What does osteoarthritis in the knee mean?
Osteoarthritis, also known as joint wear and tear, is a degenerative disease in which the articular cartilage is progressively destroyed . Then the bones of the joints rub against each other because the cartilage’s shock absorbing and lubricating effect is missing.
The consequences of this rubbing are: pain , swelling , stiffness, limited mobility and, in some cases, the formation of bony outgrowths.
As a rule, osteoarthritis of the knee joint occurs on both sides, but it is often more pronounced in one knee; there is the same probability whether the left or right side is affected.
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What happens with knee arthrosis?
A knee suffering from osteoarthritis has degenerated articular surfaces and the leg does not move as it should.
The following changes are noticeable:
- Roughness and thinning of the cartilage layer on the articular surface of the tibia or between the kneecap and femur.
- The bone beneath the cartilage reacts by compressing its structure.
- All of the tissues in the joint are more active than usual, as if the body is trying to repair the damage.
- Bone grows on the outside of the joint and forms bony ridges, also known as osteophytes.
- The synovial membrane can swell and produce an increased amount of fluid, leading to joint swelling known as “effusion” or “water on the knee.”
- Capsule and ligaments condense and retract.
These changes inside and outside the joint are partly the result of the inflammatory process and the body’s attempt to repair the damage.
In many cases, the body’s attempts to heal itself are successful and the changes inside the joint do not cause great pain or pain that would be severely disabling.
In other cases, however, this mechanism works less well and the knee suffers damage.
This process leads to instability and the patient shifts the weight to the other joints.
The result is symptoms that become more intense over time and persist over time.
Causes of knee osteoarthritis
Age is a major risk factor for knee osteoarthritis, but young people can also develop it.
In some cases it can be hereditary, in other cases it arises as a result of sprains , fractures , infections or obesity.
The exact causes of knee arthrosis are not yet known to science. Many factors lead to degeneration of knee cartilage, including overuse and trauma , but osteoarthritis of the knee joint can develop for no apparent reason.
The development of osteoarthritis is favored by the following circumstances:
- Age: Older people are more likely to develop osteoarthritis.
- Over the years, excessive stress or intense pressure on the joint can wear down the cartilage.
- The majority of people suffering from osteoarthritis are over 45 years old.
- There are types of sports that put a particularly heavy strain on the knee joint ; these include athletics, soccer, and tennis; they can be the cause of osteoarthritis.
- Repetitive activities and jobs, which means constant stress; the result is similar to playing certain sports.
The likelihood of developing osteoarthritis is increased in people who overuse the knee, such as in activities that involve frequent lifting and carrying of heavy objects, squatting, and bending the legs. With a higher weight load, greater pressure is exerted on the knee, which means that overweight people will develop joint degeneration more quickly . Women are affected more often. Heredity plays an important role in the development of osteoarthritis. If a family member suffers from osteoarthritis, the risk increases.
Osteoarthritis of a young knee joint can result from trauma or surgery, such as removal of the meniscus (meniscectomy) or reconstruction of the anterior cruciate ligament, and can affect people under the age of 30.
How is she noticeable? Symptoms of knee osteoarthritis
The pain associated with osteoarthritis is usually gradual, but it can also come on suddenly. The joint can become stiff and swollen, making it difficult to bend and extend the knee. Pain and swelling are worse in the morning and after rest.
The pain may increase after exertion, for example after a walk, climbing stairs or kneeling.
The pain can cause a feeling of knee weakness, with consequent “lock” or “instability”.
Many patients notice a worsening of symptoms when the weather changes, usually 2 days before it rains or snows.
One has the feeling as if the bones are rubbing against each other or as if there is sand in the joint.
In an advanced stage, night pain also occurs, which prevents the patient from sleeping.
Diagnosis of knee osteoarthritis
The doctor examines the affected joint for stiffness, swelling, and redness.
The range of motion must also be checked.
In addition, laboratory tests and imaging diagnostic procedures can be prescribed.
Technical investigations
Cartilage is not visible on an X-ray , but the reduced distance between the joint surfaces (joint space) indicates cartilage loss.
An X-ray can also show bony outgrowths at the edge of the joint.
Many people have signs of osteoarthritis before they experience the symptoms.
Magnetic resonance imaging (MRI) uses radio waves and a magnetic field to create detailed images of bones and soft tissues, including cartilage.
This method is useful for examining the condition of the cartilage, menisci and ligaments of the knee joint.
Laboratory
Tests Blood tests can rule out other causes of joint pain, such as arthritis and autoimmune diseases.
Arthrocentesis is the analysis of the synovial fluid.
The doctor punctures the affected joint with a hollow needle and removes fluid from the joint space.
Examination of the synovial fluid can indicate whether the pain is caused by gout or an infection.
Knee osteoarthritis is a process of degeneration of the knee joint. The first stage consists of fissure and degradation of the cartilage.
Non surgical treatment
There are various treatment options for knee osteoarthritis. The effectiveness of the treatment varies from case to case.
The decision as to which therapy to use should be made jointly by the doctor and the patient.
The goals of treatment include relieving pain, improving function, and reducing symptoms.
Patient satisfaction is paramount when treating knee arthrosis.
In the initial phase, arthrosis of the knee joint is treated with conservative (non-surgical) therapies.
These fall into four main groups: lifestyle changes; exercises ; aids; other methods.
Natural Remedies
Home remedies include : weight loss, changing sports from joint-straining activities like running and jumping to recommended sports like swimming, cycling, and gymnastics.
Movements that increase the symptoms, such as climbing stairs, should be reduced to a minimum.
