Osteoarthritis of the knee joint

Knee pain is most often a manifestation of arthrosis 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 knee degenerative processes that address both the causes and the symptoms.The most important thing for every patient is to know the causes, symptoms, and treatment options of the disease.

Where does knee pain come from?

Degenerative knee disease (arthrosis, degenerative changes, osteoarthritis) is a condition of chronic inflammation of the joints.Although age is the main risk factor, unfortunately the disease can affect people at a very young age.As a result of the inflammation, the cartilages as well as the ligaments, meniscus and other joint structures are damaged.However, the loss of cartilage tissue determines the aggravation of the development of arthrosis to the greatest extent.The natural shock absorber between the bones, which is 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, are irritated with every movement.The friction causes pain, swelling (visible on ultrasound and sometimes with the naked eye), stiffness, reduced mobility, and later the formation of bone spurs, called osteophytes (visible on X-ray and ultrasound).The basis of this disease is chronic inflammation, which destroys the cartilage.Skillful treatment of inflammation, regeneration of cartilage and maintenance of the biomechanical properties of the joint (rehabilitation) play a decisive role in overcoming 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 among young people, the risk increases after the age of 45.Many 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 arthrosis.

Causes of knee arthrosis

The most common cause of knee arthritis is age.Almost all of us experience some degree of degenerative changes at some age.However, several factors increase the risk of significant osteoarthritis, even at a younger age:

• Age- the regeneration capacity of the cartilage decreases with advancing age.At the same time, the number of cycles of the joint increases, micro-overloads accumulate, and sometimes serious injuries occur.
• He is overweight– Excess weight increases the load on the knee joint.Every extra kilogram weighs an additional 3-4 kg on your knees.Abnormal fat tissue produces substances that enter the joint through the blood and cause damage.
• Arteriosclerosis(poor blood supply to the bone under the cartilage, bone infarctions)
• Diabetes
• Hormonal disorders– it has been proven that a 5 kg weight loss can reduce pain by up to 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 ("curvature") of the limb can also be inherited, which can cause overloading of this knee compartment and the development of degenerative changes.This occurs with valgus or varus deformity of the knee.
• Not- Women over 55 are more likely to get sick than men of the same age.It is influenced by hormonal factors.
• Injuries and overuse– Injuries usually depend on what kind of activity a person is doing.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 such as football, tennis, basketball or sprinting, are at increased risk of developing osteoarthritis of the knee joint.A large group of our patients enjoy recreational sports, but they are also often very intensive sports enthusiasts.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.A lot can be achieved with relatively simple tools.It is important to remember to do regular and moderate strengthening exercises and stretches.In fact, weak muscles surrounding the knee reduce knee stability and lead to faster cartilage wear and degenerative changes.Inadequately trained muscles contract easily, causing overuse of tendons, entheses (places where they attach to bones), and ligaments.The biomechanics of a joint damaged in this way accelerates the "wear" of its elements.It is necessary to adjust training, subsequent regeneration, diet, sometimes nutritional supplements and intra-articular injections of special drugs (hyaluronic acid, platelet-rich plasma PRP).
• Other reasons– People with rheumatoid arthritis, the second most common type of arthritis, are more likely to develop osteoarthritis.Above all, these patients need 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 hypermobility of the joints) are also at increased risk for osteoarthritis.Blood within the joint greatly damages the cartilage, so hemophilia can lead to severe damage and the need for joint replacement.

If conservative treatment does not bring results, surgery to replace the joint with an artificial knee endoprosthesis (also known as alloplasty) is recommended.

Symptoms of arthrosis of the knee joint

This disease progresses differently depending on 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 subchondral bone of the damaged cartilage
• knee swelling
• feeling of warmth in the joint
• knee stiffness, especially in the morning or after long periods of immobility, such as sitting in an office or watching TV
• a decrease 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, later even walking.
• squeaking, cracking or popping sounds in the knee, especially due to sudden movement of the knee joint
• many also say that changes in the weather affect the level of pain and joint function.

How is knee arthrosis diagnosed?

The diagnosis of osteoarthritis of the knee joint is primarily based on a description of the patient's medical history, an accurate description of the current symptoms and an orthopedic examination.During the conversation with your doctor, you should pay attention to what causes the increased pain and what relieves it.You should also find out if anyone in the family has a history of osteoarthritis or rheumatic disease.

