Osteoarthritis of the knee joint

Pain in the knee is the most common manifestation of osteoarthritis of the knee joint.This disease affects millions of people worldwide.But endoprosthesis is not always necessary!There are new effective treatments for degenerative knee processes that address both the causes and the symptoms.It is most important for every patient to know the causes and symptoms of the disease and the possibilities of its treatment.

Where does knee pain come from?

Degenerative knee disease (arthrosis, degenerative changes, osteoarthritis) is a condition of chronic joint inflammation.Although age is the main risk factor, unfortunately, the disease can also affect people at a very young age.As a result of inflammation, cartilage, ligaments, meniscus and other joint structures are damaged.However, the loss of cartilage tissue to the greatest extent determines the worsening of the development of arthrosis.The natural shock absorber between the bones, which is the cartilage, becomes weakened.When this happens, the bones within the joint move closer together (loss of cartilage thickness) and rub against each other.Every movement irritates the ends of the nerve fibers, which are exposed due to the loss of cartilage thickness.Friction causes pain, swelling (visible on ultrasound and sometimes even with the naked eye), stiffness, reduced mobility, and later the formation of bone spurs called osteophytes (visible on x-rays and ultrasound).The basis of this disease is chronic inflammation that destroys cartilage.Skillful management of inflammation, cartilage regeneration and care of the biomechanical properties of the joint (rehabilitation) play a decisive role in the control of progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

Arthrosis of the joint is the most common type of intra-articular inflammation.Although the disease can also occur among young people, the risk increases after the age of 45.Numerous studies show that osteoarthritis of the knee joint is one of the most common.The study also shows that women are more prone to arthrosis.

Causes of knee arthrosis

The most common cause of knee osteoarthritis is old age.Almost all of us experience some degree of degenerative changes at some age.However, there are a number of factors that increase the risk of significant osteoarthritis, even at a young age:

• Old age- the ability to regenerate cartilage tissue decreases with age.At the same time, the number of joint cycles increases, micro-overloads accumulate, and sometimes serious injuries.
• Excessive weight– Excessive body weight increases the load on the knee joint.Every extra kilogram puts 3-4 kg more stress on your knees.Abnormal fat tissue produces substances that travel through the blood to the joint and cause damage.
• Atherosclerosis(poor blood supply to subchondral bone, bone infarction)
• Diabetes
• Hormonal disorders- It has been proven that losing 5 kg of body weight can reduce pain by as much as 50%.
• Hereditary factor- genetic factors play an important role in the development of osteoarthritis.The occurrence of arthrosis or rheumatic disease in the parents significantly increases the risk of developing the disease in the patient.The wrong axis ("curvature") of the extremity can also be inherited, which causes overloading of this section of the knee and the development of degenerative changes.This happens in case of valgus or varus deformity of the knee.
• Rod- Women older than 55 get sick more often than men of the same age.Hormonal factors influence.
• Injuries and overloads- As a rule, injuries depend on the type of activity a person engages in.People who perform work while kneeling, squatting or lifting heavy objects are more likely to develop degenerative changes due to frequent and irregular loading and pressure on joint surfaces.
• Sports- professional athletes, especially in sports such as football, tennis, basketball or sprinting, have an increased risk of developing osteoarthritis of the knee joint.A large group of our patients includes people who play sports recreationally, but often very intensively.Among them, runners have the most problems with their knees (and feet).This means that athletes must take every precaution to avoid injury and overuse.Much can be achieved with relatively simple means.It is important to remember to do regular and moderate strengthening and stretching exercises.In fact, weak muscles surrounding the knee reduce its stability and lead to faster cartilage wear and degenerative changes.Improperly trained muscles contract easily, creating overload in tendons, entheses (places of attachment to bones) and ligaments.The biomechanics of a joint damaged in this way accelerates the "wear and tear" of its elements.It is necessary to adjust training, recovery after it, diet, sometimes nutritional supplements and intra-articular injections of special drugs (hyaluronic acid, PRP plasma rich in platelets).
• Other reasons- People suffering from rheumatoid arthritis, which is the second most common type of joint inflammation, are more likely to suffer from osteoarthritis.First of all, these patients need proper treatment of the underlying disease by a rheumatologist, as well as comprehensive multi-orthopedic procedures.In addition, people with certain metabolic disorders (such as those resulting from excess iron or growth hormone) or connective tissue disorders (such as constitutional joint hypermobility) are also at increased risk for osteoarthritis.Blood inside the joint greatly damages the cartilage, so hemophilia can lead to serious damage and the need for a joint replacement.

