I. What is osteoarthritis?
Osteoarthritis is also called degenerative arthritis, commonly known as “bone spurs” and “osteophytes”, but in fact is not an inflammatory disease, but mainly a degenerative change, which is the aging and wear of joints, especially the aging of joint cartilage. Osteoarthritis represents the aging of the joints and is therefore called age-related arthritis. Osteoarthritis is the most common joint disease and the prevalence increases rapidly with age; more than 50% of people older than 65 years have radiographic evidence of osteoarthritis, but 25% will be symptomatic. 80% of people older than 75 years will be symptomatic. Osteoarthritis is the leading cause of pain and disability in older adults. The main cause of osteoarthritis is the destruction of articular cartilage, the softening and loss of elasticity of the articular cartilage matrix, the loss of strength, and the sclerosis or cystic degeneration of the subchondral bone and the formation of bone fragments. This results in pain and movement disorders, which can lead to severe disability of the affected limb. Although osteoarthritis begins in the articular cartilage, it affects the entire joint structure, including the subchondral bone, ligaments, synovium, joint capsule and extra-articular muscles, and eventually results in joint deformity and loss of function due to total loss of articular cartilage.
Osteoarthritis is a degenerative disease of the joints that used to be thought of as a disease unique to the elderly, but recently it has been discovered that human joints can develop asymptomatic degenerative changes as early as 30 years of age, or even younger. When you reach the age of 40 or 50, you will experience symptoms that indicate that the degeneration of your joints has reached your bones and it is too late to start paying attention.
Osteoarthritis can occur in joints throughout the body and manifests as pain, swelling, friction sounds, deformities and limited movement in the corresponding joint. However, the incidence of osteoarthritis of the knee is the highest. Approximately 41% of patients with osteoarthritis have osteoarthritis of the knee. This is because the knee is a heavily loaded, active joint that is susceptible to trauma, strain, and wind and cold irritation. Simple knee degeneration first appears in the patellofemoral joint, and knee pain can appear in the 30s and 40s, manifesting as pain when going down steps and pain when standing up from a squat, but no discomfort when walking on a flat surface. When squatting, the knee joint can feel abnormal friction when touched with the hand. Some patients may also experience swelling of the joint. This stage of the disease is often diagnosed as “chondromalacia patellae”. Osteoarthritis of the knee is a very slow progressive disease, taking more than 10 years or more from the first painful episode to the advanced stage of the disease. However, many factors can accelerate the progression of the disease: including significant internal or external deformity of the knee joint at a young age, overweight, or some work that can increase the burden on the knee joint, such as long-term squatting, mountain field work, etc.
Second, osteoarthritis etiology.
The etiology of osteoarthritis has yet to be studied in depth. At present, the disease is generally divided into two major primary and secondary species. Primary is the most common.
1, age: age is the most risk factors, the incidence is directly proportional to age. With aging, repetitive use of the knee joint can stimulate inflammatory changes in the cartilage. In addition, the decrease in mucopolysaccharide content in cartilage in old age, the loss of chondroitin sulfate in the matrix, and the decrease in toughness make it vulnerable to mechanical injury and degenerative changes. Especially in more than 45 years old women are common, more than 50 years old women about 60% will be affected by this disease.
2, obesity: obese weight increases the load on the joints and due to changes in posture, gait, etc., resulting in changes in the biomechanics of the joints. Most obese people knee osteoarthrosis common site concentrated in the medial cartilage. Especially the lack of exercise obese people are more likely to suffer from this disease.
3, genetic: the prevalence of osteoarthritis in different races and populations is different and this inference is drawn.
4, estrogen: the incidence is higher in women and increases significantly after menopause, and is related to the discovery of estrogen receptors in articular cartilage. Therefore, many scholars inferred that the occurrence of osteoarthritis in female patients is related to estrogen.
5, climate factors: people who often live in a humid, cold environment have more symptoms. This may be due to the bottom of the temperature and poor blood circulation in the bone.
6, joint morphology: many patients with knee osteoarthritis have congenital knee valgus deformity or patellar subluxation deformity, etc.. The imbalance in the line of force makes these patients more susceptible to osteoarthritis than others of the same age.
