Development and management of osteoarthritis of the knee joint
Osteoarthritis is a chronic joint disease whose main changes are degenerative changes of the cartilage surfaces of the joint 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 middle-aged and elderly people and heavy workers.
The main causes are.
1. Chronic strain injury. Chronic poor posture and weight-bearing, for example, female textile workers, welders, and greenhouse vegetable planters. Posture leads to cartilage damage in the knee joint.
2, obesity. Weight gain and the onset of osteoarthritis of the knee is 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 trabeculae become thin and stiff, their tolerance to pressure decreases, so the chances of osteoarthritis increase in people with osteoporosis.
4. Trauma and force bearing. Frequent knee injuries, such as fractures, damage to cartilage and ligaments. Abnormal state of the joint, such as when the link is in an unstable state after patellar resection, when the joint is subjected to muscle force imbalance and coupled with local pressure, degenerative degeneration of the cartilage can occur. At present, Professor Cong Haibo intends to explore the relationship between factors such as dietary habits and osteoarthritis in the Jiaodong region through clinical research.
5. Dietary factors Currently, Prof. Cong Haibo intends to investigate the relationship between dietary habits and osteoarthritis in the Jiaodong region through clinical research.
Clinical manifestations
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 is seen. 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. 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.
1. History of repeated strain or trauma.
2. Knee pain and stiffness, which is more pronounced when waking up in the morning, relieved by activity, and 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, the intercondylar ridge of the tibia becomes sharp, the joint space becomes narrower, the subchondral bone is dense, and sometimes intra-articular free bodies are seen.
Treatment.
Appropriate health care and preventive measures should also be taken in the early stages of the lesion, adhering to the principle of prevention.
Because osteoarthritis develops slowly, early symptoms are mild, and there are no obvious functional effects, so not all patients need treatment; only the appearance of joint stiffness and severe pain are indications for treatment.
Non-surgical treatment methods.
1. Proper rest.
Work and live within the limits of your condition, do not overload the affected joint, get wet, cold, or overwork it, 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
Will be introduced
3.Physiotherapy
It can release pain and muscle spasm, help improve blood circulation and reduce swelling. Hot compresses can be applied, preferably wet heat. Hot air baths and hot spring baths 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 you have conditions for warm mineral bath, whirlpool bath is more effective.
4, drugs: non-steroidal anti-inflammatory analgesics are still commonly used in the treatment of osteoarthritis effective drugs, commonly used drugs for ibuprofen, fentanyl, fotarine, etc.. The effect is better with drugs that relieve muscle spasm, but these drugs inevitably have gastrointestinal stimulation. Patients with poor gastrointestinal disorders are prohibited.
5.Injection therapy.
There are two kinds of injections: local pain point injection and intra-articular injection, both of which should be strictly sterilized and accurately positioned. Injection therapy is characterized by the direct arrival of drugs at the local foci, which can eliminate inflammatory stimuli, block the occurrence and development of pathological reflexes, eliminate inflammatory exudation hyperplasia swelling, relieve muscle tension or muscle spasm, improve local blood circulation, and stop primary and excitation pain.
Surgical options.
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 roll and have more activities and are not willing to undergo artificial joint replacement, a healing at the osteotomy will not limit the activity level, and its can refer to the theory of uneven subsidence.
3. Chondroplasty. In the past, chondroplasty refers to the surgical removal of 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 of this procedure, it is not yet widely carried out in China.
4. 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 in patients over 60 years of age. 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.