Diagnosis: 1. Clinical symptoms: localized pain, swelling, and stiffness of the knee joint. 2. Local signs: enlargement, swelling, effusion, limitation of flexion and extension activities, sensation of friction of activities, inversion, valgus, straightening of extension and limitation of flexion of the knee joint. 3. Adjunctive examinations: X-rays are most important, CT and MRI are of little value. Treatment: The overall treatment includes non-pharmacological treatment, pharmacological treatment and surgical treatment. For early to mid-stage patients, surgery is usually not required, but rather non-pharmacologic and pharmacologic treatments are used in parallel, while advanced patients usually require knee replacement surgery for treatment. In my clinical practice, the majority of early stage patients are around 50 years of age, most of the mid-stage patients are around 60 years of age, and most of the severe late stage patients are around 70 years of age, this division by age is very rough, just to facilitate the understanding and comparison with their own situation. The incidence of female patients is much higher than that of male patients, and the age range of onset is much earlier and more severe. In fact, the difference between patients is very large, and the term “advanced” here is completely different from the meaning of “advanced” tumors that we usually hear, which only refers to the pathological changes of osteoarthritis that are very serious and have little to do with life expectancy. The first thing you should do is to use a hot water bag or electric blanket to warm up your bed before you go to sleep. Special attention should be paid to keeping the knee warm in summer, as air conditioning is now ubiquitous. It is important to avoid the cold air blowing directly into the knee area and to avoid the overall room temperature being too low, so it is best not to wear shorts and skirts and not to expose the knee directly to the “cool” air-conditioned air. If you need to sit and work for a long time or watch TV or something like that, it is best to cover both knees with a small blanket to keep warm in winter and cool in summer. In the summer when sitting in a car because you have to open the air conditioning, so the car is best to have a warm blanket, cover the knees, the best way to drive people with a slightly longer blanket, just to use the insurance belt fixed in the waist, so as not to slip off. It is also important to avoid driving or riding motorcycles or electric cars, which can cause the knees to catch the wind. In short, you need to pay attention to avoid any situation that makes the knee cold and windy. 2, need to pay attention to avoid activities: should pay attention to try not to squat, do not kneel, do not sit on a small stool, do not sit on a low sofa, do not carry heavy things, do not climb buildings, do not climb mountains, not to keep squatting on squatting “practice” knee joint, these movements will produce a lot of stress on the knee joint, thus inducing pain, increase Wear and tear, so should be avoided. In particular, the effectiveness of conservative treatment is greatly reduced for people who live on the 4th floor or above without an elevator, and I usually take care that they “follow my advice for six months and if their symptoms do not worsen, then my method is effective. People living in villas and leap-frog apartments also need to be aware of the need to move downstairs as much as possible. These dwellings have only one flight of stairs, but actually require repeated trips up and down, so it is advisable to move the bedroom downstairs or install an internal elevator. Many farming tasks need to squat to do, also need to be careful to avoid, picking a burden even more not. When you stand up after sitting for a long time, if you have pain, stiffness and other discomfort, you should pay attention to the action of repeatedly flexing and extending the knee joints, followed by patting and rubbing both knees with both hands, and then stand up with both hands supporting the handrail to reduce the stress on the knees, which I call “one movement, two patting, three support” three-step process, and this is especially important in patients in the middle and late stages. 3. Training activities that are encouraged: Having said that, it does not mean that patients with knee osteoarthritis should not be active. There is ample evidence from evidence-based medicine that low-volume aerobic exercise can reduce the painful symptoms of arthritis. These activities include walking, bicycling, swimming, gentle dancing, etc. Of course, these aerobic activities also require a total level of activity. Moderate exercise activities, such as brisk walking, jogging, slow jumping rope, etc., are also possible, provided that a good warm-up is done; various ball games should be limited to non-confrontational, recreational-oriented sports, and the intensity and total volume of exercise should be controlled. For the purpose of competition, all kinds of confrontational and strenuous sports are recommended to be avoided. In summary, regular exercise in moderation is encouraged, but the level of intensity and total volume of exercise should be controlled, and a good warm-up should be done so that there is no discomfort in the knee on the day of exercise and for 2-3 days thereafter. Younger patients with early to mid-stage osteoarthritis need more activity training, and older patients with advanced osteoarthritis need to maintain their ability to walk. 4. Crutches: In elderly patients with advanced osteoarthritis, if the knee problem affects the ability to walk, it is recommended to use the opposite side of the cane or elbow cane, that is, if the symptoms of osteoarthritis are obvious on the left side of the knee, the right hand should be used to hold the cane or elbow cane, and vice versa. There are several advantages to using a cane: first, you can use it to reduce the force on your knee, second, you can remind yourself to move carefully to avoid falling, and third, you can warn others to avoid being hit. Medication: At present, there is a great divide in the use of medication, and individual physicians may have very different views. The following is my personal routine medication program at this stage of clinical work: 1. Painkillers: Chinese people often have great concerns about painkillers, believing that they cannot cure diseases, are addictive, have side effects, etc. These are very unfair prejudices. In fact, when the body is in pain, painkillers are a good thing, the patient is in pain, the word “pain” is very important, so painkillers are also very important, the key is the rational use. In the treatment of knee osteoarthritis, pain medication can be divided into two categories: topical and oral. Patients with mild pain in the early stages can often be pain-free with reasonable non-pharmacologic measures, so pain medication is generally not needed. Topical painkillers: Patients in the middle stage often have pain, and topical painkillers are preferred. There are a variety of topical creams on the