7, joint strain: occupational types of work (miners, field workers, athletes, textiles, etc.) have a high prevalence. This means that strain on the joints can increase joint degeneration. Studies have shown that the incidence of knee pain and knee osteoarthritis in residents of buildings without elevators are higher than those in cottages.
8, other: joint trauma: fractures, dislocations, cruciate ligament and meniscus injuries can increase the local load and wear on the cartilage surface of the joint; severe trauma, especially fractures, may also change the function of other parts, leading to osteoarthritis. Rheumatoid arthritis, large osteoarthrosis, gout, diabetes, scoliosis and other diseases can lead to osteoarthritis of the knee.
Third, the signs and symptoms of osteoarthritis of the knee.
1. Pain.
The pain of osteoarthritis of the knee, the pain is mostly located between the patella and femur or around the patella, the medial side of the knee joint. The location can also be irregular. It is often unknown from time to time, sometimes with improvement, sometimes with weight gain, and pain at night. The pain increases at night when the knee joint is straightened, and when walking, even if you cannot walk at all. The pain is especially worse when going downhill and down stairs. You cannot squat when urinating or defecating, and when standing up, the pain worsens and you feel a clicking sound inside the knee joint. The pain is often related to the temperature, air pressure and environment, and worsens when the weather changes, so it is called “old cold leg” and “weather station”.
2. Swelling.
Swelling can be caused by fluid accumulation in the knee joint or by soft tissue degeneration and hyperplasia, such as synovial hypertrophy and fat pad hypertrophy. It is most often seen as a result of a combination of two or more causes. The swelling of the affected leg is obvious in contrast to the opposite leg and can be seen at a glance. Patients can sometimes feel a puffiness in the affected area when they touch it with their hands, and sometimes they feel a little warm.
Knee effusion can cause significant swelling, soreness and pain in the joint. When the fluid buildup reaches a certain level, the upper part of the patella may become swollen and protrude. This is caused by swelling of the suprapatellar bursa. As the fluid builds up, the posterior part of the knee joint also bulges. That’s why patients often say, “When I look in the mirror, the top part of the knee bulges up,” and in severe cases it looks like a goose’s head.” Chinese medicine calls this “goose head gangrene”.
Not all patients with osteoarthritis will develop fluid in the knee joint. Don’t exaggerate and be overly afraid of “fluid retention”. Nowadays, some people are very nervous when they hear “fluid”, but on the contrary, some people are very relieved when they hear “no fluid” and feel that it is not a big deal. From a medical point of view, edema is only a sign of osteoarthritis of the knee, and it does not mean that it is serious because of edema or that it is safe because there is no edema.
3. Deformity.
The most common deformity is inversion of the knee, called “O” shaped leg. There are also names such as “X” shaped leg and “K” shaped leg, which are based on the angle of the knee joint degeneration. These are all signs of advanced osteoarthritis of the knee.
4. Functional impairment.
This includes stiffness and instability of the knee joint. Patients often complain of a “weak leg” sensation and are often concerned about this instability. When there are free bodies in the joint, there may be “interlocking” and “popping”, causing sudden and intense pain, often accompanied by a sense of fear. The muscles around the joint can atrophy over time, and long-term joint pain can cause the patient to unconsciously remain in flexion, resulting in joint contracture and affecting the patient’s daily life and work.
Fourth, osteoarthritis of the knee in Chinese medicine identification.
Osteoarthritis of the knee is a Western medical diagnosis, but according to the theory and clinical manifestations of Chinese medicine, it belongs to the category of “paralysis” and “atrophy”. After a long period of exploration, TCM theory suggests that osteoarthritis of the knee is closely related to “deficiency”, “evil” and “stasis”. Liver and kidney deficiency is the root of the disease, wind, cold and dampness is the external cause of paralysis, and blood stasis is the pathological product of the disease process. The deficiency can lead to deficiency, and the deficiency makes it difficult for the evil and stasis to be removed, while the evil and stasis are both mutually affected. The treatment of this disease mostly adopts the methods of both tendon and bone, internal and external treatment, such as Chinese medicine, fumigation, manipulation, acupuncture, etc., which have achieved remarkable results. Because it is “green” and safe, it is very popular among patients.
When combined with joint edema or joint enlargement, the knee joint becomes goose head-like, so it is called goose head gangrene in Chinese medicine; when combined with inflammation, it is called epiphyseal gangrene in Chinese medicine; because knee pain is often aggravated by the external attack of wind, cold and dampness, so the people also call it “old cold leg”.
