be within 3-6 months, and the degree should not be >30°, which can only be corrected through rehabilitation exercises after surgery.
(7) Other factors: If you are unable or unwilling to undergo artificial joint replacement or osteotomy for various reasons, you can try arthroscopic surgery; in addition, arthroscopy has a diagnostic role and can help determine the next step of treatment when the diagnosis and treatment are controversial.