Your orthopedic surgeon may recommend additional tests, including:

• x-ray, which shows the severity of bone lesions, including: narrowing of the joint space, osteophytes (bone spurs), subchondral sclerosis, sharpening of the intercondylar eminence, abnormal limb axis.
• Ultrasound- click here to learn more.
• MPT- magnetic resonance imaging - most often performed when the X-ray and ultrasound do not show a clear cause of the joint pain.
• Blood test- to eliminate other causes of diseases, such as rheumatic 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 the highly effective treatment of osteoarthritis of the knee joint.With the use of modern methods and treatment with growth factors (GPS = PRP, Platelets Rich Plasma), it is increasingly possible to postpone or even interrupt the stage of surgery (knee replacement).These methods use the body's natural ability to inhibit osteoarthritis and strengthen joint cartilage.

The most important goal of knee osteoarthritis treatment is pain relief and restoration of range of motion in addition to mobility.The treatment plan must be selected individually.In addition, treatment usually involves a combination of the steps described below.

Conservative treatment (non-surgical)

• Weight loss.Losing just 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.
• Painkillers 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 cannot use painkillers for more than 10 days without consulting your doctor.Taking them longer increases the likelihood of side effects.The most important of these 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,
• gastric and duodenal ulcer (damage to the gastric mucosa by the hydrochloric acid 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 (for example, hormonal disorders, diabetes) and local (irreversible damage to joint cartilage!) effects.Therefore, this form of therapy should only be reserved for patients who are scheduled to undergo knee replacement surgery (arthroplasty) in the near future.
• Ultrasound intervention.Injection of the area affected by the disease with the appropriate drug under ultrasound guidance.It is a very effective form of therapy, which, however, requires a high level of training and practice from an orthopedic doctor.
• Hyaluronic acid injections, so-called viscosupplementation.Hyaluronic acid is injected into the knee joint and increases the viscosity of the synovial fluid and thus its lubricating properties.It reduces friction between cartilage surfaces, knee pain, swelling 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 poor penetration into the joint through the skin, subcutaneous tissue, fascia, etc.through its protective layer.Sprays provide better penetration of the active ingredient.
• Knee joint stabilizers and orthoses.It is 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.It is a very important part of the therapeutic process.Strengthening and stretching exercises are often required.Massage and manual therapy performed by an experienced physiotherapist 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, 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 several advantages and disadvantages.With the right surgical education (correct assessment of the damaged structures and the possibility of restoration), a significant improvement can be achieved quickly.However, all operations involve risks, so they are performed only when the damage to the intra-articular structures is severe and conservative treatment methods do not give a positive effect.The most commonly performed procedures for knee arthritis include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– minimally invasive endoscopic procedure.It ensures the safe restoration of most intra-articular structures.A longitudinal camera and instruments are inserted into the knee through two small skin incisions (several millimeters) in the front of the knee.This procedure is often performed on athletes (complex reconstructions of ligaments, cartilages, meniscal sutures) and relatively young patients in the initial stages of arthrosis (usually under 60).In the first case, it is possible to return to professional sports within a short period of time, in the second case, the discomfort is reduced and the patient moves in time or the need for endoprosthesis ceases.
• Osteotomy– a procedure for "cutting" the bone, correcting the axis of the limb and uniting the bones.In this way, the painful part of the knee, most often the medial part, is alleviated (this is the part that is most often damaged).Osteotomy is often recommended for knee fractures (eg, proximal tibial fractures) if they have not been properly 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 delay in the need for an endoprosthesis, the disadvantage is the need for long-term immobilization in plaster to allow the bone to heal.
• Knee prosthesis(alloplasty, endoprosthesis) is a major surgical intervention, during which the ends of the joint bones are cut out in a suitable way, and then the metal parts of the prosthesis are placed on it (so-called bone cement or only mechanically).The new joint surfaces form so-called liners: made of polyethylene, ceramic or metal.It is possible that part of the knee (medial) or the entire knee joint needs to be replaced.The aim of the surgery is to restore greater mobility and eliminate pain.In most cases, this is what happens.However, this is a large 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 is recommended for patients over 55 years of age with severe osteoarthritis, for whom adequate and intensive conservative treatment did not yield the expected results.This operation is contraindicated in the elderly, in heart or respiratory failure, in hormonal disorders (mainly related to the thyroid gland), after a stroke or other serious internal disease.Intensive conservative treatment is recommended for these patients.However, according to statistics, despite certain 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 surgery is still treatment with PRP growth factors, viscosupplementation and individually selected, professional rehabilitation.In my practice, in cooperation with high-quality radiologists, rheumatologists and physiotherapists, I monitor the progression of osteoarthritis and select the appropriate treatment.