V. Treatment of osteoarthritis.
At present, medicine has no ability to reverse the course of osteoarthritis, and the condition of most patients will continue to develop and deteriorate. Therefore, the vast majority of patients need to be treated. The basic purpose of treatment is to relieve symptoms, improve function, delay the process and correct deformities, and improve the quality of life of patients. Therefore, conservative treatment cannot completely cure osteoarthritis, but it can relieve the symptoms and slow down the process. Only in advanced stages, the use of artificial joint replacement surgery is the fundamental method to completely solve osteoarthritis.
1. Self-care and self-medication.
The primary treatment for osteoarthritis is non-pharmacological. Its preferred method is to implement a proper lifestyle and acquire relevant health knowledge. This has a better effect on reducing pain, reducing the number of visits to the doctor, improving the quality of life and maintaining joint function. This includes appropriate physical exercise, diet modification, weight loss, muscle strengthening and related physical therapy, etc.
1) Actively eliminate or avoid causative factors.
Remove stress and rest: help the patient to face the disease and build up confidence. Do not overload the joints, get wet, or get cold. Avoid prolonged standing and sitting, and do not leave the joints in a certain position for too long.
Eliminate factors of joint strain: obese patients should lose weight appropriately, ride more, walk less, climb less, climb stairs, etc. According to the specific situation within the scope of the condition allows the correct and appropriate physical exercise to improve the metabolism of nerves, muscles and bones and joints to slow down the rate of its aging progress. This is because muscle exercise to increase joint stability not only relieves joint pain, but also prevents further development of the disease and facilitates its recovery. It should never be assumed that rest and inactivity is the only way to protect the joints. This is especially important for the weight-bearing knee joint. Pillows under the knee to relieve pain during sleep should be avoided. Wearing a knee brace or elastic bandage is very beneficial to protect the knee and other joints.
2) Exercise therapy.
Exercise for patients with osteoarthritis should be divided into two. Proper and appropriate exercise can prevent, slow down and slow down the process of osteoarthritis. Beneficial exercises include: swimming, walking, bicycling, supine straight leg raises or resistance training and non-weight bearing joint flexion and extension activities. Incorrect excessive exercise can aggravate osteoarthritis. Harmful exercises are those that increase joint torsion or overload the joint surfaces: activities such as climbing hills, stairs or squatting and standing.
Appropriate sports exercises are quite beneficial in maintaining and improving joint movement and enhancing muscle strength of the affected joints. Active non-weight-bearing exercises are the main focus, first for muscle strengthening exercises, and then gradually practice to increase joint mobility.
Four-step practice method: A, straight leg raise exercise: supine, the affected knee straight up 30-40cm, the heel is equivalent to the height of the toe on the healthy side, try to maintain in this position, can not hold on to the same time to put down the rest, the above count once. Then repeat the exercise, 10-15 times per group. Twice a day. B. Weighted straight leg raise exercise: the same action as above, the back of the foot should carry a certain amount of weight, can start from 1 kg, gradually increase to 5 kg, if you can adhere to more than 1 minute, you can carry out the next exercise. D. Weight-bearing long-arc exercise: the patient sits on the bedside, bends the knee 90°, drops the lower leg, the weight of the affected foot starts from 10 kg, gradually increases to 20 kg, sits and lifts the leg to straighten the exercise, if it can be insisted for more than 1 minute, the life and work can basically reach normal.
Sitting knee extension exercise: the patient is placed on the bed, the affected knee is straightened as much as possible, the foot is extended, the ipsilateral hand presses down on the knee, the contralateral hand bends to reach the foot.
Sitting knee swing flexion and extension exercises: the patient sits on the edge of the bed, with the affected calf hanging down, and presses the affected limb with the help of the healthy limb to increase flexion.
Supine knee flexion exercise: the patient lies on his back, the affected limb is flexed at 90°, the affected knee is flexed as much as possible, and the healthy limb is used to assist in pressing the affected calf to increase the flexion of the knee joint.
Kneeling knee flexion exercise: The patient sits on his knees in bed and kneels backwards on his own to increase the angle of knee flexion.
