Knee osteoarthritis

Knee pain is often a symptom of knee osteoarthritis.This disease affects millions of people around the world.But a colonoscopy is not always necessary!There are effective new treatments for knee osteoarthritis that address both the cause and the symptoms.The most important thing for each patient is to know the causes and symptoms of the disease as well as the possibility of treatment.

Where does knee pain come from?

Knee degenerative disease (arthritis, degenerative changes, osteoarthritis) is a chronic inflammatory joint condition.Although age is the main risk factor, unfortunately the disease can also affect people at a very young age.Due to inflammation, cartilage is damaged first of all, as well as ligaments, menisci and other joint structures.However, it is the loss of cartilage tissue that determines to the greatest extent the aggravation of the development of arthritis.The natural shock absorber between bones, cartilage, becomes weaker.When this happens, the bones inside the joint move closer together (lose cartilage thickness) and rub against each other.The nerve fiber ends are exposed due to the loss of cartilage thickness, and are irritated every time they move.Friction causes pain, swelling (visible on ultrasound and sometimes with the naked eye), stiffness, reduced mobility and then 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 controlling disease progression.

Who is affected by osteoarthritis, a degenerative joint disease?

Arthritis is the most common type of intra-articular inflammation.Although the disease can occur even in young people, the risk increases after age 45. Many studies show that knee osteoarthritis is one of the most common diseases.Research also shows that women are more susceptible to arthritis.

Causes of knee arthritis

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 increase the risk of osteoarthritis significantly, even at younger ages:

• Year old– The ability to regenerate cartilage tissue gradually decreases with age.At the same time, the number of cycles of the joint increases, microscopic overload accumulates and sometimes causes serious injury.
• Overweight– Excess body weight increases the load on the knee joint.Each additional kilogram will add 3-4 kilograms to your knees.Abnormal fatty tissue produces substances that travel through the blood into the joints and cause damage.
• Atherosclerosis(poor blood supply to the subchondral bone, bone infarction)
• diabetes
• Hormonal disorders– it has been proven that losing 5 kg of body weight can reduce pain by even 50%.
• Genetic factors– Genetic factors play an important role in the development of osteoarthritis.The presence of joint disease or rheumatism in the parents significantly increases the risk of the disease in the patient.Incorrect axis (“curvature”) of the limb can also be hereditary, causing overload in this knee compartment and the development of degenerative changes.This occurs in cases where the knee has a varus or varus deformity.
• Sex– Women over 55 years old are more susceptible to the disease than men of the same age.Influence of hormonal factors.
• Injury and overload– In principle, injuries depend on the type of activity a person performs.People who perform work while kneeling, squatting or lifting heavy objects are more likely to develop osteoarthritis due to frequent and improper loading and pressure on joint surfaces.
• Sport– Professional athletes, especially sports such as football, tennis, basketball or sprinting, are at high risk of developing knee osteoarthritis.A large group of our patients also practice recreational sports, but often very intensively.Among them, runners have the most problems with their knees (and feet).This means athletes must take every precaution to avoid injury and overuse.Much can be achieved by relatively simple means.It is important to remember to perform strengthening and stretching exercises regularly and moderately.In fact, it is weak muscles around the knee that reduce the knee's stability and lead to the cartilage wearing down faster and leading to degeneration.Improperly trained muscles easily contract, creating overload in tendons, attachment points (where bones attach), and ligaments.The biomechanics of a joint damaged in this way will accelerate the "wear and tear" of its parts.It is necessary to adjust training, subsequent recovery, diet, sometimes nutritional supplements and injections of special drugs into the joints (hyaluronic acid, platelet-rich plasma PRP).
• Other reasons– People with rheumatoid arthritis, the second most common type of arthritis, are more likely to have osteoarthritis.These patients first need appropriate treatment of the underlying disease by a rheumatologist, as well as comprehensive orthopedic procedures.Additionally, people with certain metabolic disorders (such as those due to iron or growth hormone overload) or connective tissue disorders (such as constitutional joint hypermobility) are also at increased risk of 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 does not bring results, joint replacement surgery with an artificial knee joint (also called alloplasty) is indicated.

Symptoms of knee osteoarthritis

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

• Knee pain increases with activity and decreases with rest.The cause is the opening of free nerve endings of the subchondral bone of damaged cartilage.
• knee swelling
• feeling of warmth in the joints
• stiff knees, especially in the morning or after a long period of immobility, such as after sitting at the office or watching TV
• reduced range of motion of the knee joint (English. ROM. - Range of motion), such as making it difficult to get up from a chair or out of a car.Difficulty going up and down stairs and even walking.
• squeaking, crunching, or popping sounds in the knee, especially from sudden movements of the knee joint
• Many people also believe that weather changes affect pain levels and joint function.

How can knee arthritis be diagnosed?

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.When talking with your doctor, you should pay attention to what makes your pain increase and what reduces it.You should also find out if anyone in your family has had osteoarthritis or rheumatism in the past.

Your orthopedic surgeon may recommend additional tests, including:

• X-ray, shows the severity of bone lesions, including: joint space narrowing, bone spurs (bone spurs), subchondral sclerosis, intercondylar protrusions, abnormal limb axis.
• supersonic- click here to learn more.
• MPT- MRI - performed most often when X-rays and ultrasounds do not show an obvious cause of joint pain.
• Blood test- to eliminate other causes of diseases, such as rheumatism, Lyme disease (boreliosis), etc.

