In layman’s terms, a joint is the joint surface of bone, joint surface, joint capsule and joint cavity, and the auxiliary structures include ligaments, joint discs and synovial membranes, etc. The human body can move freely without this basic structure of the joint. The articular cartilage is the main tissue of the joint surface, which is very important to protect the bone, avoid wear and tear, and guarantee the function of the joint.
Joint cartilage is composed of 65-80% water, including glycoproteins, collagen, chondrocytes, and so on. Cartilage is like a porous structure: collagen is a mesh of long, thin fibers, glycoprotein is an elastic sphere, and chondrocytes sleep peacefully in deep sockets of protection. All components must be intact and in proper proportion to ensure the loading capacity of the cartilage. If the collagen becomes less, it will loosen the meshwork connections, making the joint susceptible to deformation and accelerated wear under stress. And if the glycoprotein inclusions decrease, it will make it less elastic, making the joint relatively susceptible to wear as well. As we age, these materials will “naturally fade” or “functionally deteriorate”, resulting in what is known as “osteoarthritis”.
Osteoarthritis, also known as osteoarthritis, degenerative arthritis, proliferative arthritis, and age-related arthritis, is a joint disease caused by a variety of factors that lead to fibrosis, cracking, ulceration, and loss of joint cartilage. The pathological manifestations are destruction of articular cartilage, subchondral bone sclerosis or cystic changes, osteophytes at the joint edges, synovial hyperplasia, joint capsule twinning, ligamentous laxity or twinning, muscle atrophy and weakness, etc., which leads to clinically disabling joint function ……
Osteoarthritis is more common in middle-aged and elderly patients, with a prevalence age of 45 years or older, and more women than men. It is usually associated with age, weight, gender, and occupation. There are about twice as many women as men with osteoarthritis, which may be related to the weight-bearing structure of the joints in women and hormonal changes in menopausal women that lead to significant osteoporosis compared to men. Professional athletes and overweight (BMI greater than 30) are also more likely to develop degenerative osteoarthritis. According to statistics, at least half of people over 65 years of age show signs of degeneration (narrowing of joint spaces, bone spur formation, etc.) on X-rays. The disability rate can be as high as 50% or more. It occurs in joints with high load and high activity, such as the knee, spine (cervical and lumbar spine), hip, ankle, hand, etc. The disease can be divided into two categories: primary and secondary. Primary osteoarthritis occurs mostly in middle-aged and elderly people, with no clear systemic or local factors, and is related to genetic and physical factors. Secondary osteoarthritis can occur in young adults and can be secondary to trauma, inflammation, joint instability, chronic recurrent cumulative strain or congenital disease.
1, the clinical manifestations of osteoarthritis include.
(1) joint pain and pressure pain: early pain is mild, or intermittent pain, rest is better, activity is worse, pain can be related to weather changes. Late pain is persistent, or with night pain or pain at rest. Examination of the joint has pressure pain. In severe cases of osteoarthritis of the lower extremities, it is difficult to walk, or even to leave the house or sleep at night.
(2) Joint stiffness: stiffness and tightness of the joint when waking up, called morning stiffness, can be relieved by moving the joint, and the stiffness lasts no more than 30 minutes.
(3) Enlarged joints: Enlarged and deformed joints of the hands, knees and ankles are obvious.
(4) Bone rubbing sound or rubbing sensation: There is bone rubbing sound or rubbing sensation in the joint when moving.
(5) Inflexible joint movement: joint pain, decreased mobility, muscle atrophy, joint weakness, leg weakness or joint locking during walking, or in severe cases, inability to straighten the joint or walk.
When the patient has the above clinical manifestations, it is necessary to go to the hospital bone and joint department for formal consultation. A professional osteoarthritis physician will first perform the necessary laboratory tests and auxiliary X-rays to further differentiate the patient from rheumatoid arthritis, septic arthritis, tuberculous arthritis, etc.
Laboratory tests for osteoarthritis include routine blood tests, protein electrophoresis, immune complexes, and serum complement, which are generally within normal limits. Patients with synovitis may have mildly elevated C-reactive protein (CRP) and hematocrit (ESR). Patients with secondary osteoarthritis present with abnormal laboratory tests of the primary disease. In contrast, adjunctive x-ray examination may reveal asymmetry and narrowing of the joint space, osteosclerosis, cystic changes, hyperplasia of the joint edges, formation of osteophytes, with joint effusion, and sometimes free bodies or joint deformation in the joint.