Lie down and “pedal the tricycle”: Every morning and evening, lie down in bed and imitate the action of pedaling the tricycle. The lying position can reduce the burden of the easily damaged joints; all joints from the ankle to the shoulder joint should be exercised.
Water exercise: Water exercise is supported by the buoyancy of water and can reduce the pressure of weight on the knee joint, especially in obese patients. It also helps to strengthen the patient’s cardiorespiratory function, improve muscle endurance, even if they accidentally fall, so it is not easy to lead sports injuries, more use of swimming can help the recovery of patients with osteoarthritis of the knee.
2. Diet therapy.
Currently targeted dietary therapy seems to lack in-depth research. The most common is the propaganda of supplement}. Patients with osteoarthritis of the knee should be given adequate attention in their diet.
Consume foods high in calcium: to ensure the normal needs of bone metabolism. The calcium intake of the elderly should be increased by about 50% compared to the average adult, that is, not less than 1200 mg of calcium per day composition, so it is advisable to eat more milk, eggs, soy products, vegetables and fruits, and if necessary, calcium supplements. However, there should be noted that calcium deficiency in the body mostly leads to leg cramps and osteoporosis, and osteoarthritis both have great differences in pathology and clinical manifestations. From a medical point of view, osteoporosis produces “osteophytes”, which are related to the above-mentioned osteophytes due to osteoarthritis and jointly affect the production of osteoarthritis, thus calcium supplementation for the prevention and treatment of osteoarthritis It is not obvious that it is effective, so do not stop other treatments just because you have taken calcium supplements.
Eat high amounts of vitamin D foods: Vitamin D can help the absorption of calcium. Therefore, you should take more D dairy products or tablets containing D to help the absorption of calcium.
Increase the intake of multivitamins: Vitamin C tablets are essential for antioxidants and type II collagen synthesis. Recent studies on micronutrients for osteoarthritis have found that a high intake of antioxidants, especially vitamin C, may protect the joints to prevent the progression of osteoarthritis, so taking vitamin C orally is beneficial. Other elements such as A, B1, B6, B12, C and D as well as elements necessary for building bone, such as minerals such as calcium, V, selenium, zinc, and gummy foods increase intake appropriately.
3.Physical therapy.
Physiotherapy is physical therapy. It plays an important role in the treatment of this disease, especially for those who cannot relieve symptoms or tolerate drugs. In the acute stage, the main focus is on pain relief and swelling reduction; in the chronic stage, the main focus is on enhancing local blood circulation and improving joint function.
Heat therapy, hydrotherapy, wax therapy, ultrasound, vinegar ion introduction, etc. can be used to relieve pain and accompanying muscle spasm and help maintain and restore joint function. Heat therapy for 15-20 minutes before joint exercise can help relieve joint pain and reduce stiffness. The skin should be washed first to prevent burns; conductive heat and ultrasound therapy are prohibited for joints that have undergone arthroplasty and are equipped with metal components to avoid deep burns. Conditions can be better for spa baths and other effects.
4, drug treatment.
Since the 1990s, international attention has been paid to the study of osteoarthritis treatment, and the treatment drugs are divided into two categories of drugs to improve the symptoms and change the condition. For patients with early or mid-stage osteoarthritis, compared with other methods, drug therapy has the advantages of being accessible, easy to use, reliable and easy to maintain, which is worth promoting in this area that has not yet been generally emphasized in China.
Although many of these drugs are available to treat osteoarthritis, none of them can reverse and stop the course of osteoarthritis. Medication can only reduce symptoms for a period of time. Therefore many patients eventually progress to an intermediate to advanced stage and will have to undergo surgery.
Oral medications include the following.
① Anti-inflammatory painkillers: Acetaminophen is preferred abroad, which is effective in relieving pain, has few adverse effects and is inexpensive. Usually the total amount of 1 day does not exceed 3g, but long-term high dose use has been reported to cause liver or kidney damage. If these drugs are not effective in relieving pain or are accompanied by knee joint effusion, other drugs should be used.
