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Osteoarthritis of the knee joint.

osteoarthritis of the knee joint

Knee pain is usually a manifestation of osteoarthritis of the knee joint.This disease affects millions of people around the world.But a stent is not always necessary!There are new effective treatments for knee degenerative processes that address both the causes and symptoms.The most important thing for every patient is to know the causes and symptoms of the disease and the possibilities of its treatment.

Where does knee pain come from?

Degenerative knee disease (osteoarthritis, degenerative changes, osteoarthritis) is a condition of chronic inflammation of the joint.Although age is the main risk factor, unfortunately the disease can also affect people at very young ages.As a result of inflammation, first of all, cartilage is damaged, as well as ligaments, menisci and other joint structures.However, it is the loss of cartilage tissue that determines to a greater extent the aggravation of the development of osteoarthritis.The natural cushion between bones, cartilage, weakens.When this happens, the bones within the joint move closer together (loss of cartilage thickness) and rub against each other.The ends of the nerve fibers, which are exposed due to the loss of cartilage thickness, become irritated with each movement.Friction causes pain, swelling (visible on ultrasound and sometimes even to the naked eye), stiffness, decreased mobility, and subsequently the formation of bone spurs called osteophytes (visible on x-rays and ultrasound).The basis of this disease is chronic inflammation that destroys cartilage.Adequate treatment of inflammation, cartilage regeneration and care of the biomechanical properties of the joint (rehabilitation) play a decisive role in controlling progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

Joint osteoarthritis is the most common type of intra-articular inflammation.Although the disease can appear even among young people, the risk increases after 45 years of age.Numerous studies show that osteoarthritis of the knee joint is one of the most common.The study also shows that women are more likely to suffer from osteoarthritis.

Causes of knee osteoarthritis.

The most common cause of knee osteoarthritis is 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 major osteoarthritis, even at a younger age:

  • age– the ability of cartilage tissue to regenerate decreases with age.At the same time, the number of joint cycles increases, microoverloads and, sometimes, serious injuries accumulate.
  • overweight– Excess body weight increases the load on the knee joint.Each extra kilogram loads your knees with another 3-4 kg.Abnormal fatty tissue produces substances that travel through the blood to the joint and cause damage.
  • Atherosclerosis(poor blood supply to the subchondral bone, bone infarcts)
  • Diabetes
  • Hormonal disorders– It has been shown that losing 5 kg of body weight can reduce pain by even 50%.
  • hereditary factor– Genetic factors play an important role in the development of osteoarthritis.The appearance of osteoarthritis or rheumatic disease in the parents significantly increases the risk of suffering from the disease in the patient.An incorrect axis (“curvature”) of the limb can also be inherited, causing overload of this compartment of the knee and the development of degenerative changes.This occurs in case of valgus or varus deformity of the knee.
  • Gender– Women over 55 are more likely to get sick than men of the same age.Hormonal factors influence.
  • Injuries and overload– As a general rule, injuries depend on the type of activity a person performs.People who work kneeling, squatting, or lifting heavy objects are more likely to develop degenerative changes due to frequent and inappropriate loading and pressure on joint surfaces.
  • sports– Professional athletes, especially in sports disciplines such as football, tennis, basketball or sprinting, have a higher risk of developing osteoarthritis in the knee joint.A large group of our patients are also people who practice recreational sports, but often very intensively.Among them, runners are the ones who 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 perform regular, moderate stretching and strengthening exercises.In fact, it is the weak muscles surrounding the knee that reduce its stability and cause faster cartilage wear and degenerative changes.Poorly trained muscles contract easily, creating overload on tendons, entheses (places of attachment to bones) and ligaments.The biomechanics of the joint thus damaged accelerates the “wear” of its elements.It is necessary to adjust training, subsequent recovery, diet, sometimes nutritional supplements and intra-articular injections of special medications (hyaluronic acid, platelet-rich plasma, PRP).
  • Other reasons– People who suffer from rheumatoid arthritis, which is the second most common type of joint inflammation, are more likely to develop osteoarthritis.These patients require, first of all, adequate treatment of the underlying disease by a rheumatologist, as well as comprehensive multi-orthopedic procedures.Additionally, 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 joint replacement.

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

Symptoms of osteoarthritis of the knee joint.

This disease progresses differently depending on severity, 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 with rest.It is caused by the opening of free nerve endings in the subchondral bone from damaged cartilage.
  • knee swelling
  • feeling of heat in the joint
  • stiffness in the knee, especially in the morning or after a long time of immobility, such as after sitting in the office or watching television
  • a decrease in the range of motion of the knee joint (eng. ROM. - Range of motion), making it difficult, for example, to get up from a chair or get out of a car.Difficulty going up and down stairs, and later even walking.
  • Cracking, popping, or popping sounds in the knee, especially as a result of sudden movement of the knee joint.
  • Many people also say that climate changes affect the level of pain and joint function.

How can knee osteoarthritis be diagnosed?

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

Your orthopedic surgeon may recommend additional tests, including:

  • X-ray, showing the severity of bone lesions, including: joint space narrowing, osteophytes (bone spurs), subchondral sclerosis, sharpening of the intercondylar eminence, abnormal limb axis.
  • Ultrasound- click here for more information.
  • MPT- MRI - most often performed when x-rays and ultrasound do not show a clear cause of joint pain.
  • blood test- eliminate other causes of diseases, such as rheumatoid diseases, Lyme disease (boreliosis), etc.

