The general treatment of osteoarthritis of the knee includes health education for patients, self-training, weight loss, aerobics, joint mobility training, muscle training, mobility aids, occupational therapy, joint protection and aids for daily life, etc. A significant proportion of patients can reduce their symptoms and resume normal work and life through the above treatments.
I. Recommended treatment measures
1. Patients with a body mass index (BMI) of more than 25 should lose at least 5% of their body weight.
BMI (Body Mass Index, Body Mass Index in English, or BMI for short), is a number derived by dividing body weight in kilograms by height in meters squared, and is a standard commonly used internationally to measure how fat or thin the human body is and whether it is healthy. The BMI of healthy Chinese adults is between 18.5 and 24, and obesity is considered an important predisposing factor for osteoarthritis of the knee, so a BMI of more than 25 should be recommended for appropriate weight loss to promote recovery.
Body mass index (BMI) = weight (kg)/height (m) squared.
2. Aerobic low-intensity adaptive exercise.
Persistent aerobic low-intensity exercise can make the body’s respiratory, circulatory, digestive, muscular, skeletal and other systems get natural stimulation, keeping physical decline to a minimum, which has a huge effect on improving health. A large number of studies have shown that as long as you feel “a little tired” when exercising, you have reached the level of moderate aerobic exercise, so it is enough to feel “a little tired” or “a little tired” when exercising. The “slightly tired” or “a little tired” is enough.
3, non-steroidal anti-inflammatory and analgesic drugs.
Non-steroidal anti-inflammatory analgesics (NSAIDs) are the most commonly used drugs for the treatment of osteoarthritis, the purpose of which is to reduce joint pain and other symptoms, slowing the process of cartilage degeneration and the pathological progression of osteoarthritis. The American Pain Society recommends acetaminophen (e.g., paracetamol) as the drug of choice for osteoarthritis pain relief, with the main adverse effects being gastrointestinal and allergic reactions. At present, the choice of cyclooxygenase-2 inhibitors (such as celecoxib, etc.), its analgesic effect is strong, and there are few gastrointestinal adverse reactions.
4.Intra-articular injection of glucocorticoids.
Glucocorticoids (e.g. Depo-Provera) have anti-inflammatory, anti-rheumatic and anti-allergic effects and generally relieve the pain, soreness and stiffness of the affected knee within 2-4 hours after intra-articular injection. The recommended dose of intra-articular injection is 1-2ml/time. After obtaining good efficacy, the dose should be gradually reduced at suitable intervals from the beginning to the lowest amount that can fully achieve clinical efficacy for maintenance treatment.
5.For meniscal injury or free body formation, arthroscopic surgery is feasible.
The meniscus has the function of buffering pressure, reducing friction and increasing joint mobility in the joint, and damage to the meniscus will directly affect the function of the joint, accelerate joint degeneration and poor cartilage regeneration. Due to the nutritional support of joint fluid, some of the free bodies can continue to grow in the joint cavity, stimulating and accelerating the process of joint degeneration. Conventional conservative treatment, such as oral and topical medications, cannot eliminate or reduce the free body, and after the diagnosis is confirmed, the free body should be removed by surgery.
6, patellar support belt for short-term pain relief.
7, Chinese medicine dialectical internal and external treatment.
Chinese medicine generally classifies this disease as “paralysis (disease)” to treat, the so-called paralysis, that is, wind, cold, damp, heat and other evil Qi closed blocking meridians, affecting the flow of Qi and blood, resulting in pain, heavy, aching, numbness, or joint flexion and extension of unfavorable, stiff, swollen deformation and other symptoms of the limb bones, joints, muscles and other diseases collectively. Treatment is generally based on the basic principle of dispelling evil and opening up the ligaments, identifying the prevalence of evil qi and the deficiency of positive qi, and giving drugs to dispel wind, disperse cold, remove dampness, clear heat, resolve phlegm and remove blood stasis, taking into account “promoting paralysis and opening up the ligaments” orally or externally. Studies have shown that kidney deficiency and blood stasis are common in osteoarthritis of the knee, accounting for more than 60% of patients, and that kidney deficiency and blood stasis are also closely related to joint cartilage degeneration. In vitro and in vivo tests have shown that tonifying the kidney and invigorating the blood can increase the secretion of synovial fluid in the joint, reduce the destruction of cartilage cells, inhibit apoptosis, and have multi-target effects on various factors affecting joint degeneration, such as oxygen free radicals, NO, and RNA reverse transcriptase. The current dialectical treatment is often based on the method of tonifying the kidneys and benefiting the qi, eliminating blood stasis and opening the ligaments, together with acupuncture, massage and physiotherapy, etc. Most patients in the early stage of the disease can receive good therapeutic results.
