Osteoarthritis of the knee joint

Pain in the knee is most often a manifestation of osteoarthritis of the knee joint.This disease affects millions of people around the world.But endoprosthesis is not always required!There are new effective treatments for degenerative processes in the knee that target 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 disease of the knee (arthrosis, 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 a very young age.As a result of inflammation, first of all, cartilage is damaged, as well as ligaments, meniscus and other joint structures.However, the loss of cartilage tissue determines to the greatest extent the deterioration of the development of arthrosis.The natural shock absorber between the bones, which is the cartilage, weakens.When this happens, the bones inside 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 loss of cartilage thickness, are irritated with every movement.The 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 control of inflammation, cartilage regeneration and care of the biomechanical properties of the joint (rehabilitation) play a crucial role in controlling the progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

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

Causes of knee arthrosis

The most common cause of knee osteoarthritis is age.Almost all of us experience some degree of degenerative changes at a certain 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 cycles of the joint increases, micro-overloads accumulate, and sometimes serious injuries.
• Overweight– Excess body weight increases the load on the knee joint.Each extra kilogram burdens the knees with another 3-4 kg.Abnormal fat tissue produces substances that travel through the blood into the joint and cause damage.
• atherosclerosis(poor blood supply to subchondral bone, bone infarcts)
• Diabetes
• Hormonal disorders– it has been shown 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 the disease in the patient.The incorrect axis ("distortion") of the limb can also be inherited, which leads to overloading of this knee compartment and the development of degenerative changes.This happens with valgus or varus deformity of the knee.
• gender- Women over 55 are sick more often than men of the same age.Hormonal factors influence.
• Injuries and overuse– As a rule, injuries depend on the type of activity that a person performs.People who perform work while kneeling, squatting or lifting heavy objects are more likely to develop degenerative changes due to the frequent and incorrect loading and pressure on the joint surfaces.
• Sports- professional athletes, especially in sports 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, weak muscles around the knee reduce its stability and lead to faster cartilage wear and degenerative changes.Improperly trained muscles contract easily, putting strain on tendons, entheses (places of attachment to bones) and ligaments.The biomechanics of the 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, platelet-rich plasma PRP).
• Other reasons– People suffering 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 complex 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 in the joint severely damages the cartilage, so hemophilia can lead to serious damage and the need for a joint replacement.

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

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 joint
• knee stiffness, especially in the morning or after a long period of immobility, such as after sitting at the office or watching TV
• 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 even walking.
• creaking, crunching or popping 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 osteoarthritis 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 causes the pain to increase 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: narrowing of the joint space, osteophytes (bone spurs), subchondral sclerosis, exacerbation of the intercondylar elevation, abnormal axis of the limb.
• Ultrasound- click here to learn more.
• MPT- nuclear magnetic resonance - performed most often when X-ray and ultrasound examination do not show a clear cause of the pain in the joint.
• Blood test- to eliminate 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 revealed new possibilities for extremely effective treatment of arthrosis of the knee joint.Increasingly, it is possible to postpone or even cancel the stage of replacement surgery (knee joint 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 regimen must be selected individually.In addition, treatment usually involves 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.
• Exercises.Strengthening and stretching the muscles around the knee provides greater stability, proper biomechanics and reduced 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 keep in mind: you cannot use painkillers for more than 10 days without consulting your doctor.Their longer intake increases the likelihood 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 less, and bleeding becomes a common cause of death,
• peptic ulcer of the stomach and duodenum (destruction of the gastric mucosa from hydrochloric acid contained in the gastric juice),
• gastritis of the stomach and duodenum,
• reduced blood clotting (possible bleeding),
• kidney failure,
• bone marrow destruction.

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 effects (for example, hormonal disorders, diabetes) and local (irreversible damage to the articular cartilage!).Therefore, this form of therapy should only be reserved for patients who need to undergo knee replacement surgery (arthroplasty) within a short period of time.
• Ultrasound intervention.Injection of the affected area with an appropriate medication under ultrasound control.A very effective form of therapy, which, however, requires high qualification and experience of an orthopedic doctor.
• Hyaluronic acid injections, the 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.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 may provide temporary relief.However, their effect is significantly limited by the weak penetration into the joint through the barrier of the skin, subcutaneous tissue, fascia, etc.Sprays provide better penetration of the drug.
• Knee joint stabilizers and orthoses.Mainly indicated for damage to the anterior cruciate ligament (ACL) or other ligaments.They help maintain better stability of the knee joint, thereby preventing further damage to the cartilage and meniscus.
• Physiotherapy.A very important part of the therapeutic process.Strengthening and stretching exercises are often necessary.Most important are massage and manual therapy performed by an experienced physiotherapist.Physical therapy (eg cryotherapy, ultrasound, iontophoresis or TENS currents) is supportive.Acupuncture, which is already used in daily hospital practice in Germany, may 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 a number of advantages as well as disadvantages.With the right qualification for surgery (correct assessment of the damaged structures and the possibility of their recovery), a significant improvement can be quickly achieved.However, every operation carries a risk, which is why 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.Provides safe restoration of most intra-articular structures.Through two small (a few millimeters) skin incisions 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, cartilages, suturing of the meniscus) and in relatively young patients with the initial stage of arthrosis (usually under 60 years of age).In the first case, it becomes possible to return to professional sports in a short period of time, in the second, the discomfort decreases and the patient moves in time or the need for endoprosthetics 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 often the medial part (this 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 such an operation largely depends on the correct classification of the patient and the correct performance of the procedure itself.The advantage is the shift in time of the need for endoprosthetics, the disadvantage is the need for long-term immobilization in plaster for bone healing.
• Knee replacement(alloplasty, endoprosthetics) is a major surgical operation in which the ends of the joint bones are cut in a suitable way, after which the metal parts of the prosthesis are placed on them (on the so-called bone cement or only mechanically).The new joint surfaces form the so-called liners: made of polyethylene, ceramic or metal.One part of the knee (medial) or the entire knee joint may need to be replaced.The goal of the operation is to restore greater mobility and eliminate pain.This happens in most cases.However, this is a major and difficult 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 the age of 55 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 some risk, the overall results of endoprosthesis implantation surgeries in recent years have been very good.

Therefore, the importance of early diagnosis and regular contact with an orthopedist 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 appropriate treatment in collaboration with highly qualified radiologists, rheumatologists and physiotherapists.