Osteoarthritis of the knee joint

Knee pain is most often a manifestation of osteoarthritis of the knee joint.This disease affects millions of people worldwide.But an endoprosthesis is not always required!There are new effective treatments for degenerative knee processes that address both the causes and the 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 (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 very young ages.As a result of inflammation, cartilage is damaged first of all, as well as ligaments, meniscus and other joint structures.However, it is the loss of cartilage tissue that determines to the greatest extent the severity of the development of arthrosis.The natural shock absorber between the bones, which is cartilage, weakens.When this happens, the bones within the joint come 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, are irritated with every movement.The friction causes pain, swelling (visible on ultrasound and sometimes with the naked eye), stiffness, decreased mobility, and later the formation of bony pillars 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 crucial role in controlling progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

Arthritis of the joints is the most common type of intra-articular inflammation.Although the disease can also appear in 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 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 younger age:

• Age– the ability of cartilage tissue to regenerate decreases with age.At the same time, the number of joint cycles increases, micro-overloads and sometimes serious injuries accumulate.
• Overweight– Excess body weight increases the load on the knee joint.Each additional kilogram loads the knees with another 3-4 kg.Abnormal fat tissue produces substances that travel through the blood to the joints and cause damage.
• atherosclerosis(poor blood supply to the subchondral bone, bone infarcts)
• dIABETES
• Hormonal disorders- It has been proven that losing 5 kg of body weight can reduce pain by 50%.
• Hereditary factor– Genetic factors play an important role in the development of osteoarthritis.The appearance of arthrosis or rheumatic disease in the parents significantly increases the risk of the disease in the patient.An incorrect axis ("curvature") of the limbs can also be inherited, causing overloading of this knee joint and the development of degenerative changes.This happens 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.
• Damage and overload– As a rule, injuries depend on the type of activity a person does.People who perform work while kneeling, sitting 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, are at increased risk of developing osteoarthritis of the knee joint.A large group of our patients are also people who practice recreational sports, 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, it is the weak muscles surrounding the knee that reduce its stability and lead to faster cartilage wear and degenerative changes.Improperly trained muscles contract easily, putting strain on tendons, entheses (places where they attach to bones) and ligaments.The biomechanics of the damaged joint in this way accelerates the "wearing out" 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 platelet-rich plasma).
• 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, 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 is very damaging to the cartilage, so hemophilia can lead to serious damage and the need for joint replacement.

When conservative treatment does not bring results, surgery is indicated to replace the joint with an artificial knee endoprosthesis (also called alloplasty).

Symptoms of arthrosis of the knee joint

This disease progresses differently depending on the severity, age, physical activity and other predispositions, but 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 the free nerve endings of the subchondral bone of the damaged cartilage
• swelling of the knee
• feeling of warmth in the joints
• knee stiffness, especially in the morning or after a long period of immobility, such as after sitting at an office or watching TV
• a decrease in the range of motion of the knee joint (eng. 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.
• popping, cracking, or popping sounds in the knee, especially as a result of sudden movement of the knee joint
• many people also say that weather changes affect the level of pain and joint function.

How can knee arthrosis be diagnosed?

The diagnosis of osteoarthritis of the knee is mainly based on a description of the patient's medical history, an accurate description of the current symptoms and an orthopedic examination.In a conversation with your doctor, you should pay attention to what leads to increased pain and what relieves 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 indicates the severity of bone lesions, including: joint space narrowing, osteophytes (bone spurs), subchondral sclerosis, intercondylar eminence sharpening, abnormal limb axis.
• ULTRASOUND- click here to learn more.
• MPT- magnetic resonance - is most often performed when X-rays and ultrasound do not show a clear cause of joint pain.
• Blood test- for the elimination of other causes of diseases, such as rheumatoid diseases, 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) 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 prevent osteoarthritis and strengthen articular cartilage.

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

Conservative (non-surgical) treatment

• Loss of body weight.Losing a few pounds can significantly reduce knee pain.
• Exercises.Strengthening and stretching the muscles around the knee provides greater stability, proper biomechanics and reduced pain.
• Analgesic and anti-inflammatory.There are many medications on the market that help reduce pain and inflammation (called NSAIDs - Non-Steroidal Anti-Inflammatory Drugs).But keep in mind: You cannot use painkillers for more than 10 days without consulting your doctor.Taking them for a longer time increases the possibility 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 of the stomach and duodenum (destruction of the gastric mucosa by the hydrochloric acid found in the gastric juice),
• gastritis of the stomach and duodenum,
• decreased blood coagulation (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 (for example, hormonal disorders, diabetes) and local (irreversible damage to the articular cartilage!).Therefore, this form of therapy should be reserved only for patients who are scheduled to undergo knee replacement surgery (arthroplasty) within a short period of time.
• Ultrasound intervention.Injecting the area affected by the disease with the appropriate medicine under ultrasound guidance.A very effective form of therapy, which, however, requires high qualifications and experience from an orthopedic doctor.
• Hyaluronic acid injections, the so-called viscosupplementation.Hyaluronic acid is given by injection into the knee joint and increases the viscosity of the synovial fluid and therefore its lubricating properties.It reduces friction between cartilage surfaces, knee pain, stiffness 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 ointment.These ointments are used externally and can bring temporary relief.Their action, however, is significantly limited by poor joint penetration through the barrier of the skin, subcutaneous tissue, fascia, etc.Sprays ensure better penetration of the herb.
• Knee joint stabilizers and orthoses.It is mainly indicated 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 necessary.Massage and manual therapy performed by an experienced physiotherapist are most important.Physical therapy (eg cryotherapy, ultrasound, iontophoresis or TENS currents) works supportively.Acupuncture, which is already used in daily hospital practice in Germany, may also have an effect.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 strain on your knees.

Surgical treatment

The operation has a number of advantages as well as disadvantages.With the right qualifications for surgery (accurate assessment of damaged structures and the possibility of their restoration), significant improvement can be achieved quickly.However, every operation 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 common procedures performed for osteoarthritis of the knee include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– Minimally invasive endoscopic procedure.Provides safe restoration of most intra-articular structures.Through two small incisions (a few millimeters) in the skin at 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 suture) and in the case of relatively young patients with the initial stage of arthrosis (usually under 60 years old).In the first case, it becomes possible to return to professional sports in a short period of time, in the second, discomfort is reduced and the patient is moved in time or the need for endoprosthetics is eliminated.
• Osteotomy– a procedure for "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 damaged most often).Osteotomy is often recommended for a fracture in the knee area (eg, a proximal tibia fracture) if it has not been properly treated.The success of such an operation depends mainly on the correct classification of the patient and the correct execution of the procedure itself.The advantage is the shift in time to the need for endoprosthetics, the disadvantage is the need for long-term immobilization in a cast to allow the bone to heal.
• Knee replacement(alloplasty, endoprosthetics) is a major surgical operation in which the ends of the articular bones are cut in the right way, then the metal parts of the prosthesis are placed on them (in the so-called bone cement or only mechanically).The new articular surfaces form the so-called linings: made of 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, this is a major and serious 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 appropriate 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 some risks, the overall results of surgical operations for the implantation of an endoprosthesis in recent years are very good.

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