domestic market, mainly Chinese medicines, but also a few Western topical medicines, which can basically be used. The efficacy of traditional Chinese medicine creams varies greatly among individuals, so a cream that A thinks is very good may feel very bad to B. Therefore, there is a trial and adaptation process at the beginning. The most important thing is not to believe in special drugs and secret recipes, all the “good for you” stuff is basically a blow. Oral painkillers: When the symptoms are severe during the attack period, you can add short-term oral painkillers, which can range from two or three days to less than two months. The preferred oral painkiller is acetaminophen, which is a century-old drug with good pain relief for mild pain and relatively mild side effects in the gastrointestinal tract, liver and kidney. There are many kinds of drugs, the most commonly used are non-steroidal anti-inflammatory analgesics, because the chemical structure and anti-inflammatory mechanism of these drugs are different from glucocorticoid steroidal anti-inflammatory drugs (SAIDs), so they are also called non-steroidal anti-inflammatory drugs (NSAIDs), they play the role of pain relief by inhibiting the sterile inflammatory response at the lesion site. The main side effects of NSAIDs are gastrointestinal and cardiovascular, and they are usually recommended to be taken for a short period of time when the symptoms are severe. ” refers to 2 to 3 weeks, or 1 to 2 months, for suppressing inflammatory response and relieving pain, thus improving quality of life, and because of the short duration of medication, the side effects of the drug can be well circumvented. These painkillers are called first-tier painkillers. If comprehensive treatment with longer-term first-tier painkillers still fails to relieve pain and seriously affects the quality of life, surgery or higher-level painkillers such as second-tier or even third-tier drugs need to be considered. Second-tier pain medications include tramadol and some weak opioids, which usually act directly on the central nervous system and have strong analgesic effects, but do not inhibit the inflammatory response of the joint itself. The most common side effect is nausea or even vomiting in the early stage of the drug, which will disappear after 2-3 days, and the incidence of this side effect can be greatly reduced by starting to take smaller doses. Because of its good analgesic effect, the new AAOS guidelines have upgraded its rating to “highly recommended”. The third tier of pain medications are strong opioids, typically represented by morphine. However, morphine has many side effects, including nausea, vomiting, constipation, respiratory depression, and most troublesome of all, it has a short duration of action, requires constant dosing, and is also an injection, making it extremely inconvenient to use. Addiction is not a concern for Chinese patients, as morphine has a low addictive potential when the body is in severe pain, and the patients who need strong opioids are ultra-elderly, inoperable patients with advanced OA, where pain relief is the focus and addiction is not. A better option than morphine is the use of buprenorphine transdermal patches, which are 30 to 50 times more effective than morphine for analgesia, require only a very small dose to work well, have no respiratory depression, are far less addictive than morphine, last up to a week after being made into a patch, and affect bathing. This patch is an excellent choice for advanced patients who cannot be operated. 2. Glucosamine sulfate: This is a class of drugs that is highly controversial in both the literature and the guidelines, but widely used in clinical practice, and their ratings in the guidelines go up and down, very erratically. is its explicit denial of the role of nutraceuticals. The best quality glucosamine sulfate is recognized as Viguride, produced by the Italian pharmaceutical company Roda, which was the first to develop glucosamine sulfate in the world and is currently the only such drug that has been shown to be effective in treating OA in the UK’s most authoritative evidence-based medical database, with no other manufacturer producing a similar product that has so far had better evidence of its effectiveness. The problem with Vigorous is that it has never been submitted to the U.S. Food and Drug Administration (FDA) for approval, and therefore is not available in the U.S. market. In Hong Kong, Macau, and Taiwan, Viguron is an over-the-counter drug that can be bought at Watsons and Mannings supermarkets for about 1/3 of the price on the mainland, except in Europe, mainland China, and other parts of the world, where it is a prescription drug and must be prescribed by a doctor. 3, sodium hyaluronate: the recent two new editions of the U.S. guidelines are also downgraded, but doctors in various countries are widely used in clinical practice this drug. The problem in China is that there are many manufacturers and the quality varies; the Sodium Hyaluronate used in our hospital is the first mass-produced Sodium Hyaluronate in China, and its reliability has been fully demonstrated by nearly 20 years of experience. It should be noted that intra-articular injection of sodium hyaluronate in the knee joint is an invasive operation, so it should not be performed too often. Intra-articular injections are a strictly aseptic procedure to avoid joint infection. The injection requires the patient to straighten the knee joint, enter the needle from both sides of the patella, remove the fluid if there is any accumulation, and ensure that the injection needle is in the joint cavity before injecting. When the knee is flexed, the patella is stretched tightly and the needle cannot be inserted from both sides. If the needle is inserted from both sides of the knee, it will enter the infrapatellar fat pad and cause more pain after injection. 4.Local closure: Local closure treatment can effectively relieve pain, but its duration is only about 4 weeks, and there is a risk of infection, and increases the risk of infection during the later artificial knee replacement surgery, so the loss is not worth the gain. Surgical treatment: If the patient’s symptoms are severe and significantly affect the quality of life, if conservative treatment is difficult to improve, and if the diagnosis of OA is confirmed by X-rays and the degeneration is more severe, then there is an indication for surgery, and artificial knee replacement surgery can be performed. Arthroscopic irrigation has been clearly proven to be ineffective, and many patients with OA are reported to have “meniscal damage” after an MRI, and therefore go for arthroscopic irrigation and repair surgery. However, this is a treatment that has been clearly denied because of strong evidence-based medical evidence of its ineffectiveness, and the procedure has not been covered by US health insurance since 2010, with European countries following suit since 2011 and 2012. The only procedure where arthroscopic techniques are effective in the treatment of OA is free body removal.