What are all the treatments for osteoarthritis of the knee? How to treat osteoarthritis of the knee? The knee is an important weight-bearing joint in the body and is very susceptible to strain. Osteoarthritis of the knee is mainly caused by degeneration and strain of the knee joint. It occurs in middle-aged and elderly people, especially postmenopausal middle-aged and elderly women. Its main symptoms are walking pain, joint stiffness, and in severe cases, joint deformity and activity difficulties, such as squatting difficulties. The incidence of knee osteoarthritis has a tendency to be younger. With the improvement of living standard and longer life expectancy, the quality of life will be seriously affected if the symptoms of osteoarthritis of the knee appear prematurely or if the diagnosis of osteoarthritis of the knee is confirmed without reasonable and standardized treatment and effective delay of disease progression and development of joint deformity. Why is osteoarthritis of the knee more common in middle-aged and old women? Osteoarthritis of the knee is more common in middle-aged and old-aged women, especially post-menopausal women, which is related to the changes in hormone metabolism level and body shape of women. After women enter menopause or menopause, the level of estrogen, which has a protective effect on articular cartilage and bone metabolism, decreases significantly. Decreasing estrogen levels will accelerate joint degeneration and lead to osteoporosis. In addition, after middle age, women are prone to obesity, weight gain will increase the burden on the knee joints, accelerating the wear and aging of the knee joint structure, causing degenerative arthritis. Wearing high heels is also a causal factor in increasing the burden on women’s knees. Why is osteoarthritis of the knee in women many unilateral onset and mostly medial? Due to genetic, developmental, lifestyle and other factors, women’s knee joints have a tendency to turn inward, and with the aggravation of degeneration, the inner side of the wear and tear is serious or collapsed, which will form the knee inversion deformity. In severe cases, it is manifested as “O” shaped leg. These patients tend to have relatively better preservation of the lateral side of the knee. If the knee joint is only one side of the compartment, traditionally speaking, only unicondylar replacement can not correct the line of force, and total knee replacement can correct the line of force, but if one side of the compartment can still be preserved, it is a pity to carry out total knee replacement. In recent years, a new concept has been proposed for the treatment of osteoarthritis of the knee with problems in the line of force, that is, if there are problems in the line of force and the unicondylar joint of the knee is still partially functional, osteotomies and orthopedic surgeries can be used to correct the line of force and slow down the time of knee replacement. Does obesity predispose to osteoarthritis of the knee? Weight gain is a cause of osteoarthritis of the knee, but it is not the main cause. Osteoarthritis of the knee is mainly related to women’s hormone metabolism and physiological characteristics. Women are less active and their bone and joints are less strong than men’s. Especially after menopause, the hormone level decreases and the joints degenerate faster. There is also a major problem with development. Many women with knee osteoarthritis have early onset of medial knee pain, which means that many have unilateral knee onset. Obese patients, although heavier, have a greater weight bearing capacity if they are stronger. With a good line of force, the knee is compressed both medially and laterally, and the knee is weight-bearing bilaterally, in which case the osteoarthritis progresses more slowly. What types of knee osteoarthritis treatments are available? Depending on the degree of progression of osteoarthritis of the knee, we tend to use a “ladder” of treatments: First ladder: mainly refers to non-surgical treatments, such as weight reduction, physiotherapy, medication, and arthrocentesis. Stage 2: Knee-sparing surgery, such as arthroscopic surgery, unicondylar replacement of the knee, osteotomies and orthopedic surgery. Third-stage treatment: i.e. total knee surface structure replacement, which is the ultimate surgical treatment. What refinements and improvements have been made to the treatment of osteoarthritis of the knee in recent years? Most doctors and patients have accepted and agreed on the three stages of treatment for osteoarthritis of the knee. In the last few years, many orthopedic surgeons have developed a consensus on how to perform knee-sparing surgery for patients with force line problems, which has resulted in a large number of patients benefiting from the surgery. For the treatment of patients with knee joint force line problems, eligible for the first osteotomy orthopedic surgery to deal with the force line problem, some patients can correct the force line, after the force line is restored, a short period of time may not be considered for joint replacement, especially for the 65 years of age or younger with force line problems of osteoarthritis of the knee, is more suitable. In layman’s terms, it means that the patient walks crookedly, and after the force line is corrected through surgery, the patient will not walk crookedly, and the patient will not have pain when he/she walks. This type of orthopedic surgery through osteotomy is a knee preserving surgery, which is more acceptable to patients. In the past, the force line was corrected by total knee replacement, which was less acceptable to older patients. Why is an osteotomy called a “knee-sparing” treatment? The knee osteotomy and orthopedic surgery is called “knee preserving surgery” because it corrects the knee joint force line and relieves the cause of joint pain, preserving all or part of the knee joint structure compared to “total knee replacement”. If a patient’s knee joint strength is corrected by osteotomy and orthopedic surgery, does that mean that he or she will not need to have knee replacement surgery in the future? It can be said that for older patients, around 65 years of age, if there is no pain for a few years after the surgery, or if the pain improves with arthroscopic or other conservative treatments, replacement surgery may not be necessary. This type of orthopedic osteotomy does not affect future joint replacements. Patients who develop significant indications for knee replacement in the future may be able to undergo replacement surgery. What are the indications for orthopaedic, arthroscopic, unicondylar and total knee replacement surgery? Patients with knee pain need to go to the hospital to find out which type of arthritis they have, which needs to be differentiated from rheumatoid arthritis, synovitis, knee infections, etc. It is also