②Non-steroidal anti-inflammatory drugs: These drugs have anti-inflammatory, analgesic and antipyretic effects, and are the most commonly used drugs to treat osteoarthritis. However, some of them, such as aspirin, salicylic acid, pautazone, indomethacin and naproxen, have an inhibitory effect on the synthesis of proteoglycan in the joint cartilage matrix, which is not conducive to osteoarthritis and should not be used, at least not for a long time. Other drugs, such as diclofenac, meloxicam, nabumetone, etodolac, sulforaphane and acimicin, have no adverse effect on the synthesis of cartilage matrix proteoglycans, and even have a role in promoting synthesis, which is suitable for use. Moreover, meloxicam, etodolac and nabumetone, which are selective cyclooxygenase-2 (COX-2) inhibitors, have comparable gastrointestinal safety to specific COX-2 inhibitors and have fewer cardiovascular and renal adverse effects.
Risk factors for gastrointestinal damage associated with these drugs include: age 65 years or older, history of ulcers, heavy use of multiple NSAIDs, concomitant corticosteroids, continuous use for more than 3 months, rheumatoid arthritis, female, smoking, and alcoholism.
Opioids: In patients with moderate to severe osteoarthritis of the knee, opioids are used as a last resort when the above medications fail to relieve pain. The drugs often used in this category are codeine and tramadol. They are effective, but the adverse effects of these drugs, such as nausea, vomiting, diarrhea and excessive sweating, as well as a certain degree of tolerance and potential dependence, are worthy of attention.
④ Glucosamine: Anti-inflammatory drugs can only relieve or reduce the symptoms of osteoarthritis, not alter its lesion progression. For this reason, people have been exploring disease-modifying drugs to control the development of osteoarthritis for many years. Glucosamine is considered to be the first disease-modifying or slow-acting drug for osteoarthritis, as it has both anti-inflammatory and pain-relieving effects on the development of knee osteoarthritis. In vitro experiments have also confirmed its good effect on cartilage metabolism, and it is also called a chondroprotective agent. Long-term treatment with glucosamine can stop the progression of osteoarthritis of the knee. In the United States, glucosamine is a nutritional product available in supermarkets. In Europe and elsewhere, it is a prescription drug. In recent years, it has been gaining attention from clinicians and patients in China. If you can seize the opportunity to start and adhere to longer-term treatment in the early stage of osteoarthritis, you may have taught good results.
Diacerein: This drug can inhibit the activity of metalloproteinases and stabilize the lysosomal membrane to play an anti-inflammatory and protective effect on joint cartilage, thus improving the course of osteoarthritis. Trials have shown that it can significantly improve the patient’s symptoms, and its adverse effects are only transient diarrhea.
Intra-articular injections.
There are two main types of drugs that can be injected into the joint cavity, one is a hormonal drug and the other is a hyaluronic acid preparation.
(1) Hormonal drugs: Some physicians still use intra-articular injections of hormonal drugs to treat osteoarthritis. Although it can temporarily reduce pain, multiple intra-articular injections of hormonal drugs can degenerate the joint and lead to “corticosteroid arthropathy”. Hormones also inhibit the synthesis of normal joint cartilage matrix and increase the likelihood of infection. Therefore, hormone injections can only be given once in patients with joint oozing and severe pain.
② Hyaluronic acid preparations: The high viscosity of the synovial fluid in the joint cavity provides a virtually frictionless surface for joint movement and is therefore very beneficial for normal joint function. In osteoarthritis, hyaluronic acid is destroyed, the viscosity of the synovial fluid is reduced, lubrication is lost and the smooth movement of the joint surface is lost, leading to further destruction of the joint. Intra-articular hyaluronic acid supplementation is beneficial in relieving joint pain, increasing mobility, eliminating synovial inflammation and delaying disease progression. These drugs are mainly used in osteoarthritis of the knee for those who do not respond well to conventional therapy or who cannot tolerate painkillers or non-steroidal anti-inflammatory drugs.
Hyaluronic acid preparations are extracted and purified from chicken crowns and are therefore contraindicated in people with allergies to chicken or eggs. Domestic preparation of sodium hyaluronate injection is given once a week in the joint cavity for 5 consecutive weeks as a course of treatment. Imported preparations such as sodium hyaluronate, once a week for 3 consecutive sessions.
Among the above mentioned drugs, vitamins and glucosamine can be used as basic and long-term drugs. Diacerein can be used in combination with glucosamine or alone at the beginning of treatment. Anti-inflammatory analgesics can be applied at any time for a short period of time depending on the patient’s manifestations such as joint pain or swelling. Hyaluronic acid supplementation therapy has a good effect of improving symptoms, improving function and improving quality of life, and should be promoted for patients with indications and conditions.
