Osteoarthritis of the knee joint

Knee pain is most often a manifestation 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 knee processes that address both the causes and symptoms.The most important thing for each 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 people at a very young age.As a result of inflammation, first of all, cartilage is damaged, as well as ligaments, menisci and other joint structures.However, it is the loss of cartilaginous tissue that largely determines the worsening of the development of osteoarthritis.The natural shock absorber between bones, which is cartilage, is weakened.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, become irritated with each 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.Skillful management of inflammation, cartilage regeneration and care for the biomechanical properties of the joint (rehabilitation) play a decisive role in controlling the progressive disease.

Who is affected by osteoarthritis, a degenerative joint disease?

Joint osteoarthritis is the most common type of intra-articular inflammation.Although the disease can occur even among young people, the risk increases after age 45.Numerous studies show that osteoarthritis of the knee joint is one of the most common.The study also shows that women are more prone 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 several factors that increase the risk of significant osteoarthritis, even at a younger age:

• Age– the regeneration capacity of cartilaginous tissue decreases with increasing age.At the same time, the number of joint cycles increases, microoverloads accumulate, and sometimes serious injuries.
• Overweight– Excess body weight increases the load on the knee joint.Every extra kilogram loads your knees by another 3-4 kg.Abnormal fatty tissue produces substances that travel through the blood to the joint and cause damage.
• Atherosclerosis(poor blood supply to subchondral bone, bone infarcts)
• Diabetes
• Hormonal disorders– it has been proven 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 occurrence of osteoarthritis or rheumatic disease in parents significantly increases the risk of the disease in the patient.An incorrect axis (“curvature”) of the limb can also be inherited, causing overload of this knee compartment and the development of degenerative changes.This occurs in case of valgus or varus deformity of the knee.
• Gender– Women over 55 are more likely to get sick than men of the same age.Influence of hormonal factors.
• Injuries and overload– As a rule, injuries depend on the type of activity the person performs.People who perform work kneeling, squatting or lifting heavy objects are more likely to develop degenerative changes due to frequent and inappropriate loading and pressure on the joint surfaces.
• Sports– professional athletes, especially in sports such as football, tennis, basketball or running, are at greater risk of developing osteoarthritis of the knee joint.A large group of our patients are also people who play recreational sports, but often very intensely.Among them, runners have the most problems with their knees (and feet).This means athletes must take every precaution to avoid injuries and overuse.Much can be achieved by relatively simple means.It's important to remember to do regular, 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.Poorly trained muscles contract easily, creating overload on tendons, entheses (attachment sites to bones) and ligaments.The biomechanics of the damaged joint accelerate the “wear” 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, which is 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 procedures.Additionally, people with certain metabolic disorders (such as those resulting from excess iron or growth hormone) or connective tissue disorders (such as constitutional joint hypermobility) are also at increased risk for osteoarthritis.Blood within the joint greatly damages the cartilage, so hemophilia can cause serious damage and the need for joint replacement.

When conservative treatment does not bring results, surgery to replace 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 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 from the damaged cartilage.
• knee swelling
• feeling of heat in the joint
• knee stiffness, especially in the morning or after a long period of immobility, such as after sitting at the office or watching TV
• decreased range of motion of the knee joint (eng. ROM. - Range of Movement), 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.
• creaking, grinding, or popping sounds in the knee, especially as a result of sudden movement of the knee joint
• Many people also say that climate change affects the degree of pain and joint function.

How to diagnose knee osteoarthritis?

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.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 ever suffered from osteoarthritis or rheumatoid diseases.

Your orthopedic surgeon may recommend additional testing, 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 axis of the limbs.
• Ultrasound- click here to find out more.
• MPT- MRI - is most often performed when x-rays and ultrasound do not show a clear cause of joint pain.
• Blood test- to eliminate other causes of diseases, such as rheumatoid diseases, Lyme disease (boreliosis), etc.

Treatment methods for arthrosis of the knee joint

The development of orthopedics in recent years has opened up new opportunities for the extremely effective treatment of osteoarthritis of the knee joint.It is increasingly possible to delay or even cancel the replacement surgery stage (knee replacement) through the use of modern methods and treatment with growth factors (GPS = PRP, Platelet Rich Plasma).These methods utilize 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 along with mobility.The treatment plan must be selected individually.Additionally, treatment usually contains a combination of the steps described below.

Conservative (non-surgical) treatment

• Body weight loss.Losing 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.
• Analgesics and anti-inflammatories.There are many medications on the market that help reduce pain and inflammation (called NSAIDs – Non-Steroidal Anti-Inflammatories).But remember: you cannot use painkillers for more than 10 days without consulting your doctor.Taking them for longer increases the likelihood of side effects.The most important of them 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 a doctor is very 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 medications and relieve pain.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 will undergo knee replacement surgery (arthroplasty) in a short space of time.
• Ultrasound intervention.Injection into the area affected by the disease with the appropriate medication under ultrasound guidance.A very effective form of therapy, which, however, requires high qualifications and experience from the orthopedic doctor.
• Hyaluronic acid injections, 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, clicking 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 bring temporary relief.Its action, however, is significantly limited by poor penetration into the joint through the skin barrier, subcutaneous tissue, fascia, etc.Sprays provide better penetration of the medicine.
• Knee joint stabilizers and orthoses.Mainly indicated for injuries 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.Physiotherapy (e.g. cryotherapy, ultrasound, iontophoresis or TENS currents) acts in a complementary way.Acupuncture, which is already used in daily hospital practice in Germany, can also have an effect.Your physical therapist will teach you ways 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 strain on your knees.

Surgical treatment

The operation has a number of advantages and disadvantages.With the appropriate qualifications for surgery (correct assessment of damaged structures and the possibility of their restoration), significant improvements can be achieved quickly.Each operation, however, carries a risk, therefore it is performed only when the degree of damage to intra-articular 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.Ensures safe restoration of most intra-articular structures.Through two small skin incisions (several millimeters) on 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, meniscal sutures) and in the case of relatively young patients with early-stage osteoarthritis (generally under 60 years of age).In the first case, it becomes possible to return to professional sports in a short space of time, in the second, discomfort is reduced and the patient is moved in time or the need for endoprostheses is eliminated.
• Osteotomy– procedure to “cut” the bone, correct the axis of the limb and fuse the bones.In this way, the painful part of the knee, most often the medial part, is relieved (it is the most frequently damaged part).Osteotomy is often recommended for a fracture in the knee region (for example, a proximal tibial fracture) if it has not been adequately 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 time change in the need for endoprostheses, the disadvantage is the need for prolonged 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 trimmed appropriately and then the metal parts of the prosthesis are placed on them (in so-called bone cement or just mechanically).The new joint surfaces form so-called coverings: made of polyethylene, ceramic or metal.A part of the knee (medial) or the entire knee joint may need to be replaced.The goal of surgery is to restore greater mobility and eliminate pain.This is what happens in most cases.However, this is a large and complicated operation for which the patient must be well prepared.Complications, although rare, can be very serious (including bone infections, loosening of implants, thromboembolic complications).Therefore, knee replacement should be reserved for people over 55 years of age 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 gland), after a stroke or other serious internal diseases.These patients receive intensive conservative treatment.However, according to statistics, despite some risks, the overall results of surgical operations for endoprosthesis implantation in recent years are very good.

Therefore, the importance of early diagnosis and regular contact with a podiatrist must 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 select appropriate treatment in collaboration with high-quality radiologists, rheumatologists and physical therapists.