When conservative treatment fails, joint replacement surgery with an artificial knee endoprosthesis (also called alloplasty) is indicated.

Symptoms of arthrosis of the knee joint

This disease progresses differently depending on weight, age, physical activity and other predispositions, but by far the most common symptoms are:

• pain in the knee joint that increases with activity and decreases at rest.It is created by the opening of the free nerve endings of the subchondral bone of the damaged cartilage
• knee swelling
• feeling of heat in the joint
• knee stiffness, especially in the morning or after prolonged periods of immobility, such as sitting in an office or watching television
• reduction in the range of motion of the knee joint (ROM. - Range of Motion), which makes it difficult, for example, to get up from a chair or get out of a car.Difficulty going up and down stairs, and later walking.
• creaking, grinding, or cracking in the knee, especially as a result of sudden movement of the knee joint
• Many people also say that changes in weather affect the level of pain and joint function.

How can knee arthrosis be diagnosed?

The diagnosis of osteoarthritis of the knee is based primarily on a description of the patient's history, an accurate description of the current symptoms and an orthopedic examination.In the conversation with the doctor, you should pay attention to what leads to increased pain, and what alleviates it.You should also find out if anyone in the family has previously suffered from osteoarthritis or rheumatoid diseases.

Your orthopedic surgeon may recommend additional tests, including:

• x-ray, which shows the severity of bone lesions, including: narrowing of the joint space, osteophytes (bone spurs), subchondral sclerosis, sharpening of the intercondylar eminence, abnormal limb axis.
• Ultrasound- click here to learn more.
• MPT- magnetic resonance imaging - performed most often when X-rays and ultrasound do not show a clear cause of pain in the joint.
• Blood test- to eliminate other causes of the disease, such as rheumatoid disease, Lyme disease (borreliosis), etc.

Methods of treatment of arthrosis of the knee joint

The development of orthopedics in recent years has opened up new possibilities for extremely effective treatment of osteoarthritis of the knee joint.It is increasingly possible to postpone or even cancel the stage of replacement surgery (knee replacement) using modern methods and treatment with growth factors (GPS = PRP, Platelets Rich Plasma).These methods use the body's natural ability to inhibit osteoarthritis and strengthen joint cartilage.

The most important goals of knee osteoarthritis treatment are pain relief and restoration of range of motion with mobility.The treatment plan must be chosen individually.In addition, treatment usually includes a combination of the steps described below.

Conservative treatment (non-surgical)

• Weight loss.Losing even a few pounds can significantly reduce knee pain.
• Exercises.Strengthening and stretching the muscles around the knee ensures greater stability, proper biomechanics and reduces pain.
• Analgesics and anti-inflammatory drugs.There are many drugs on the market that help reduce pain and inflammation (called NSAIDs - non-steroidal anti-inflammatory drugs).But remember: you can't use painkillers for more than 10 days without consulting a doctor.Taking them longer increases the likelihood of side effects.The most important of them are:
• bleeding from the upper gastrointestinal tract (stomach and duodenum) - especially in the USA, where the availability of NSAIDs is high and the availability of doctors is much less, and bleeding becomes a common cause of death,
• peptic ulcer on the stomach and duodenum (destruction of the gastric mucosa by hydrochloric acid contained in the gastric juice),
• gastritis of the stomach and duodenum,
• reduced blood clotting (possible bleeding),
• kidney failure,
• destruction of the bone marrow.

This is why it is so important to use other methods that do not cause systemic side effects.