8. Knee joint replacement.
For long-term non-surgical treatment is ineffective, serious deformation of the joint, and affect life can be reliable knee replacement. At present, the operation, instruments and postoperative support treatment of knee replacement are quite mature (see the section “What is knee replacement”), and most patients can resume normal working life through this type of surgery.
II. Possible treatment measures
1. Sodium hyaluronate injection in the knee joint cavity.
Hyaluronic acid is the main component of the synovial fluid of the knee joint cavity and is one of the components of the articular cartilage matrix, which plays the role of lubricating the joint and reducing friction between tissues;. Intra-articular injection can significantly improve the inflammatory response of synovial tissue, enhance the viscosity and lubricating function of synovial fluid, protect articular cartilage, promote the healing and regeneration of articular cartilage, relieve pain and increase the mobility of joints. The dose of intra-articular injection is often 25 mg/dose once a week for five weeks, which must be strictly aseptic. However, certain studies in recent years have concluded that the clinical efficacy of viscous substances such as sodium glassate is not clear, and therefore is not recommended.
2. Acupuncture point extraction.
According to current evidence from evidence-based medicine, acupuncture is significantly more effective than other methods such as massage and physiotherapy for the relief of patients with osteoarthritis of the knee with pain as the main complaint. However, whether this therapy has relevant long-term efficacy and expected regression is yet to be further studied. Acupuncture points are generally used: internal and external knee eye, foot Sanli, Sanyinjiao, hanging bell, Taixi and other dialectical points, twice a week for four weeks as a course of treatment.
3. Massage physiotherapy.
Massage can obviously alleviate the symptoms of the affected knee mainly stiffness, treatment is generally used patella massage, quadriceps, calf triceps and other techniques, twice a week, four weeks as a course of treatment. Infrared, laser, low frequency and other physical therapy can promote the absorption of local inflammatory substances, increase neuromuscular excitability and biological activity, cause local vasodilation, improve local blood circulation and tissue nutrition, and have a certain effect on relieving some of the symptoms of pain and stiffness.
4.Glucosamine or chondroitin sulfate drugs.
Glucosamine is the most important monosaccharide that constitutes polyglucosamine (GS) and proteoglycan in the cartilage matrix of joints. Normal people can synthesize GS through the amination of glucose, but in the chondrocytes of osteoarthritis patients, GS synthesis is obviously blocked or insufficient, resulting in softening of cartilage matrix and loss of elasticity, destruction of collagen fiber structure, and increase of cartilage surface lumen to make bones worn and destroyed. Glucosamine can block the pathogenesis of osteoarthritis, promote the synthesis of proteoglycans with normal structure in chondrocytes, and inhibit the production of enzymes that damage tissue and cartilage, reduce damage to chondrocytes, improve joint movement, relieve joint pain, and delay the course of osteoarthritis. However, the American Academy of Orthopaedic Surgeons has issued guidelines for the treatment of osteoarthritis of the knee in the United States in recent years, in which such drugs have been listed as not recommended for treatment.
III. Non-recommended treatment measures
1. Arthroscopic exploration and debridement.
It was previously thought that arthroscopic exploration and cleanup for the treatment of osteoarthritis of the knee was characterized by less pain, fewer complications, faster recovery, and significant efficacy. However, recent studies have shown that the long-term outcome of this procedure is poor, with patients recurring within 1 year, and that the procedure tends to aggravate the degenerative process of the joint. Therefore, arthroscopic surgery is not necessarily superior to physical therapy or drug treatment, and it is mainly only for patients with osteoarthritis who have meniscal tears or the presence of free bodies in the joint cavity, and does not support the widespread use of arthroscopy in other cases.
2. Puncture irrigation.
Joint puncture irrigation has been a highly controversial treatment for osteoarthritis. Theoretically, puncture irrigation can remove inflammatory substances from the joint, promote metabolism, and improve symptoms. However, after extensive research, joint cavity irrigation has not been effective and has increased the possibility of intra-articular infection and accelerated joint degeneration.
3. Foot orthopaedic devices.
This type of treatment is mainly aimed at restoring the mechanical and mechanical alignment of the joint, with a large one-time investment and inaccurate long-term efficacy, and treatment requires oral or topical medication, which can easily cause joint stiffness and impaired movement.