Osteoarthritis of the knee joint

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

Where does knee pain come from?

Degenerative knee disease (arthrosis, degenerative changes, osteoarthritis) is a chronic inflammatory condition 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, it is the loss of cartilage tissue that determines the severity of the development of arthrosis.The natural shock absorbers between the bones, i.e. cartilage, become weak.When this happens, the bones in 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, are irritated with every movement.Friction causes pain, swelling (visible on ultrasound and sometimes even with the naked eye), stiffness, decreased mobility, and later the formation of bone spurs called osteophytes (visible on X-ray and ultrasound).The basis of this disease is chronic inflammation that destroys cartilage.Efficient management of inflammation, regeneration of cartilage and maintenance of joint biomechanical properties (recovery) play an important 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 this disease can occur even among young people, the risk increases after the age of 45.Many studies show that osteoarthritis of the knee joint is one of the most common.The study also showed 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 several factors that significantly increase the risk of 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-loads accumulate, and sometimes serious injuries.
• Excess body weight- Excess body weight increases the load on the knee joint.Every extra kilogram weighs your knees by another 3-4 kg.Abnormal fatty tissue produces substances that travel through the blood into the joints and cause damage.
• Atherosclerosis(poor blood supply to subchondral bone, bone infarction)
• diabetes
• Hormonal disorders– it has been proven that losing weight by 5 kg can reduce pain by up to 50%.
• Hereditary factors– genetic factors play an important role in the development of osteoarthritis.The occurrence of arthrosis or rheumatic disease in parents significantly increases the risk of disease in the patient.An incorrect axis ("curvature") of the limb can also be inherited, causing overload of this knee compartment and the development of degenerative changes.This occurs in cases 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 overloads– As a rule, injuries depend on the type of activity a person does.People who do work while kneeling, squatting or lifting heavy objects are more likely to experience degenerative changes due to frequent and improper loads 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 of the knee joint.A large group of our patients are also people who practice recreational sports, but often very intensively.Among them, runners suffer from knee (and leg) problems the most.This means that athletes must take every precaution to avoid injury and overuse.A lot can be achieved in a relatively simple way.It is important to remember to do regular and moderate strengthening and stretching exercises.In fact, weak muscles surround the knee which reduces its stability and leads to faster cartilage wear and degenerative changes.Muscles that are not trained properly contract easily, creating overload in tendons, entheses (where they attach 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 afterwards, diet, sometimes nutritional supplements and intra-articular injections of special drugs (hyaluronic acid, platelet-rich plasma PRP).
• Another reason– People with rheumatoid arthritis, which is the second most common type of joint inflammation, are more likely to develop osteoarthritis.These patients need, first of all, proper treatment of the underlying disease by a rheumatologist, as well as a comprehensive multi-orthopedic procedure.In addition, people with certain metabolic disorders (such as those caused by excess iron or growth hormone) or connective tissue disorders (such as constitutional joint hypermobility) are also at higher risk for osteoarthritis.Blood in the joints is very damaging to the cartilage, so hemophilia can cause serious damage and the need for joint replacement.

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

Symptoms of arthrosis of the knee joint

The disease develops differently depending on the severity, age, physical activity and other tendencies, 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 the free nerve endings of the damaged subchondral cartilage
• knee swelling
• heat in the joints
• stiffness in the knees, especially in the morning or after a long period of immobility, such as after sitting at the office or watching TV
• 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 then also walking.
• a creaking, throbbing or popping sound in the knee, especially due to sudden movement of the knee joint
• many also say that weather changes affect the level of pain and joint function.

How can knee arthrosis be diagnosed?

The diagnosis of knee osteoarthritis is based primarily 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 leads to increased pain and what relieves it.You should also find out if anyone in the family has had osteoarthritis or rheumatoid disease before.

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, sharpening of the intercondylar prominence, 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 joint pain.
• Blood test- to eliminate the causes of other diseases, such as rheumatoid disease, Lyme disease (borreliosis), etc.

Methods of treatment for arthrosis of the knee joint

Orthopedic developments in recent years have opened up new opportunities for highly effective treatment of osteoarthritis of the knee joint.It is increasingly possible to delay or cancel the stage of replacement surgery (knee replacement) through the use of modern methods and treatment with growth factors (GPS = PRP, Platelets Rich Plasma).This method uses the body's natural ability to prevent osteoarthritis and strengthen articular cartilage.