5.Comprehensive treatment of Chinese medicine.
For thousands of years, Chinese medicine has not only accumulated rich clinical experience in the treatment of knee pain, but has also gained new insights into its modern mechanism of action in the treatment of osteoarthritis of the knee. Chinese medicine emphasizes both internal and external treatment, combination of movement and static, tendon and bone, and cooperation between doctors and patients. It has been proved that Chinese medicine can improve the disorder of oxygen free radical metabolism, and manipulation can improve the abnormal blood rheology of osteoarthritis. The organic combination of various Chinese medical methods can complement the advantages of various therapies, combine internal and external, and take into account both the symptoms and the root cause, which can significantly shorten the course of treatment and improve the efficacy.
Internal treatment method: refers to the oral administration of Chinese herbal medicine, which is divided into two kinds of treatment methods: identification and typing and specific prescription. According to the nature of pain in the affected limb, the degree of swelling of the joint and the number of concurrent symptoms, the disease is divided into: qi stagnation and blood stasis type, cold and damp paralysis type, liver and kidney deficiency type, and so on. The treatment is based on the method of tonifying the liver and kidney, activating blood circulation and removing blood stasis, dispelling wind and dampness, warming menstruation and dispersing cold, resolving phlegm and softening hardness. Specialized prescription treatment is based on a certain geographical and climatic environment, there is a certain prominent main symptom identification, and take a certain formula as the basis for addition, reduction and tailoring, in the fundamental, still based on dialectical treatment, and combined with dialectical treatment.
External treatment: The external treatment of TCM is a major feature of TCM treatment. There are more reports on the treatment of this disease, which can be divided into external ointment, Chinese medicine decoction external washing, acupuncture, Chinese medicine ion introduction, massage, etc.
Chinese herbal fumigation: it has both warmth and pharmacological effects and acts directly on the affected area. Chinese medicine fumigation method is mostly used to dispel wind and dampness, disperse cold, invigorate blood circulation and relieve pain, which are similar to each other. Combined with modern physical therapy equipment, Chinese medicine can also be used for ion introduction, fumigation in the bath box and other methods, so that it can better act on the affected area.
Acupuncture method: divided into milli-needle acupuncture method, acupuncture cupping method, fire acupuncture and warm moxibustion cupping method, water acupuncture acupuncture injection method, etc., in the acupuncture points to take local acupuncture points, combined with the meridian acupuncture points, in order to achieve the effect of dredging the meridians, activating blood and removing blood stasis. Tui Na method is the most convenient, quick, non-invasive and easily accepted by patients. It is divided into two aspects of treatment: disease identification and evidence-based treatment, so that the overall and local aspects are taken into account. Clinically, there are far more people who use disease-specific treatment than evidence-based treatment.
Manipulation: By relaxing soft tissues, loosening adhesions, releasing interlocking, increasing joint mobility, improving stress conditions in the knee joint, eliminating inflammation inside and outside the joint, reducing pressure in the joint and bone, and creating favorable conditions for cartilage repair.
Beryllium acupuncture therapy: A therapy that integrates acupuncture therapy and closed surgical therapy. It achieves the purpose of loosening soft tissue adhesions and scars, improving blood circulation, relieving pain and restoring function through needling, cutting and peeling of the lesion.
6.Surgical treatment.
There are various surgical methods, including joint washout, arthroscopic surgery, joint cleaning, osteotomy and orthopedic surgery, etc.; joint fusion, arthroplasty, artificial joint replacement, etc. without joint preservation, and new cartilage and chondrocyte transplantation, etc. In addition to strict control of the indications, various surgeries should be selected according to the expectations of each patient, age, general condition, affordability and other factors.
Joint washout: It is suitable for early and middle stage patients. The joints are often swollen and painful, without significant symptoms of interlocking. Joint irrigation is the most “minimally invasive” procedure. It is performed by inserting only two thick needles through the skin into the joint and using different irrigation solutions to improve the internal environment of the knee joint and bring it towards a positive circulation. The operation is short, the impact on the joint is slight, and the recovery of the joint can be accelerated with various integrated conservative treatments in Chinese medicine after the operation.