Combining history, clinical manifestations, and laboratory and X-ray examinations, osteoarthritis can be detected and diagnosed. For osteoarthritis, it is necessary to achieve “early detection, early diagnosis and early treatment”.
2, for the first onset, the symptoms are not heavy should be preferred to non-pharmaceutical treatment include.
(1) reduce unreasonable exercise, weight loss.
(2) Physical therapy: heat, physical therapy, acupuncture, etc.
(3) Use of crutches to reduce weight bearing.
(4) If there is inversion or valgus deformity of the joint, orthopedic brace or orthopedic shoes can be used accordingly.
If necessary, local medication can effectively relieve mild to moderate joint pain, and adverse drug reactions are less common. For osteoarthritis of superficial joints, various anti-inflammatory and pain-relieving emulsions, creams and patches can be used. For moderate to severe pain local drugs can be used in combination with oral NSAIDs, with various oral drugs, injections, and suppositories. Generally, acetaminophen is chosen, and when the effect is not good, non-selective NSAIDs and selective COX-2 inhibitors can be used according to the specific situation, and now commonly used are celecoxib, meloxicam, etc. In principle, the drug should be selected after careful consultation of the drug instructions and assessment of the risk factors of the drug (patient’s risk of gastrointestinal, hepatic, renal and cardiovascular diseases), using the lowest effective dose possible and avoiding overdose or repeated or superimposed use of similar drugs. After 3 months of medication, blood and stool routines, fecal occult blood and liver and kidney function are checked at your option depending on your condition. Specialized osteoarthritis physicians often recommend intra-articular injections of sodium hyaluronate-based viscoelastic supplements to nourish and lubricate joint cartilage, which in turn can slow the progression and extent of degenerative changes in osteoarthritis.
Unfortunately, most patients have difficulty in detecting osteoarthritis early, and conservative combination therapy may not be effective in relieving the progression of the disease, so surgical intervention may be considered.
3. The aims of surgical treatment are to.
(1) further assist in the diagnosis.
(2) to reduce or eliminate pain.
(3) prevent or correct deformity.
(4) prevent further aggravation of joint damage.
(5) to improve the function of the joint.
Surgical treatment is mainly through arthroscopy (endoscopy) and open surgery. These include.
(1) free body removal.
(2) joint debridement.
(3) osteotomy.
(4) joint fusion
(5) arthroplasty (artificial joint replacement, etc.).
Arthroscopic surgery: Arthroscopic surgery is a minimally invasive surgical procedure that has developed rapidly over the past 20 years, and has been widely used in the field of joint surgery for both diagnosis and treatment. For patients with osteoarthritis, arthroscopic surgery is primarily indicated for recurrent acute or subacute joint pain. It can be performed through 2-3 small microscopic holes to clean and repair degenerated articular cartilage, meniscus and synovium, and to remove intra-articular free bodies. The surgery is less invasive, recovery is fast, and you can go down to the ground a few days after the surgery. It is suitable for osteoarthritis with mild to moderate degeneration with little joint deformity. The emerging technique of articular cartilage transplantation has achieved certain results, which may bring greater benefits to patients with osteoarthritis.
Osteotomy: The mechanism of action is to correct the mechanical weight-bearing axis of the lower extremity, reconstruct the normal joint stress distribution, and change the weight-bearing surface of the joint, so that the diseased articular cartilage can be freed from abnormal stress and given the opportunity to repair, in order to correct the deformity and improve the symptoms. At present, the more commonly used surgical method is osteotomy orthopedic surgery, which is suitable for early osteoarthritis combined with hip and knee inversion, and the combination of arthroscopic surgery is more ideal.
Arthroplasty: is one of the most successful orthopedic surgery, the efficacy is certain, can effectively relieve joint pain, restore joint function, is an important means of treatment of advanced osteoarthritis.
4.Prevention of osteoarthritis.
(1) Reduce weight: take scientific and reasonable methods to lose weight in order to reduce the weight bearing of the joints.
(2) the use of formal methods of exercise, moderate activity, reduce unreasonable exercise such as prolonged excessive running and jumping, squatting, as far as possible not repeatedly walking up and down the stairs frequently, avoid poor standing, sitting and standing posture.
(3) Timely and proper treatment of joint trauma, active application of crutches and walkers after injury to reduce joint damage, timely rest, and physical therapy, etc.
(4) Early correction of lower limb or joint deformities, including internal derangement of the knee, external derangement of the knee, hip dysplasia, internal derangement of the hip, external derangement of the hip and various joint subluxations.