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 an endoprosthesis is not always necessary!There are new, effective treatments for degenerative knee processes that address both the causes and 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 knee disease (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 very young people.Due to inflammation, first of all, cartilage is damaged, as well as ligaments, meniscus and other joint structures.However, it is the loss of cartilaginous tissue that determines to a greater extent the aggravation of the development of arthrosis.The natural shock absorber between the bones, which is the 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, exposed due to the loss of thickness of the cartilage, are irritated with every movement.Friction causes pain, swelling (visible on ultrasound and sometimes even to the naked eye), stiffness, decreased mobility, and subsequently the formation of bone spurs called osteophytes (visible on X-rays and ultrasound).The basis of this disease is chronic inflammation that destroys cartilage.The wise management of inflammation, the regeneration of the cartilage and the care of the biomechanical properties of the joint (rehabilitation) play a decisive role in controlling the progression of the disease.

Who suffers from osteoarthritis, a degenerative joint disease?

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

Causes of knee osteoarthritis

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 a number of factors that increase the risk of significant osteoarthritis, even at a young age:

• Age– the ability of cartilaginous tissue to regenerate decreases with increasing age.At the same time, the number of cycles of the joint increases, micro-overloads and sometimes serious injuries accumulate.
• Overweight– Excess body weight increases the load on the knee joint.Every extra kilogram loads your 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 the subchondral bone, bone infarcts)
• Diabetes
• Hormonal disorders– it has been shown that losing 5 kg of body weight can reduce pain by up to 50%.
• Hereditary factor– Genetic factors play an important role in the development of osteoarthritis.The onset of arthrosis or rheumatic diseases in parents significantly increases the risk of disease in the patient.An incorrect axis (“curvature”) of the limb may also be hereditary, causing overloading of this knee compartment and the development of degenerative changes.This occurs in cases of valgus or varus knee deformity.
• Type– Women over 55 are more likely to get sick than men of the same age.Hormonal factors influence.
• Injuries and overload– Accidents generally depend on the type of activity carried out by a person.People who perform kneeling, squatting jobs or lift heavy objects are more likely to develop degenerative changes due to frequent and improper loads and pressures on the joint surfaces.
• Sport– Professional athletes, especially in sports such as football, tennis, basketball or sprinting, are at greater risk of developing osteoarthritis of the knee joint.A large group of our patients are also people who participate in recreational sports, but often very intensively.Among these, runners have more knee (and foot) problems.This means athletes must take every precaution to avoid injury and overuse.A lot can be achieved with relatively simple means.It's important to remember to do regular, moderate strengthening and stretching exercises.In fact, it is the weak muscles surrounding the knee that reduce its stability and lead to faster wear of the cartilage and degenerative changes.Improperly trained muscles contract easily, creating overload in the tendons, entheses (places of attachment to the bones), and ligaments.The biomechanics of the joint thus damaged accelerates the "wear and tear" of its elements.It is necessary to adjust training, subsequent recovery, diet, sometimes nutritional supplementation and intra-articular injections of special drugs (hyaluronic acid, platelet-rich plasma PRP).
• Other reasons– People who suffer 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, adequate treatment of the underlying disease by a rheumatologist, as well as comprehensive multi-orthopedic procedures.Additionally, 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 significantly damages the cartilage, so hemophilia can lead to serious damage and the need for joint replacement.

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

Symptoms of arthrosis of the knee joint

This disease progresses differently depending on severity, age, physical activity and other predispositions, 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
• sensation of heat in the joint
• knee stiffness, especially in the morning or after a long period of immobility, such as after sitting in the office or watching TV
• a 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 later even walking.
• crackling, crackling, or popping sounds in the knee, especially due to sudden movement of the knee joint
• many people also say that climate change affects the extent of pain and joint function.

How can knee osteoarthritis be diagnosed?

The diagnosis of knee osteoarthritis is based mainly on the 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 already suffered from osteoarthritis or rheumatoid diseases.

Your orthopedic surgeon may recommend additional tests, including:

• X-rays, 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 find out more.
• MPT- MRI - is performed most often when X-rays and ultrasound do not show a clear cause of pain in the joint.
• Blood tests- eliminate other causes of diseases, such as rheumatoid diseases, Lyme disease (boreliosis), etc.