Treatment methods for knee osteoarthritis

The development of orthopedics in recent years has opened up new opportunities for extremely effective treatment of knee osteoarthritis.It is increasingly possible to delay or even cancel the stage of replacement surgery (knee replacement) through the use of modern methods and growth factor treatment (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 to reduce pain and restore range of motion and mobility.The treatment plan must be chosen individually.Additionally, treatment often includes a combination of the steps described below.

Conservative treatment (no surgery)

• Reduce body weight.Losing even a few pounds can significantly reduce knee pain.
• Exercise.Strengthening and stretching the muscles surrounding the knee provides greater stability, proper biomechanics, and pain relief.
• Pain relievers and anti-inflammatory drugs.There are many drugs on the market that help relieve pain and reduce inflammation (called NSAIDs - Nonsteroidal Anti-Inflammatory Drugs).But remember: You cannot use pain relievers for more than 10 days without consulting your doctor.Taking them 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 NSAID availability is high, and physician availability is much less, and bleeding becomes a common cause of death,
• duodenal ulcer (destruction of the gastric mucosa by hydrochloric acid contained in gastric juice),
• inflammation of the stomach and duodenum,
• reduced blood clotting (possible bleeding),
• kidney failure,
• bone marrow destruction.

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

• Corticosteroid injections, called steroid knee blockers.Steroids are powerful anti-inflammatory and pain relievers.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 scheduled for short-term knee replacement surgery (arthroplasty).
• Ultrasound intervention.Inject appropriate medication into the diseased area under ultrasound guidance.However, a very effective form of therapy requires a high level of expertise and experience on the part of the chiropractor.
• Hyaluronic acid injections, known as viscosity supplements.Hyaluronic acid is injected into the knee joint and increases the viscosity of the synovial fluid, thereby increasing its lubricating properties.Reduces friction between cartilage surfaces, knee pain, creaking and stiffness, often improving range of motion.
• Tablets contain glucosamine, collagen, chondroitin.Research has not proven their effectiveness, although they are very popular.
• Anti-inflammatory ointment.These ointments are used externally and may provide temporary relief.However, their effect is significantly limited by their weak ability to penetrate the joint through the skin barrier, subcutaneous tissue, fascia, etc.Sprays help the medicine penetrate better.
• Stabilizers and knee orthotics.Indicated mainly when damaging 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 cartilage.
• Physical therapy.A very important part of the treatment process.Strengthening and stretching exercises are often necessary.Massage and manual therapy performed by an experienced physical therapist is most important.Physical therapy (eg, cryotherapy, ultrasound, iontophoresis, or TENS current) is supportive.Acupuncture, which is already used daily in hospitals in Germany, may also help.Your physical therapist will teach you how to improve your muscle strength and joint flexibility at home.He should also show you how to perform basic daily exercises without putting too much strain on your knees.

Surgical treatment

This activity has some advantages as well as disadvantages.With appropriate surgical expertise (accurate assessment of damaged structures and their potential for recovery), significant improvement can be quickly achieved.However, each surgery carries risks, so it is only performed when the level of damage to intra-articular structures is severe and conservative treatment methods do not bring positive results.The most commonly performed procedures for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

• arthroscopy- Minimally invasive endoscopic method.It ensures safe recovery of most intra-articular structures.Through two small skin incisions (a few millimeters) in the front of the knee, a vertical camera and instruments are inserted into the knee.This procedure is often performed in athletes (complex reconstruction of ligaments, cartilage, meniscus suturing) and in the case of relatively young patients with early stages of joint disease (usually under 60 years of age).In the first case, it is possible to return to professional sports in a short time, in the second case, discomfort is reduced and the patient is transferred in time or the need for a prosthesis is eliminated.
• Bone cutting– a procedure that “cuts” the bone, adjusts the axis of the limb, and connects the bones.In this way, the painful part of the knee, usually the middle part, will be relieved (which is the part most often damaged).Osteectomy is often recommended for a fracture in the knee area (eg, proximal tibia fracture) if it is not treated properly.The success of such an operation largely depends on the correct triage of the patient and the correct implementation of the procedure.The advantage is that it changes the time it takes to use a prosthesis, the disadvantage is that it requires long-term fixation with plaster for the bone to heal quickly.
• Knee replacement(alloplasty, arthroplasty) is a major surgery in which the ends of the articular bones are cut off in the appropriate way, after which metal parts of the prosthesis are placed on them (on so-called bone cement or mechanically threaded).The new joint surfaces form the so-called lining: made of polyethylene, ceramic or metal.Part of the knee (middle) or the entire knee joint may need to be replaced.The goal of surgery is to restore better mobility and eliminate pain.This is what happens in most cases.However, this is a large and complicated surgery for which the patient must prepare well.Complications are rare but can be very serious (including bone infection, implant loosening, thrombotic complications).Therefore, knee replacement should be reserved for people over 55 years old with severe osteoarthritis for whom proper and intensive conservative treatment has not brought the expected results.This operation is contraindicated in the elderly, with heart or respiratory failure, hormonal disorders (mainly related to the thyroid gland), post-stroke or other serious medical illnesses.These patients are offered intensive conservative treatment.However, according to statistics, although there are some risks, the overall results of laparoscopic implant surgery 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 surgery remains treatment with PRP growth factors, viscosity supplements and individually selected professional rehabilitation.In my practice, I monitor the progression of osteoarthritis and select appropriate treatments in collaboration with high-quality radiologists, rheumatologists, and physical therapists.