Osteoarthritis of the knee joint

Knee pain is usually an expression of osteoarthritis 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 processes in the knee that address both the causes and the symptoms.The most important thing for every patient is to know the causes and symptoms of the disease as well as the options for its treatment.

Where does knee pain come from?

Degenerative knee disease (osteoarthritis, degenerative changes, osteoarthritis) is a chronic inflammation of the joint.Unfortunately, although age is the main risk factor, the disease can also affect people at a very young age.The inflammation initially damages cartilage, ligaments, meniscus and other joint structures.However, it is the loss of cartilage tissue that determines most of the aggravation of the development of osteoarthritis.The natural shock absorber between the bones, the cartilage, is weakened.This causes the bones in the joint to 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, 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 treatment of inflammation, cartilage regeneration and care of the biomechanical properties of the joint (rehabilitation) play a crucial role in controlling the progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

Joint osteoarthritis is the most common form of intra-articular inflammation.Although the disease can also occur in young people, the risk increases after the age of 45.Numerous studies show that osteoarthritis of the knee joint is one of the most common.The study also shows that women are more susceptible 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 throughout our lives.However, there are a number of factors that increase the risk of significant osteoarthritis at a younger age:

• Old– With increasing age, the ability of cartilage tissue to regenerate decreases.At the same time, the number of cycles in the joint increases, micro-overloads and sometimes serious injuries increase.
• Overweight– Excessive body weight increases the stress on the knee joint.Each additional kilogram puts an additional 3-4 kg of strain on your knees.Abnormal fatty tissue produces substances that enter the joint via the blood and cause damage.
• arteriosclerosis(poor blood supply to the subchondral bone, bone infarcts)
• diabetes
• Hormonal disorders– It has been proven that losing 5 kg of weight can reduce pain by as much as 50%.
• Hereditary factor– Genetic factors play an important role in the development of osteoarthritis.The occurrence of osteoarthritis or a rheumatic disease in the parents significantly increases the patient's risk of developing the disease.An incorrect axis (“curvature”) of the limb can also be inherited, which leads to overloading of this knee joint and the development of degenerative changes.This happens when there is a valgus or varus deformity of the knee.
• Gender– Women over 55 years of age are more likely to become ill than men of the same age.Hormonal factors influence.
• Injuries and overuse– Injuries usually depend on the type of activity a person performs.People who work while kneeling, squatting, or lifting heavy objects are more likely to develop degenerative changes due to frequent and improper stress and pressure on the joint surfaces.
• sport– Professional athletes, especially in sports disciplines such as football, tennis, basketball or sprinting, have an increased risk of developing osteoarthritis of the knee joint.A large group of our patients are also people who do recreational sports, although often very intensively.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 means.It is important to remember to perform regular and moderate strengthening and stretching exercises.In fact, it is the weak muscles around the knee that reduce its stability and lead to faster cartilage wear and degenerative changes.Incorrectly trained muscles contract easily, resulting in overloading of tendons, entheses (bone attachment points), and ligaments.The biomechanics of the joint damaged in this way accelerates the “wear and tear” of its elements.It is necessary to adjust training, recovery after it, diet, sometimes nutritional supplements and intra-articular injections of special drugs (hyaluronic acid, platelet-rich plasma PRP).
• Other reasons– People who suffer from rheumatoid arthritis, the second most common joint inflammation, are more likely to develop osteoarthritis.These patients first require proper treatment of the underlying disease by a rheumatologist as well as comprehensive multi-orthopedic procedures.In addition, people with certain metabolic disorders (e.g. those resulting from an excess of iron or growth hormone) or connective tissue disorders (e.g. constitutional hypermobility of the joints) are also at increased risk of osteoarthritis.Blood in the joint severely damages the cartilage, so hemophilia can lead to serious damage and the need for joint replacement.

If conservative treatment is unsuccessful, surgical replacement of the joint with an artificial knee endoprosthesis (also called alloplasty) is indicated.

Symptoms of osteoarthritis of the knee joint

This disease progresses differently depending on the 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 when the cartilage is damaged
• Knee swelling
• Feeling of warmth in the joint
• Stiffness in the knee, especially in the morning or after prolonged immobility, for example after sitting in the office or watching TV
• a reduction 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 climbing up and down stairs and later even walking.
• creaking, grinding or popping noises in the knee, especially as a result of sudden movement of the knee joint
• Many people also say that weather changes affect the level of pain and joint function.

How is knee osteoarthritis diagnosed?

The diagnosis of osteoarthritis of the knee joint is based primarily on a description of the patient's medical history, a detailed description of the current symptoms and an orthopedic examination.When talking to your doctor, you should pay attention to what causes pain to increase and what relieves it.You should also find out whether anyone in the family has ever suffered from osteoarthritis or rheumatoid diseases.

Your orthopedic surgeon may recommend additional testing, including:

• roentgen, which shows the severity of bone lesions, including: narrowing of the joint space, osteophytes (bone spurs), subchondral sclerosis, tightening of the intercondylar eminence, abnormal limb axis.
• Ultrasonic- Click here to find out more.
• MPT- Magnetic resonance imaging - is most often done when X-rays and ultrasound scans do not show a clear cause of joint pain.
• Blood test- to eliminate other causes of disease such as rheumatoid diseases, Lyme disease (Boreliosis), etc.

Treatment methods for osteoarthritis of the knee joint

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

The main goals of treating knee osteoarthritis are to relieve pain and restore range of motion and range of motion.The treatment plan must be selected individually.In addition, treatment usually involves a combination of the steps described below.

