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 a stent 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 each patient is to know the causes and symptoms of the disease as well as the possibilities of its treatment.

Where does knee pain come from?

Degenerative knee disease (osteoarthritis, degenerative changes, osteoarthritis) is a chronic condition of inflammation of the joint.Although age is the main risk factor, unfortunately the disease can also affect very young people.Due to inflammation, the cartilage is first damaged, as well as ligaments, menisci and other joint structures.However, it is the loss of cartilage tissue that to the greatest extent determines the worsening of the development of osteoarthritis.The natural shock absorber between the bones, which is cartilage, weakens.When this happens, the bones inside 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 each movement.Friction causes pain, swelling (visible on ultrasound and sometimes even with the naked eye), stiffness, decreased 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.Competent management of inflammation, cartilage regeneration and care of the biomechanical properties of the joint (rehabilitation) play a decisive role in controlling the course of the 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 in young people, the risk increases after age 45.Many 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 a certain age.However, there are a number of factors that increase the risk of significant osteoarthritis, even at a younger age:

• Age– the ability of cartilage tissue to regenerate decreases with age.At the same time, the number of cycles of the joint increases, micro-overloads accumulate, and sometimes serious injuries.
• Overweight– Excess body weight increases the load on the knee joint.Each additional kilo loads your knees with an additional 3 to 4 kg.Abnormal fatty tissue produces substances that travel through the blood to the joints and cause damage.
• Atherosclerosis(poor blood supply to the subchondral bone, bone infarction)
• Diabetes
• Hormonal disorders– it has been proven that losing 5 kg of 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 diseases in parents significantly increases the risk of disease in the patient.An incorrect axis (“curvature”) of the limb can also be inherited, causing this compartment of the knee to overload and develop degenerative changes.This occurs when there is a valgus or varus deformity of the knee.
• Sex– Women over 55 are more likely to get sick than men of the same age.Hormonal factors influence.
• Injuries and overload– Generally, injuries depend on the type of activity a person performs.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.
• Sport– professional athletes, especially in sports disciplines such as football, tennis, basketball or sprinting, are at increased risk of developing osteoarthritis of the knee joint.A large group of our patients are also people who play recreational sports, but 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.Many things can be accomplished by relatively simple means.It is 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 cartilage wear and degenerative changes.Poorly trained muscles contract easily, creating overload in tendons, entheses (places of attachment to bones) and ligaments.The biomechanics of the damaged joint accelerate 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 with rheumatoid arthritis, which is the second most common type of joint inflammation, are more likely to develop osteoarthritis.These patients primarily 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 of osteoarthritis.Blood inside the joint causes significant damage to the cartilage, so hemophilia can lead to serious damage and require 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 free nerve endings in the subchondral bone of damaged cartilage.
• knee swelling
• feeling of warmth in the joint
• knee stiffness, especially in the morning or after a long period of immobility, such as after sitting at a desk or watching television
• 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.
• popping, cracking, or clicking noises in the knee, especially following sudden movement of the knee joint
• Many people also say that climate change affects pain levels and joint function.

How to diagnose knee osteoarthritis?

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

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 find out more.
• MPT- magnetic resonance imaging - is performed most often 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.

Methods for treating 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.It is increasingly possible to delay or even cancel the stage of replacement surgery (knee arthroplasty) thanks to the use of modern methods and treatment with growth factors (GPS = PRP, Platelets Rich Plasma).These methods use the body's natural ability to inhibit osteoarthritis and strengthen joint cartilage.

The most important goals of treating osteoarthritis of the knee are pain relief and restoration of range of motion and 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 stretching the muscles around the knee provides greater stability, good biomechanics and reduced pain.
• Analgesics and anti-inflammatories.There are many medications on the market that help reduce pain and inflammation (called NSAIDs – Nonsteroidal Anti-Inflammatory Drugs).But keep in mind: you cannot use painkillers for more than 10 days without consulting your doctor.Taking them for longer increases the risk of side effects.The most important of them 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 is becoming 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 hemorrhage),
• kidney failure,
• destruction of 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-inflammatories and pain relievers.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 be reserved only for patients who are scheduled to undergo knee replacement (arthroplasty) within a short period of time.
• Ultrasound intervention.Injection of 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 an orthopedic doctor.
• Hyaluronic acid injections, 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 containing 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 is, however, considerably limited by poor penetration into the joint through the skin barrier, subcutaneous tissues, fascia, etc.Sprays allow better penetration of the medication.
• Knee joint stabilizers and orthoses.Indicated primarily for injuries to the anterior cruciate ligament (ACL - Anterior Cruciate Ligament) or other ligaments.They help maintain better stability of the knee joint, preventing further damage to the cartilage and meniscus.
• Physiotherapy.A very important part of the therapeutic process.Strengthening and stretching exercises are often necessary.Massages and manual therapy performed by an experienced physiotherapist are the most important.Physiotherapy (e.g. cryotherapy, ultrasound, iontophoresis or TENS currents) acts supportively.Acupuncture, 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 daily without putting too much strain on your knees.

Surgical treatment

The operation has many advantages, but also disadvantages.With the right surgical qualifications (correct assessment of damaged structures and the possibility of their restoration), significant improvement can be achieved quickly.However, every operation carries a risk.Therefore, it is carried out only when the degree of damage to intra-articular structures is serious and conservative treatment methods do not bring a positive effect.The most commonly performed procedures for knee osteoarthritis include arthroscopy, osteotomy, and knee replacement.

• Arthroscopy– minimally invasive endoscopic procedure.It guarantees safe restoration of most intra-articular structures.Through two small skin incisions (several millimeters) located at 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, cartilages, meniscal sutures) and in relatively young patients with an initial stage of osteoarthritis (generally under 60 years old).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 shifted in time or the need for endoprostheses is eliminated.
• Osteotomy– a 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 (this is the part that is most often damaged).Osteotomy is often recommended for a fracture of the knee region (for example, 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 correct execution of the procedure itself.The advantage is the time lag in the need for stents, the disadvantage is the need for long-term immobilization in plaster to allow the bone to heal.
• Knee replacement(alloplasty, endoprosthetics) is a major surgical operation in which the ends of the joint bones are cut out appropriately and then the metal parts of the prosthesis are placed on them (on the so-called bone cement or only mechanically).The new joint surfaces form what are called coverings: made of polyethylene, ceramic or metal.It may be necessary to replace part of the knee (midline) or the entire knee joint.The goal of the surgical procedure is to restore greater mobility and eliminate pain.This is what happens in most cases.However, it is a heavy and cumbersome operation for which the patient must be well prepared.Complications, although rare, can be very serious (notably bone infections, implant loosening, thromboembolic complications).Knee arthroplasty should therefore be reserved for people over 55 years of age suffering from severe osteoarthritis in whom appropriate and intensive conservative treatment has not produced the expected results.This operation is contraindicated in the elderly, suffering from 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, despite certain risks, the overall results of stent implantation surgical operations in recent years are very good.

It is therefore important to emphasize the importance of early diagnosis and regular contact with a podiatrist.The best alternative to surgery remains treatment with PRP growth factors, viscosupplementation and individually selected professional rehabilitation.In my office, I monitor the progression of osteoarthritis and select the appropriate treatment in collaboration with high-level radiologists, rheumatologists and physiotherapists.