Osteoarthritis is a chronic joint disease in which the main changes are degenerative changes in the cartilage surfaces of the joints and secondary osteophytes. The main manifestations are joint pain and immobility. It is also called “age-related arthritis”, “proliferative arthritis” or “degenerative arthritis” and is a chronic, progressive, degenerative joint disease that involves one or more joints. It most commonly involves the knee joint. It is a common disease in the middle-aged and elderly, as well as in people with heavy workloads.
It has been reported that 60% of people over 60 years of age suffer from this disease. As society ages, the number of patients with osteoarthritis of the knee will tend to increase. There is no ideal treatment for this disease, and it has become an important cause of reduced quality of life and disability in the elderly. The pathogenesis of the disease is caused by the degeneration of the bone and joint of middle-aged and elderly people or those who are engaged in heavy physical labor. Due to the imbalance of pressure on the joint surface and the excessive weight-bearing, the articular cartilage is worn out, the subchondral bone is exposed and hardened, and osteophytes are formed, resulting in a series of clinical symptoms and signs.
A. The main causes of osteoarthritis of the knee are.
1, chronic strain injury. Long-term poor posture, weight-bearing force, such as female textile workers, welders, planting greenhouse vegetable workers. Posture leads to knee cartilage damage.
2, obesity. Weight gain and the onset of osteoarthritis of the knee are directly proportional. Obesity is also a factor in the aggravation of the disease.
3, gender factors, the incidence of women is significantly higher than men, about 4:1.4 bone density. When the subchondral bone trabeculae become thin and stiff, their tolerance to pressure is reduced, so the chances of osteoarthritis increase in osteoporotic people.
4. Trauma and force bearing. Frequent knee injuries, such as fractures, damage to cartilage and ligaments. Abnormal state of the joint, such as in the post-patellar resection link in an unstable state, when the joint withstand muscle force imbalance and coupled with local pressure, there will be degenerative changes in the cartilage.
Second, the clinical manifestations of osteoarthritis of the knee joint are mainly
1, pain: almost all cases have knee pain. The degree of pain is generally mild and moderate, a few are severe, and occasionally severe pain or no pain. The pain is characterized by initiation pain, weight-bearing pain, active activity pain and rest pain. Knee pain is a common complaint of patients with this disease. The early symptoms are pain during stair walking, especially when going down stairs. In the later stages, pain even when not moving and pain even when sleeping, i.e. resting pain.
2. Swelling and deformation: Due to joint effusion, soft tissue degeneration and hyperplasia, bone superfluous formation, etc., joint swelling, deformation over time, and even semi-dislocation changes occur.
3.Dysfunction: The coordination of joint activities changes, such as playing soft leg, slipping feeling, kneeling feeling. There may be popping and grinding sounds when the joints move. Reduced motor ability, such as joint stiffness, instability, reduced range of motion, and decreased ability to live and work.
Diagnostic criteria for osteoarthritis of the knee.
1. History of repeated strain or trauma.
2. Knee pain and stiffness, more pronounced when waking up in the morning, relieved by activity, aggravated by more activity, and relieved by rest.
3. Late pain persists, joint activity is significantly limited, quadriceps muscle atrophy, joint effusion, and even deformity and intra-articular free bodies.
4. Friction sounds can be detected during knee flexion and extension activities.
5. Frontal and lateral X-rays of the knee joint show lip-like osteophytes on the joint edges of the patella, femoral condyles, and tibial plateau, sharp tibial intercondylar ridge, narrowing of the joint space, dense subchondral bone, and sometimes intra-articular free bodies.
Fourth, the treatment of osteoarthritis of the knee joint.
Appropriate health care and preventive measures should also be taken in the early stages of the disease, adhering to the principle of prevention. Osteoarthritis develops slowly, with mild symptoms and no obvious functional effects in the early stages, so not all patients need treatment, but only the appearance of joint stiffness and severe pain is an indication for treatment. The main non-surgical treatment methods are
1. Proper rest: Work and live within the limits of your condition, do not overload the affected joint, get wet, get cold, or overexert yourself, and avoid prolonged sitting and standing. The knee joint should not be left in a certain position for a long time, and the joint should be moved appropriately. Eliminate joint strain factors: obese patients should moderate diet, reduce weight, even if the reduction of 3-4 kg, the effect is very obvious; adhere to more car (including bicycle) less walking, especially less up and down the steps and walk uneven road.