Conservative treatment (non-surgical)

• Loss of body weight.Even losing a few pounds can significantly relieve knee pain.
• Exercises.Strengthening and stretching the muscles around the knee provides greater stability, proper biomechanics and less pain.
• Analgesics and anti-inflammatory drugs.There are many medications on the market that help relieve pain and inflammation (called NSAIDs - non-steroidal anti-inflammatory drugs).But remember: You should not take painkillers for longer than 10 days without consulting your doctor.Prolonged use increases the likelihood of side effects.The most important of them are:
• Bleeding from the upper gastrointestinal tract (stomach and duodenum) - particularly in the USA, where the availability of NSAIDs is high and the availability of a doctor is much less, and bleeding is becoming a common cause of death,
• Stomach and duodenal ulcer (destruction of the stomach lining by hydrochloric acid contained in the gastric juice),
• gastritis of the stomach and duodenum,
• reduced blood clotting (possible bleeding),
• kidney failure,
• Destruction of the bone marrow.

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 effects (e.g. hormonal disorders, diabetes) and local (irreversible damage to articular cartilage!).Therefore, this form of therapy should only be reserved for patients for whom knee joint replacement surgery (endoprosthetics) is planned soon.
• Ultrasound intervention.Injection of the appropriate drug into the area affected by the disease under ultrasound control.A very effective form of therapy, but it requires high qualifications and experience from an orthopedic doctor.
• Injections of hyaluronic acid, so-called viscosupplementation.Hyaluronic acid is administered by injection into the knee joint and increases the viscosity of the synovial fluid and thus its lubricating properties.Reduces friction between cartilage surfaces, knee pain, clicking and stiffness and often improves range of motion.
• Tablets with glucosamine, collagen, chondroitin.Their effectiveness has not been proven in research, although they are very common.
• Anti-inflammatory ointments.These ointments are used externally and can provide temporary relief.However, their effect is significantly limited by weak penetration into the joint through the barrier of skin, subcutaneous tissue, fascia, etc.Sprays ensure better penetration of the drug.
• Stabilizers and orthoses of the knee joint.Indicated primarily in cases of damage to the anterior cruciate ligament (ACL) or other ligaments.They contribute to better stability of the knee joint and thus prevent further damage to the cartilage and meniscus.
• Physiotherapy.A very important part of the therapeutic process.Strengthening and stretching exercises are often necessary.The most important are massage and manual therapy by an experienced physiotherapist.Physiotherapy (e.g. cryotherapy, ultrasound, iontophoresis or TENS currents) has a supportive effect.Acupuncture, which is already used in everyday hospital life in Germany, can also have an effect.Your physical therapist will show you how to improve your muscle strength and joint flexibility at home.He should also show you how to perform basic exercises every day without putting too much strain on your knees.

Surgical treatment

The operation has a number of advantages and disadvantages.With the right qualifications for the operation (correct assessment of the damaged structures and the possibility of their recovery), significant improvement can be achieved quickly.However, every operation carries a risk and is therefore only carried out if the degree of damage to the intra-articular structures is severe and conservative treatment methods do not achieve a positive effect.The most commonly performed procedures for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– minimally invasive endoscopic procedure.It ensures safe restoration of most intra-articular structures.A longitudinal camera and instruments are inserted into the knee through two small (several millimeters) incisions in the skin on the front of the knee.This procedure is often performed on athletes (complex reconstructions of ligaments, cartilage, meniscus suture) and on relatively young patients in the initial stages of osteoarthritis (usually under 60 years old).In the first case, a return to professional sports is possible in a short time, in the second case, the symptoms are reduced and the patient is relocated in a timely manner or the need for endoprosthetics is eliminated.
• Osteotomy– a procedure for “cutting” the bone, correcting the axis of the limb and bringing the bones together.In this way, the painful part of the knee is relieved, most often the medial part (this part is most often damaged).An osteotomy is often recommended for a fracture in the knee area (such as a proximal tibia fracture) if it has not been properly treated.The success of such an operation largely depends on the correct classification of the patient and the proper execution of the procedure itself.The advantage lies in the time delay in the need for endoprosthetics, the disadvantage in the need for long-term immobilization in a cast to heal the bone.
• Knee replacement(Alloplasty, endoprosthetics) is a major surgical procedure in which the ends of the joint bones are cut out in an appropriate way and 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 linings: made of polyethylene, ceramic or metal.Part of the knee (medial) or the entire knee joint may need to be replaced.The aim of the operation is to restore greater mobility and eliminate pain.This is the case in most cases.However, this is a major and complicated procedure for which the patient must be well prepared.Although complications are rare, they can be very serious (including bone infections, implant loosening, thromboembolic complications).Therefore, knee replacement should be reserved for people over 55 years of age with severe osteoarthritis for whom proper and intensive conservative treatment has not produced the expected results.This operation is contraindicated in the elderly, with heart or respiratory failure, hormonal disorders (mainly related to the thyroid gland), after a stroke or other serious internal diseases.These patients are offered intensive conservative treatment.However, according to statistics, the overall results of surgical interventions for the implantation of an endoprosthesis in recent years are very good, despite some risks.

Therefore, the importance of early diagnosis and regular contact with a podiatrist should be emphasized.The best alternative to surgery remains treatment with growth factors PRP, viscosupplementation and individually selected, professional rehabilitation.In my practice, I follow the progression of osteoarthritis and select the appropriate treatment in collaboration with highly qualified radiologists, rheumatologists and physiotherapists.