Arthroscopy: It is suitable for patients in the middle stage, who have swollen joints from time to time, frequent pain and symptoms of strangulation, which affect their life to some extent, then arthroscopic treatment is the best choice. This means that a very small mirror is inserted into the joint cavity and the image is displayed on a screen. Through arthroscopy, not only can problems in the joint be detected but also the problems inside can be solved directly under the arthroscope. The advantage of this method is that it is less invasive and quicker to recover. It is suitable for patients who have a relatively short course of disease, where conservative treatment has not worked, and where the joint is not deformed. The reason why joint debridement can treat osteoarthritis is that (1) a large amount of irrigation in the joint during joint debridement removes inflammatory substances that cause pain and swelling; (2) joint debridement removes cartilage, synovial debris and free bodies, preventing them from being trapped in the joint and accelerating the wear and tear of the joint surface; (3) joint debridement heals the accompanying damage to the meniscus and ligaments, restores joint stability and removes the factors that cause further joint degeneration. (3) arthroplasty heals the associated damage to the meniscus and ligaments, restores the stability of the joint, and removes the factors that cause further degeneration.
Artificial joint replacement: It is used for those who have developed obvious deformity, narrowed joint space or close to disappearing, and whose symptoms do not diminish continuously. Severe pain is not treated by various treatments, and functional impairment occurs and affects daily life. Because artificial joints have a limited life span, and increasing the number of surgeries increases the difficulty of surgery and reduces the success rate, they are generally used for people over 60 years of age. Of course, as technology advances, the age limit may be reduced. Many elderly patients, as well as many younger patients, are considered candidates for prosthetic joint replacement surgery. Some people are concerned about removing too much bone for a knee replacement. In medical terms, a knee replacement is essentially a surface replacement in which a thin layer of diseased cartilage and subchondral bone is cut away from the end of the joint and then the bone end of the joint is wrapped in a metal shell with a liner made of ultra-high density polyethylene, much like a cavity that is cleaned and covered with a metal sleeve. The metal shell used to be made of stainless steel, but now it is made of titanium or cobalt-chromium alloy. The biocompatibility of both is better than that of stainless steel, which means that the human body is well adapted to both metals. People are concerned about how long the artificial joint can be implanted in the body. The data from laboratory tests seem to be very encouraging. This work has been carried out abroad for a long time, and according to long-term clinical follow-up, it can be used for 15-20 years, with a longer life span for older people with less activity. After the knee is replaced, it is important to do rehabilitation under the guidance of a physician. This way the mobility of the joint is better. In Japan, people have to sit on the floor. In the north of China, people have to sit cross-legged on a bed, which is more demanding for rehabilitation after joint replacement, but not impossible. I hope that elderly patients with osteoarthritis of the knee will be brave enough to undergo surgery, so that your old age will be as bright as the sunset.
VI. Prevention of osteoarthritis.
Although it is not yet possible to completely prevent osteoarthritis from occurring, there are a number of measures that can be taken to reduce or delay the onset of osteoarthritis. These measures include reducing weight, trying not to wear high heels, protecting the joints from injury, such as avoiding repeated impact or torque on the joints, minimizing the need to do frequent ascent exercises, repairing or suturing through arthroscopy if there is meniscal damage, treating joint ligament damage in a timely manner, and surgical anatomical repositioning of intra-articular fractures. If there is deformity around the joint, surgery should be performed to correct the deformity in time. In addition, VitA, VitC, VitE and VitD supplementation can also have a preventive effect on osteoarthritis.
Degenerative changes in cartilage may begin in the 20s, and most people over 50 years of age can show osteoarthritis on X-rays. The key is to prevent the aggravation of the lesions from having a negative impact on life. In the Bone and Joint Decade, it is believed that many doctors, health professionals, patients, and community groups will work together to raise awareness of musculoskeletal disorders and to further research and develop treatment and prevention measures. Advances in prevention, diagnosis, treatment and research will greatly improve the quality of life of older adults and bring benefits to the population.
Be proactive in your prevention efforts and be aware of early warning signs of arthritis: 1) pain; 2) joint stiffness; 3) swelling sometimes occurs; and 4) difficulty moving the joint. If any symptoms occur within or around a joint and persist for more than 2 weeks, seek medical advice. Early detection and treatment are most important.