necessary to complete a full-length film examination of the standing position of both lower limbs and to evaluate the knee joint force line by measurement, as visual observation alone is not enough. If there is a problem with the knee joint force line, and there is a clear indication for surgical correction, the force line needs to be corrected, and most of the good force lines can be treated effectively by arthrocentesis and arthroscopy. Poor force line, only through the joint puncture or arthroscopy and other conservative treatment, may only be able to maintain a short-term effect. For those with good force lines, unilateral interstitial end-stage lesions can be considered for unicondylar replacement, which is also a knee-preserving surgery, with the option of total knee replacement in the future. For end-stage patients with limited knee motion, total knee replacement is recommended at an early stage if both compartments are severely diseased. What are the recommendations for prevention of osteoarthritis of the knee? Young people should strengthen exercise to store more physical capital, with age, you can gradually reduce the intensity of exercise, choose the best exercise suitable for you, do not hurt the knee exercise recommended walking, swimming (to avoid excessive force pedaling), low resistance bicycle riding, so as to strengthen the strength of the lower limbs. Physical exercise must be continuous, regular, standardized, not a moment, middle-aged and elderly people should control their weight, reduce the burden on the knee joints, up and down the stairs should not be brave, can be appropriate escalator and control the speed. Middle-aged and elderly women should pay attention to dietary supplementation of phytoestrogens before menopause. Postmenopausal to appropriate oral prophylaxis osteoporosis drugs. Diet: protein (milk, eggs), calcium (fish and shrimp, kelp, seaweed, fungus), phytoestrogens (soy products, Pueraria lobata), collagen (pig’s trotters, beef tendons) Avoid cold, damp, pay attention to warmth, keep a relaxed mood, more travel and outdoor activities. Because estrogen secretion is affected by exercise, mood and many other factors. For the prevention and treatment of osteoarthritis, do patients have any common misunderstandings? Myth 1: Some patients are afraid of pain or unwilling to crutches have no face, simply closed, or even bedridden; some excessive activity exercise; both are inappropriate. Crutches out of the activity is worth advocating, because of reduced activity, sedentary, easy to lead to functional decline, thrombosis. To avoid too much activity too fast, in the cold season morning exercise should not be too early, so as not to induce cardiovascular and cerebrovascular diseases, the loss is not worth the gain. Myth 2: A lot of calcium publicity has made many people obsessed with calcium supplementation. Under normal and reasonable diet, adults can get enough calcium through dietary supplementation. There is no need to take oral calcium supplements. For postmenopausal women, you can take part of the oral calcium, but the body’s ability to absorb calcium is limited, you need to take drugs to promote calcium absorption. But do not arbitrarily increase the dose of calcium drugs. Myth 3: Some patients with treatment osteoarthritis, indiscriminate use of drugs, hoping that through the drug quick fix. Some are afraid of drugs, and then the pain is also endured, do not take medicine. Some are afraid of puncture therapy, closed injection, worried about side effects. Long-term oral medication or local injection of drugs, there will inevitably be some side effects, oral painkillers, try to choose a smaller gastrointestinal response to the drug. For heavier joint pain, especially acute pain, appropriate pain relief is still necessary, because pain aggravates the inflammatory response. Appropriate application of analgesic and decongestant drugs in local puncture or closed treatment is also supported. Myth 4: Some patients are determined not to have surgery. In fact, knee replacement surgery and knee preservation surgery, are carried out more mature, the two types of surgery for different indications and period, according to the development of the disease needs and personal situation can be moderate choice. In rural areas, there is still less awareness of the disease awareness surgery, and many patients are not even willing to listen to the doctor’s advice. For patients with functional limitation of the knee joint, early surgery, the benefit is greater. Often appear in daily life, knee joint weakness, going up and down the stairs there is a ringing sound, joint strangulation, walking in a hurry will suddenly pain, etc., are to go to the hospital for examination and treatment? Knee bone and joint composition structure is relatively complex, often appear in different structural parts of the injury or symptoms. Knee cartilage, meniscus, cruciate ligaments, medial and lateral collateral ligaments, anterolateral ligaments, posterolateral complex and other structures are also gradually degenerated and strained. Patients with osteoarthritis of the knee often combine injuries to these structures and tissues. In the absence of a clear injury, downstairs pain, hear the ringing sound, violent activities when the local pain, are suggestive of meniscus or even cartilage in the knee joint have some damage, on the stairs, no strength to lift the knee, suggesting that the anterior cruciate ligament strain or injury, up and down the stairs are painful, do not exclude chondritis and chondromalacia patella may be. Remind everyone to pay attention to these small symptoms of the knee joint, in the early examination and clear diagnosis. Many patients with knee arthroscopy surgery, there is still pain after surgery, some are very good results, what is the main reason? Knee arthroscopy is a routine surgery, simple meniscus injury, synovitis, after treatment, relief effect is obvious, some patients combined with cartilage damage or even cartilage defect, as well as anterolateral ligament, posterior posterolateral complex injury patients, often left with pain after surgery. For patients with cartilage damage and defects, the main reliance on weight reduction, drug therapy, support protection, etc., the treatment is not effective can be considered cartilage transplantation. Patients with localized ligament injuries can be relieved by local closed injections or ligament reconstruction surgery. Each person’s situation is different, the efficacy is not the same, the disease and treatment are individualized. As the most commonly used weight-bearing joint in the human body, the knee joint is most prone to strain, so it is important to pay attention to more protection and better maintenance. You can’t always hope for a permanent solution, and many treatments have limitations, so you can’t expect too much.