knee osteoarthritis

Knee pain is most commonly a symptom of knee osteoarthritis.This disease affects millions of people worldwide.But endoprostheses are not always necessary!For degenerative conditions of the knee, there are new, effective treatments that address the causes and symptoms.The most important thing for every patient is to understand the causes and symptoms of the disease and the possibilities of treatment.

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, this disease can also affect very young people.Due to inflammation, cartilage, ligaments, menisci, and other joint structures are first damaged.However, the loss of cartilage tissue largely determines the progression of arthropathy.The natural shock absorber between bones - cartilage - can be weakened.When this happens, the bones within the joint move closer together (the cartilage is less thick) and rub against each other.As the thickness of the cartilage decreases, the ends of the nerve fibers are exposed and become irritated with every movement.Friction can cause pain, swelling (visible on ultrasound and sometimes even to 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 decisive role in controlling progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

Arthritis of the joints is the most common type of inflammation within the joints.Although the disease can occur even in young adults, the risk increases after age 45.Numerous studies have shown that knee osteoarthritis is one of the most common diseases.Research also shows that women are more likely to develop joint disease.

Causes of knee joint disease

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 many factors that increase the risk of severe osteoarthritis, even at a young age:

• age– The regenerative capacity of cartilage tissue decreases with age.At the same time, the number of cycles in the joints increases and micro-overloads accumulate, sometimes resulting in serious injury.
• overweight– Excess weight increases the load on the knee joints.For every additional kilogram, the load on the knees increases by 3-4 kilograms.Abnormal fat tissue produces substances that travel through the bloodstream into the joints and cause damage.
• atherosclerosis(Poor blood supply to subchondral bone, bone infarction)
• diabetes
• hormonal imbalance– It has been proven that a weight loss of 5 kg can even reduce pain by 50%.
• genetic factors– Genetic factors play an important role in the development of osteoarthritis.Arthropathy or rheumatic disease in a parent significantly increases the patient's risk.Incorrect axis ("curvature") of the limb can also be inherited, causing the knee joint to be overloaded and undergo degenerative changes.This condition occurs with 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 overload– In general, injuries depend on the type of activity a person does.People who kneel, squat, or lift heavy objects for work are more likely to develop degenerative changes due to frequent and inappropriate loading and stress on joint surfaces.
• sports– Professional athletes, especially those in sports such as football, tennis, basketball or sprinting, are at increased risk of knee osteoarthritis.A large group of our patients also engage in recreational sports, but often at a high intensity.Of these, runners have the most knee (and foot) problems.This means athletes must take every precaution to avoid injury and overuse.A lot can be achieved through relatively simple means.It's important to remember to perform moderate strengthening exercises and stretches on a regular basis.In fact, weak muscles around the knee can reduce its stability, leading to accelerated wear and degenerative changes in the cartilage.Improperly trained muscles can easily contract, causing overloading of 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.Adjustments to training, post-race recovery, diet, and sometimes nutritional supplements and intra-articular injections of special drugs (hyaluronic acid, platelet-rich plasma PRP) are required.
• other reasons– People with rheumatoid arthritis (the second most common type of joint inflammation) are more likely to develop osteoarthritis.These patients first require appropriate treatment of the underlying disease by a rheumatologist, as well as comprehensive multi-orthopedic surgery.Additionally, people with certain metabolic disorders (such as those caused by too much iron or growth hormone) or connective tissue diseases (such as joint hypermobility) are also at increased risk for osteoarthritis.Blood in the joints can greatly damage the cartilage, so hemophilia can cause severe damage and require joint replacement.

When conservative treatments fail, surgery is needed to replace the joint with an artificial knee endoprosthesis (also called anoplasty).

Symptoms of knee arthritis

The disease progresses differently based 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.It is caused by the opening of free nerve endings in the subchondral bone of damaged cartilage
• swelling of the knee
• A warm feeling in the joints
• Stiffness in the knees, especially in the morning or after long periods of immobility, such as sitting in an office or watching TV
• The range of motion (eng. ROM. - range of motion) of the knee joint is reduced, which makes it difficult to stand up from a chair or get out of a chair.It was difficult to go up and down stairs and even to walk.
• Creaking, creaking, or popping sounds from the knee, especially due to sudden movement of the knee joint
• Many people also say that weather changes can affect pain levels and joint function.

How is knee arthritis diagnosed?

The 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 to your doctor, you should pay attention to what makes your pain worse and what makes it less painful.You should also find out if anyone in your family has ever had osteoarthritis or rheumatoid disease.

Your orthopedic surgeon may recommend additional tests, including:

• X-ray, showing the severity of bone lesions, including: joint space narrowing, osteophytes (bone spurs), subchondral sclerosis, sharpening of the intercondylar eminence, and limb axis abnormalities.
• ultrasound- Click here to learn more.
• MPT- Magnetic Resonance Imaging - This test is most often done when X-rays and ultrasounds cannot show a clear cause of joint pain.
• blood test- Eliminate diseases caused by other causes, such as rheumatoid disease, Lyme disease (borreliosis), etc.

Treatment methods for knee arthritis

The development of orthopedics in recent years has opened up new opportunities for extremely effective treatment of knee osteoarthritis.By using modern methods and treatment with growth factors (GPS = PRP, platelet rich plasma), it is increasingly possible to postpone or even cancel the stage of replacement surgery (knee replacement).These methods harness 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 and mobility.Treatment plans must be chosen individually.In addition, treatment often involves a combination of the steps described below.