• Corticosteroid injections, called steroid knee blocks.Steroids are powerful anti-inflammatory drugs and relieve pain.Unfortunately, they have very negative systemic effects (eg hormonal disorders, diabetes) and local (irreversible damage to joint cartilage!).Therefore, this form of therapy should be reserved only for patients who are scheduled for knee replacement surgery (arthroplasty) in a short period of time.
• Ultrasound intervention.Injection of the appropriate medicine into the area affected by the disease under the supervision of ultrasound.A very effective form of therapy, which, however, requires high qualifications and experience of an orthopedic doctor.
• Hyaluronic acid injections, the so-calledviscosupplementation.Hyaluronic acid is injected into the knee joint and increases the viscosity of the synovial fluid, and thus its lubricating properties.It reduces friction between cartilage surfaces, knee pain, cracking and stiffness, often improving range of motion.
• Tablets with glucosamine, collagen, chondroitin.Research has not proven their effectiveness, although they are very common.
• Anti-inflammatory ointments.These ointments are used externally and can provide temporary relief.Their action, however, is significantly limited by weak penetration into the joint through the barrier of skin, subcutaneous tissue, fascia, etc.Sprays provide better drug penetration.
• Knee joint stabilizers and orthoses.Indicated mainly for damage to the anterior cruciate ligament (ACL) or other ligaments.They help maintain better stability of the knee joint, thus preventing further damage to the cartilage and meniscus.
• Physiotherapy.A very important part of the therapeutic process.Strengthening and stretching exercises are often required.The most important is massage and manual therapy performed by an experienced physiotherapist.Physical therapy (eg cryotherapy, ultrasound, iontophoresis or TENS current) has a supportive effect.Acupuncture, which is already used in daily hospital practice in Germany, can also have an effect.Your physical therapist will teach you how to improve muscle strength and joint flexibility at home.It should also show you how to perform basic exercises every day without putting too much stress on your knees.

Surgical treatment

The operation has numerous advantages, but also disadvantages.With proper qualification for surgery (proper assessment of damaged structures and the possibility of their restoration) significant improvement can be achieved quickly.Any operation, however, carries a risk, therefore it is performed only when the degree of damage to the intra-articular structures is severe, and conservative treatment methods do not give a positive effect.The most commonly performed procedures for osteoarthritis of the knee include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– minimally invasive endoscopic procedure.It ensures safe restoration of most intra-articular structures.Through two small (several millimeters) incisions in the skin in the front of the knee, a longitudinal camera and instruments are inserted into the knee.This procedure is often performed in athletes (complex reconstructions of ligaments, cartilage, meniscus suturing) and in relatively young patients with the initial stage of arthrosis (usually under 60 years).In the first case, it becomes possible to return to professional sports in a short period of time, in the second case, discomfort is reduced and the patient is moved on time or the need for endoprosthetics is eliminated.
• Osteotomy- the procedure of "cutting" the bone, correcting the axis of the limb and joining the bones.In this way, the painful part of the knee is relieved, most often the medial part (it is the part that is most often damaged).Osteotomy is often recommended for a fracture in the knee area (eg proximal tibial fracture) if it has not been properly treated.The success of this type of operation largely depends on the correct classification of the patient and the correct performance of the procedure itself.The advantage is the time delay in the need for endoprosthetics, the disadvantage is the need for long-term immobilization in plaster in order for the bone to heal.
• Knee replacement(alloplasty, endoprosthetics) is a major surgical operation in which the ends of the joint bones are cut out in a proper way, and then the metal parts of the prosthesis are placed on them (on the so-called bone cement or only mechanically).New joint surfaces form so-called linings: made of polyethylene, ceramic or metal.It may be necessary to replace part of the knee (medially) or the entire knee joint.The goal of the operation is to restore greater mobility and eliminate pain.This happens in most cases.However, this is a large and cumbersome operation for which the patient must be well prepared.Complications, although rare, can be very serious (including bone infections, implant loosening, thromboembolic complications).Therefore, knee replacement should be reserved for people over 55 years of age with severe osteoarthritis in whom proper and intensive conservative treatment has not produced the expected results.This operation is contraindicated in the elderly, with heart or respiratory failure, hormonal disorders (mainly related to the thyroid gland), after a stroke or other serious internal diseases.Intensive conservative treatment is offered to these patients.However, according to statistics, despite a certain risk, the overall results of surgical operations for the installation of endoprosthesis in recent years are very good.

Therefore, the importance of early diagnosis and regular contact with the pediatrician should be emphasized.The best alternative to surgery remains treatment with PRP growth factors, viscosupplementation and individually selected professional rehabilitation.In my practice, I monitor the progression of osteoarthritis and choose the appropriate treatment in collaboration with high-quality radiologists, rheumatologists and physiotherapists.