2, quadriceps functional training
3.Specific methods refer to the specific discussion in the website.
4.Physiotherapy: It can relieve pain and muscle spasm, help improve blood circulation and reduce swelling. Hot compresses are available, preferably hot and humid. Hot air bath and hot spring bath can also be applied. Heat transmission or ultrasound therapy can be used to relieve subacute pain, and induction electricity can be used for muscle atrophy. Ultrashort wave, microwave, iontophoresis have good effect of anti-inflammation and pain relief. If there are conditions for warm mineral bath, whirlpool bath is more effective.
5, drugs: non-steroidal anti-inflammatory analgesics are still commonly used in the treatment of osteoarthritis effective drugs, commonly used drugs for ibuprofen, naproxen, fenbuterol, fotarine, etc.. The effect is better with drugs that relieve muscle spasm, but these drugs inevitably have gastrointestinal irritation. Patients with poor gastrointestinal tract are prohibited.
6, injection therapy: local pain injection and intra-articular injection, both should be strictly sterilized, accurate positioning. Injection therapy is characterized by the direct arrival of drugs to the local area of the lesion, which can eliminate inflammatory stimuli, block the occurrence and development of pathological reflexes, eliminate inflammatory exudative hyperplastic swelling, relieve muscle tension or muscle spasm, improve local blood circulation, and stop primary and excitation pain.
V. Surgical options commonly used are.
1.Arthroscopic surgery. The arthroscope not only allows you to see inside the joint cavity, but also allows you to flush the knee joint with sterile saline under the arthroscope, clean the synovial debris and cartilage fragments inside the joint, and drill holes in the badly worn and rougher areas to promote the repair of new cartilage, which is, of course, different from the original cartilage and is fibrocartilage rather than “original “hyaline cartilage. Fibrocartilage is much less biomechanical than hyaline cartilage, but it can play a compensatory role and can delay further cartilage destruction. However, arthroscopic surgery cannot be 100% effective, and even if the surgery is successful, it can only provide relief and does not address the root cause of the problem. The long-term effect of surgery is not certain.
2.Osteotomy. Osteotomies are used when the joint is not properly loaded, when the load is unevenly distributed, when one side is overloaded and the other side is intact, or when the knee is inversion or valgus. The osteotomy can correct the abnormal force lines and allow the more intact side to carry more weight, improving the weight-bearing status of the joint and thus reducing symptoms. The advantage of this procedure is that it is more suitable for patients who have internal knee valgus and have a lot of activities and are not willing to accept artificial joint replacement, once the osteotomy heals, it will not limit the activity level, but for patients with osteoarthritis, the effect of osteotomy is also temporary, and it is generally believed that this procedure can buy time for patients before the eventual replacement of artificial joints, and the effect can last about 5-8 years if the surgery is successful.
3. Chondroplasty. In the past, chondroplasty involved surgically removing the degenerated articular cartilage surface and the sclerotic subchondral bone plate, or drilling holes in the subchondral bone plate to promote cartilage repair. Although the repair is of fibrocartilage rather than normal articular cartilage, the fibrocartilage acts as a substitute to a certain extent and slows down the destruction of the joint. Recently, the concept of chondroplasty has changed, in which the degenerated cartilage is removed arthroscopically and a small amount of healthy normal articular cartilage is also excised. The normal articular cartilage is cultured in the laboratory for two weeks and then reimplanted into the joint, and the cultured cartilage stimulates the regeneration of the previously destroyed cartilage. The results for older patients with osteoarthritis are less clear. Due to the limitations, this procedure is not yet widely performed in China.
4.Joint cleaning. Joint cleanup is suitable for patients over 40 years old with swollen and painful joints, obvious osteophytes at the joint edges, free bodies in the joints, and patients with mid-stage osteoarthritis who do not want to do or cannot do artificial joint replacement. However, joint debridement can only relieve symptoms, and after several years, osteophytes will continue to occur and joint pain and dysfunction may recur. Therefore, patients should try to avoid excessive weight-bearing after surgery and insist on functional exercises to prolong the time of symptom relief.