Conservative treatment (non-surgical)

• Weight loss.Losing even a few pounds can significantly reduce knee pain.
• practise.Strengthening and stretching the muscles around the knee can provide greater stability, proper biomechanics, and reduce pain.
• Analgesics and anti-inflammatory drugs.There are many medications on the market that help reduce pain and inflammation (called NSAIDs - non-steroidal anti-inflammatory drugs).But remember: Don't use pain relievers for more than 10 days without consulting your doctor.Taking them for a long time increases the likelihood of side effects.The most important of them are:
• Upper gastrointestinal (stomach and duodenal) bleeding - Particularly in the United States, where NSAIDs are in high availability and doctors have far less, bleeding is a common cause of death,
• peptic ulcers of the stomach and duodenum (hydrochloric acid contained in gastric juice destroys the gastric mucosa),
• gastric and duodenal gastritis,
• reduced blood clotting (possible bleeding),
• kidney failure,
• Bone marrow destruction.

That's why it's so important to use other methods that don't 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 (e.g., hormonal imbalances, diabetes) and local effects (irreversible damage to joint cartilage!).Therefore, this treatment modality is only suitable for patients who plan to undergo knee replacement surgery (arthroplasty) within a short period of time.
• Ultrasound intervention.Appropriate medications are injected into the area affected by the disease under ultrasound guidance.This is a very effective form of treatment but requires high qualifications and experience of the orthopedic surgeon.
• Injections of hyaluronic acid, a so-called viscoelastic supplement.Hyaluronic acid is injected into the knee joint to increase the viscosity of the synovial fluid, thus improving its lubricating properties.Reducing friction between cartilage surfaces, knee pain, popping, and stiffness, often improves range of motion.
• Tablets containing glucosamine, collagen, and chondroitin.Although they are common, research has not proven their effectiveness.
• Anti-inflammatory ointment.These ointments are applied externally and may temporarily relieve symptoms.However, their effectiveness is significantly limited by their poor permeability into joints through barriers such as skin, subcutaneous tissue, fascia, etc.Sprays provide better drug penetration.
• Knee stabilizers and orthotics.Mainly used for injuries to the anterior cruciate ligament (ACL - Anterior Cruciate Ligament) or other ligaments.They help maintain better stability in the knee joint, thereby preventing further damage to the cartilage and meniscus.
• physiotherapy.A very important part of the treatment process.Strengthening and stretching exercises are often necessary.Massage and manual therapy by an experienced physical therapist are paramount.Physiotherapy (such as cryotherapy, ultrasound, iontophoresis or TENS current) plays a supportive role.In Germany, acupuncture is already used in daily practice in hospitals and has certain effects.Your physical therapist will teach you ways to improve muscle strength and joint mobility at home.He should also show you how to perform basic exercises every day without putting too much stress on your knees.

surgical treatment

This operation has many advantages and disadvantages.With the right surgical qualifications (proper assessment of damaged structures and their potential for repair), significant improvements can be achieved quickly.However, every operation has certain risks. Surgery is only performed when the structural damage within the joint is serious, and conservative treatment methods cannot achieve positive results.The most commonly performed surgeries for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– Minimally invasive endoscopic surgery.It ensures safe restoration of most intra-articular structures.A longitudinal camera and instruments are inserted into the knee through two small (a few millimeters) skin incisions in the front of the knee.This surgery is usually performed in athletes (complex reconstruction of ligaments, cartilage, meniscal sutures) and in relatively young patients (usually under 60 years old) in the initial stages of arthropathy.In the first case, professional sports can be resumed within a short time, in the second case, discomfort is reduced and the patient is transferred in time or the need for an internal prosthesis is eliminated.
• Osteotomy– Surgery to “cut” the bones, straighten the axis of the limb, and merge the bones.In this way, the painful part of the knee (most commonly the medial part) is relieved (it is the most commonly damaged part).Osteotomy is often recommended for fractures in the knee area (eg, proximal tibial fractures) if not properly treated.The success of this surgery depends largely on the correct classification of the patient and the correct performance of the surgery itself.The advantage is that time transfer of the endoprosthesis is required, and the disadvantage is that long-term immobilization in a cast is required to allow the bone to heal.
• knee replacement surgery(Plasty, endoprosthesis) is a major surgical procedure in which the ends of the joint bones are removed in the correct way and the metal parts of the prosthesis are placed on them (on so-called bone cement or just mechanically).The new joint surface forms the so-called lining: made of polyethylene, ceramic or metal.Part of the knee (the inside) or the entire knee joint may need to be replaced.The goals of surgery are to restore greater mobility and eliminate pain.This is what happens most of the time.However, this is a large and tedious surgery and the patient must be well prepared.Complications, although rare, can be serious (including bone infection, implant loosening, thromboembolic complications).Therefore, knee replacement surgery should be reserved for people over 55 years of age with severe osteoarthritis, in whom appropriate and intensive conservative treatment has not yet produced the desired results.This procedure is contraindicated in older adults with heart or respiratory failure, hormonal imbalance (mainly related to the thyroid), stroke, or other serious medical illness.These patients received intensive conservative treatment.However, according to statistics, despite certain risks, the overall effect of artificial prosthesis implantation surgery in recent years is still very good.

Therefore, the importance of early diagnosis and regular contact with a podiatrist should be emphasized.The best alternative to surgery remains the use of growth factor PRP, viscoelastic supplements and individually selected professional rehabilitation treatments.In my practice, I work with highly qualified radiologists, rheumatologists, and physical therapists to monitor the progression of osteoarthritis and select appropriate treatments.