Treatment methods for osteoarthritis of the knee joint.

The development of orthopedics in recent years has opened up new opportunities for the extremely effective treatment of osteoarthritis of the knee joint.It is increasingly possible to delay or even cancel the replacement surgery stage (knee replacement) through the use of modern methods and treatment with growth factors (GPS = PRP, platelet-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 along with mobility.The treatment plan must be selected individually.Additionally, treatment usually contains a combination of the steps described below.

Conservative treatment (non-surgical)

  • Loss of body weight.Losing even a few pounds can significantly reduce knee pain.
  • Ceremonies.Strengthening and stretching the muscles around the knee provides greater stability, proper biomechanics, and reduced pain.
  • Painkillers and anti-inflammatories.There are many medications on the market that help reduce pain and inflammation (called NSAIDs - Nonsteroidal Anti-Inflammatories).But keep in mind: you cannot use pain relievers for more than 10 days without consulting your doctor.Taking them for longer increases the chance of side effects.The most important of them are:
    • Bleeding from the upper gastrointestinal tract (stomach and duodenum), especially in the US where the availability of NSAIDs is high and the availability of a doctor is much lower, and bleeding becomes a common cause of death.
    • peptic ulcer of the stomach and duodenum (destruction of the gastric mucosa by hydrochloric acid contained in gastric juice),
    • gastritis of the stomach and duodenum,
    • decreased blood clotting (possible bleeding),
    • kidney failure,
    • destruction of bone marrow.

That 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 (e.g. hormonal disorders, diabetes) and local (irreversible damage to articular cartilage!) effects.Therefore, this form of therapy should be reserved only for patients who are undergoing knee replacement surgery (arthroplasty) in a short period of time.
  • Ultrasound intervention.Injection of the area affected by the disease with the appropriate drug under ultrasound guidance.A very effective form of therapy that, however, requires high qualification and experience on the part of an orthopedic doctor.
  • Hyaluronic acid injections, so-called viscosupplementation.Hyaluronic acid is administered by injection into the knee joint and increases the viscosity of the synovial fluid and therefore its lubricating properties.Reduces friction between cartilage surfaces, knee pain, clicking 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 may provide temporary relief.Its action, however, is significantly limited by weak penetration into the joint through the barrier of the skin, subcutaneous tissue, fascia, etc.Aerosols provide better drug penetration.
  • Stabilizers and orthoses of the knee joint.Mainly indicated for damage to the anterior cruciate ligament (ACL - Anterior Cruciate Ligament) 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 necessary.Massage and manual therapy performed by an experienced physical therapist are the most important.Physiotherapy (e.g. cryotherapy, ultrasound, iontophoresis or TENS currents) has a supportive effect.Acupuncture, which is already used in daily hospital practice in Germany, can also have effects.Your physical therapist will teach you ways 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 pressure on your knees.

Surgical treatment

The operation has a number of advantages, as well as disadvantages.With proper qualifications for surgery (correct assessment of damaged structures and the possibility of their restoration), significant improvements can be quickly achieved.However, each operation carries a risk, therefore it is performed only when the degree of damage to intra-articular structures is severe and conservative treatment methods do not provide a positive effect.The most commonly performed procedures for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

  • Arthroscopy– minimally invasive endoscopic procedure.Ensures safe restoration of most intra-articular structures.Through two small skin incisions (several millimeters) 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 sutures) and in the case of relatively young patients with the initial phase of osteoarthritis (usually under 60 years of age).In the first case, it is possible to return to professional sports in a short period of time, in the second, discomfort is reduced and the patient is transferred in time or the need for endoprostheses is eliminated.
  • osteotomy– a procedure to “cut” the bone, correct the axis of the limb and fuse the bones.In this way, the painful part of the knee is relieved, most frequently the medial part (it is the part that is most frequently damaged).Osteotomy is often recommended for a fracture in the knee area (eg, a proximal tibia fracture) if it has not been adequately treated.The success of such an operation largely depends on the correct classification of the patient and the correct execution of the procedure itself.The advantage is the change over time in the need for stents, the disadvantage is the need for prolonged cast immobilization to allow the bone to heal.
  • knee replacement(alloplasty, endoprosthesis) is a major surgical operation in which the ends of the articular bones are cut in the appropriate way and then the metal parts of the prosthesis are placed on them (on the so-called bone cement or only mechanically).The new articular surfaces form the so-called coatings: polyethylene, ceramic or metal.Part of the knee (medial) or the entire knee joint may need to be replaced.The goal of surgery is to restore greater mobility and eliminate pain.This is what happens in most cases.However, it 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, and thromboembolic complications).Therefore, knee replacement should be reserved for people over 55 years of age with severe osteoarthritis in whom adequate and intensive conservative treatment has not given the expected results.This operation is contraindicated in elderly people, with heart or respiratory failure, hormonal disorders (mainly related to the thyroid gland), after a stroke or other serious internal diseases.These patients are offered intensive conservative treatment.However, according to statistics, despite a certain risk, the overall results of surgical operations for stent implantation in recent years are very good.

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