5.Joint fusion surgery. This surgery is to remove the joint surface and fuse the bone with the bone, which can relieve pain and restore stable weight-bearing ability, but at the expense of joint movement, and is suitable for young and heavy workers. With the emergence of artificial joints, this operation has been done less and less, but joint fusion still has its special value, due to the limitations of our country, especially in remote rural areas, heavy physical labor, the patient is not in a position to perform artificial joint replacement, joint fusion is also a better choice, in the face of those patients who have failed to replace artificial joints, joint fusion can be the only choice.
6. Artificial joint replacement. The ultimate solution for osteoarthritis of the knee is to replace the joint surface with an artificial knee joint, which is generally only considered for patients over the age of 60. In younger patients, artificial arthroplasty is generally not considered except when there are no other options and the patient has severe clinical symptoms of the lesion. The key to the treatment of osteoarthritis of the knee is early diagnosis, medical education and timely targeted treatment.
A comprehensive treatment plan needs to be developed for different patients at different stages. In the early stages, conservative treatment is the main focus, combining rest and exercise. If the above methods do not improve the symptoms of osteoarthritis, surgery is required. —- performs a total knee replacement. Total knee arthroplasty is actually a surface replacement of the knee joint that removes cartilage and replaces it with a human artifact, like a tile project. It is a very mature procedure and many elderly people have benefited from it and are no longer suffering from the disease and can travel again. After the surgery, patients often express their heartfelt feelings, “If I had known that the results were so good, why would I have suffered these years. Often the sister does it first, and then takes the initiative to introduce the sister to the surgery. Before the operation is “iron crutch Li”, after the operation has become the swallow Li San (this is the patient’s own description). This shows the positive effect.
Sixth, the elderly should pay attention to the following points to prevent osteoarthritis of the knee.
1, try to avoid physical obesity, to prevent aggravating the burden of the knee joint, once the body is overweight, we should actively lose weight and control weight.
2, pay attention to walking and labor posture, do not twist the body to walk and work. Avoid squatting for a long time, because the weight of the knee joint when squatting is 3 to 6 times its own weight.
3, when participating in physical exercise to do a good job of preparation activities, gently stretch the knee joint, so that the knee joint fully active before participating in strenuous exercise. When practicing leg press, do not lift your leg too high to prevent excessive strain on the knee joint. When practicing taijiquan, do not squat too low, and do not play several sets in a row to prevent injury to the knee joint from being overburdened.
4, the knee joint encounter cold, vasoconstriction, blood circulation becomes poor, often making the pain worse, so in cold weather should pay attention to keep warm, if necessary, wear a knee brace, to prevent the knee joint from getting cold.
5. People with osteoarthritis of the knee should try to walk up and down stairs, climb less, stand less, and lift less heavy objects to avoid overloading the knee joint and aggravating the condition.
6, people with osteoarthritis of the knee, both to avoid excessive fatigue of the knee joint, but also to carry out appropriate functional exercise to increase the stability of the knee joint, to prevent muscle atrophy of the leg, which can not only relieve joint pain, but also to prevent the progress of the disease. It is natural for the knee to develop degenerative changes as we age, but it would be a mistake to stop exercising altogether as a result. Older adults who do not exercise are prone to osteoporosis and their bodies will lack agility and coordination, making them prone to falls that can cause serious fractures.
It is best for seniors to do exercises that do not damage the knee joint, such as swimming, biking, walking, etc. It is very important to strengthen the quadriceps muscles of the thighs, which will help to reduce joint symptoms, enhance the strength and endurance around the joints and increase the stability of the joints, maintain and increase the range of motion of the joints and improve the ability to perform daily activities.
7, in terms of diet, should eat more food containing protein, calcium, collagen, isoflavones, such as milk, dairy products, soy, soy products, eggs, fish and shrimp, kelp, black fungus, chicken claws, pig’s feet, lamb shanks, beef tendons, etc. These can not only supplement protein, calcium, prevent osteoporosis, but also grow cartilage and joint lubricating fluid, but also supplement estrogen, so that the bones and joints better calcium metabolism and reduce the symptoms of arthritis.
If you have knee pain, soreness, leg pain when going downstairs, or uncomfortable joints when the weather changes, you should pay attention to these symptoms, which are the initial signs of joint disease and should be promptly seen by a hospital. I believe that with the rapid development of modern medicine, there will be better treatment for osteoarthritis of the knee joint.