Methods of treatment for arthrosis of the knee joint

The development of orthopedics in recent years has opened up new opportunities for extremely effective treatment of arthrosis of the knee joint.It is increasingly possible to delay or even cancel the phase of replacement surgery (knee replacement) through the use of modern methods and treatment with growth factors (GPS = PRP, Platelets Rich Plasma).These methods utilize the body's natural ability to inhibit osteoarthritis and strengthen joint cartilage.

The most important goals of treatment for knee osteoarthritis are pain relief and restoration of range of motion along with mobility.The treatment plan must be selected individually.Additionally, the treatment usually contains a combination of the steps described below.

Conservative (non-surgical) treatment

• Body weight loss.Losing even a few pounds can significantly reduce knee pain.
• Exercises.Strengthening and lengthening the muscles around the knee provides greater stability, correct 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 be careful: you cannot take painkillers for more than 10 days without consulting your doctor.Taking them for a longer period increases the chance of side effects.The most important 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 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 by hydrochloric acid contained in gastric juice),
• gastritis of the stomach and duodenum,
• decreased blood clotting (possible bleeding),
• kidney failure,
• destruction of the bone marrow.

This 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 and pain-relieving drugs.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 only be reserved for patients who are scheduled for short-term knee replacement surgery (arthroplasty).
• Ultrasound surgery.Injection of the appropriate drug into the area affected by the pathology under ultrasound guidance.A very effective form of therapy, which however requires high qualifications and experience on the part 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.Reduces friction between cartilage surfaces, knee pain, popping, 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 can provide temporary relief.Their action, however, is significantly limited by weak penetration into the joint through the skin barrier, 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 - Anterior Cruciate Ligament) or other ligaments.They help maintain better stability of the knee joint, thus 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 are the most important.Physical therapy (e.g. cryotherapy, ultrasound, iontophoresis or TENS currents) has a supportive effect.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.It should also show you how to do basic exercises every day without putting too much strain on your knees.

Surgical treatment

The operation presents a series of advantages, but also disadvantages.With the right qualifications for surgical intervention (correct assessment of damaged structures and the possibility of restoration), significant improvements can be achieved quickly.Each operation, however, carries risks, therefore it is performed only when the degree of damage to the intraarticular structures is severe and conservative treatment methods do not provide a positive effect.The most commonly performed procedures for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– minimally invasive endoscopic procedure.It ensures the safe restoration of most intra-articular structures.Through two small skin incisions (several millimeters) 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, cartilage, meniscus suturing) and in the case of relatively young patients with early-stage osteoarthritis (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 is reduced and the patient is moved in time or the need for the endoprosthesis is eliminated.
• Osteotomy– a procedure to “cut” the bone, correct the axis of the limb and join the bones.In this way, relief is given to the painful part of the knee, most often the medial one (it is the part that is most often damaged).Osteotomy is often recommended for a fracture in the knee area (for example, a fracture of the proximal tibia) if it has not been adequately treated.The success of this operation largely depends on the correct classification of the patient and the correct execution of the procedure itself.The advantage is the temporal shift in the need for endoprosthesis, the disadvantage is the need for long-term immobilization in plaster to allow the bone to heal.
• Knee replacement(alloplasty, endoprosthesis) is a major surgical operation in which the ends of the articular bones are cut appropriately, then the metal parts of the prosthesis are placed on them (on the so-called bone cement or just mechanically).The new joint surfaces form so-called coatings: made of polyethylene, ceramic or metal.You may need to replace part of the knee (medial) or the entire knee joint.The goal of the surgery is to restore greater mobility and eliminate pain.This is what happens in most cases.However, this is a complex and complex operation for which the patient must be well prepared.Complications, although rare, can be very serious (including bone infections, loosening of the implant, thromboembolic complications).Therefore, knee replacement should be reserved for people over the age of 55 with severe osteoarthritis in whom adequate and intensive conservative treatment has not produced the expected results.This operation is contraindicated in elderly people, with heart or respiratory failure, hormonal disorders (mainly related to the thyroid), 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 interventions for the implantation of an endoprosthesis in recent years are 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, viscosupplementation and individually selected professional rehabilitation.In my practice, I monitor the progression of osteoarthritis and choose the appropriate treatment in collaboration with high-quality radiologists, rheumatologists and physiotherapists.