Many people with knee osteoarthritis are overweight.
Even simple weight loss can reduce stress on body weight-bearing joints, such as knee joints. Reduced pressure on the joint can control pain and improve function, allowing walking without a limp.
If pain and swelling occur, a poultice with green clay can help absorb the liquid, and arnica ointment can also be used.
Physiotherapy can be helpful, especially when problems arise with activities of daily living.
Among the forms of physical therapy, magnet therapy and Tecar therapy show good results because they penetrate into the interior of the joint.
Laser therapy acts on the surface and is therefore not suitable.
The physiotherapist can show how the thigh muscles can be strengthened and the mobility of the knee joint increased. Occupational therapists can work with the patient to develop economical movement sequences in everyday life in order to reduce the pressure on the knee.
Osteopathy can be effective because it relieves joint blockages and muscle tension and reduces pressure on the leg nerves.
Aids
The use of supporting aids such as a walking stick, spring-loaded shoes, insoles , knee bandages is useful, especially in the acute phase.
There are studies on the use of knee wraps in the treatment of knee osteoarthritis. The brace is particularly effective when osteoarthritis is particularly severe on one side of the knee.
A bandage helps to stabilize and improve functionality. Usually two different types are used:
- A “relief” bandage shifts the stress away from the worn knee area .
- A “support ” bandage helps with bearing the full load.
Most studies show that the symptoms of an improved knee situation are reduced stress pain and the ability to walk longer distances.
Other therapies
Other forms of treatment are : heat or cold treatment, water aerobics (in the swimming pool), creams and elastic bandages.
The ice pack is an old home remedy that can temporarily relieve pain in the acute phase, but has no anti-inflammatory and healing effect on knee osteoarthritis.
In the post-acute phase, heat can be used to relieve joint pain, but this is not a long-term therapy.
Medication
There are different types of drugs that can be used to treat osteoarthritis of the knee. Since everyone responds differently to therapies and medication, the orthopedist must put together an individual program for each patient.
Anti-inflammatory drugs include : aspirin, paracetamol, ibuprofen; they help reduce swelling in the joint. Simple pain relievers, such as Ben-u-ron, are effective in relieving pain but do not reduce inflammation.
Analgesics (painkillers) are usually the first choice in treating knee osteoarthritis .
All medicines have side effects, including painkillers. Over time, the body can get used to it and the pain-relieving effect decreases. It is important to know that these medications can interact with other medications, for example when taking anticoagulants or blood thinners. Side effects and interactions must be discussed with the orthopedist or family doctor.
There are strong pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) .
Typical representatives of this drug group are ibuprofen, diclofenac, ketoprofen (Alrheumum), naproxen (Aleve), which are available in pharmacies with a doctor’s prescription.
Like all painkillers, NSAIDs can cause side effects, including serious ones; these include kidney and liver damage, bleeding and stomach problems. These effects are usually reversible once the drug is stopped.
Dietary supplements
Glucosamine and chondroitin sulfate are vital substances that can be taken to relieve osteoarthritis pain. They are composed of two large molecules that are also found in our articular cartilage. The dietary supplements sold in drugstores and pharmacies are synthetic or made from animal products.
Hyaluronic Acid Injections
Here, lubricating substances are injected into the knee to improve the quality of the synovial fluid.
Platelet gel injections
One of the latest treatments is platelet gel, which consists of cell fragments that, when activated, release growth factors capable of stimulating the growth of cells of mesenchymal origin (connective tissue of the embryo).
Alternative forms of therapy
Non- conventional therapies include acupuncture and the use of medicinal plants. Many types of therapy have no scientifically proven healing effect, but a therapy attempt can be worthwhile; important is the support of an expert; moreover, the doctor should always be informed about the personal decisions.
Acupuncture uses thin needles to stimulate specific points on the body to relieve pain or temporarily numb an area. It is practiced in many countries around the world and research shows that it can relieve osteoarthritis pain, however there are few scientific studies on the subject.
Finding a trained acupuncturist is important, and don’t hesitate to seek information about the needle sterilization system.
Nutrition and diet
People suffering from knee osteoarthritis are often overweight; the result of being overweight is an increased load on the knee joint , which causes the cartilage to wear out.
Advisable are a slimming diet to reduce body weight and the consumption of naturally anti-inflammatory foods; Meat and dairy products should be avoided.
When is an operation necessary? Surgical intervention for knee arthrosis
If the conservative methods do not lead to the desired success and pain also occurs at night, a surgical intervention could become necessary.
There are various surgical intervention options:
- Arthroscopy uses fiberglass technology that allows the surgeon to look inside the joint to remove debris (foreign objects) and repair the degraded cartilage .
- Osteotomy is a procedure in which the alignment of the knee is improved by affecting the shape of the bone . This type of surgery might be useful when the wear of the joint is mostly on one side of the knee, usually caused by knock knees or bowlegs; it might be recommended after a knee fracture when the bones are not straight. An osteotomy is not permanent; further surgery may be necessary.
- Joint replacement surgery , or arthroplasty, is a surgical procedure in which the joint is replaced with an artificial joint made of metal or plastic. Only a part or the entire knee joint can be replaced. Normally, knee prostheses are reserved for patients over the age of 50 who have severe arthrosis. A re-intervention may be necessary if an infection develops, the joint slips out of its seat, or the new joint shows signs of wear after years of use. With today’s surgical techniques, the majority of artificial joints last longer than 20 years. The operation involves risks, but very good results are recorded.
Cartilage transplantation is only an option for a few patients. The patient must be young, there must be only partial and traumatic cartilage damage and there must be no signs of arthrosis.