The most important treatment goals for knee osteoarthritis are pain relief and restoring 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)

• Lose weight.Losing even a few pounds can significantly reduce knee pain.
• Exercise.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 remember: You should not use painkillers for more than 10 days without consulting your doctor.Taking it 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 United States, where the availability of NSAIDs is high, and the availability of doctors is much less, and bleeding is a common cause of death,
• peptic ulcer of the stomach and duodenum (destruction of the gastric mucosa by hydrochloric acid contained in gastric juice),
• gastric and duodenal gastritis,
• decreased blood clotting (possibility of bleeding),
• kidney failure,
• bone marrow destruction.

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

• A corticosteroid injection, called a steroid knee block.Steroids are powerful anti-inflammatory and pain relievers.Unfortunately, they have very negative systemic effects (for example, hormonal disorders, diabetes) and local (irreversible damage to articular cartilage!).Therefore, this form of therapy should be reserved only for patients who are scheduled to undergo knee replacement surgery (arthroplasty) in a short period of time.
• Ultrasound intervention.Inject the affected area with the appropriate medication under ultrasound guidance.A very effective form of therapy, which, however, requires high qualifications and experience from orthopedic doctors.
• Hyaluronic acid injections, 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.Reduces friction between cartilage surfaces, knee pain, popping and stiffness, often increases range of motion.
• Tablets with glucosamine, collagen, chondroitin.Research has not proven its effectiveness, although it is very common.
• Anti-inflammatory ointment.This ointment is used externally and can bring temporary relief.Their action, however, is significantly limited by poor penetration into the joint through the skin barrier, subcutaneous tissue, fascia, etc.The spray provides better penetration of the drug.
• Knee joint stabilizers and orthoses.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, 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.Massage and manual therapy performed by an experienced physiotherapist is most important.Physical therapy (eg cryotherapy, ultrasound, iontophoresis or TENS current) works supportively.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.He should also show you how to do basic exercises every day without putting too much stress on your knees.

Surgical treatment

This operation has several advantages, as well as disadvantages.With the right qualifications for surgery (correct assessment of the damaged structure and the possibility of its recovery), a significant improvement can be achieved quickly.Every operation, however, carries risks, therefore, it is performed only when the degree of damage to the intra-articular structure 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 procedures.It ensures the safe restoration of most intra-articular structures.Through two small skin incisions (a few millimeters) in front of the knee, a longitudinal camera and instrument are inserted into the knee.This procedure is often performed in athletes (complex reconstruction of ligaments, cartilage, meniscal sutures) and in the case of relatively young patients with early stages of arthrosis (usually under the age of 60).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 on in time or the need for endoprosthetics is eliminated.
• Osteotomy– procedures to "cut" the bones, correct the axis of the limb and fuse the bones.In this way, the painful part of the knee, usually the medial part, is relieved (it is the most frequently damaged part).Osteotomy is often recommended for fractures in the knee area (eg, proximal tibia fractures) if they are not properly treated.The success of such an operation largely depends on the correct classification of the patient and the correct implementation of the procedure itself.The advantage is the time shift in the need for endoprosthetics, the disadvantage is the need for long-term immobilization in plaster to allow the bone to heal.
• Knee replacement(alloplasty, endoprosthetics) is a major surgical operation in which the end of the articular bone is cut in the right way, then the metal part of the prosthesis is placed on it (on the so-called bone cement or simply mechanically).The new articular surface forms a so-called layer: made of polyethylene, ceramic or metal.One side of the knee (medial) or the entire knee joint may need to be replaced.The goal of surgery is to restore greater mobility and relieve pain.This is what happens in most cases.However, this is a large and troublesome operation for which the patient must be well prepared.Complications, although rare, can be very serious (including bone infection, implant loosening, thromboembolic complications).Therefore, knee replacement should be reserved for people over the age of 55 with severe osteoarthritis where proper and intensive conservative treatment does not produce the expected results.This operation is contraindicated in older people, with heart or respiratory failure, hormonal disorders (especially 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 some risks, the overall results of surgical operations for endoprosthesis implantation in recent years have been very good.

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