Ms. Wang, who lives in Putuo District, Shanghai, is 57 years old this year. Starting 6 years ago, she felt a slight discomfort on her right knee, but she kept dragging her and didn't take it seriously. It was not until not long ago that she found that her right leg seemed to be difficult to walk, so she came to the hospital for treatment. After examination, the doctor diagnosed that Ms. Wu had severe knee arthritis on her right knee.
Arthritis is one of the common chronic joint diseases with a very high incidence rate. Among them, knee arthritis is the most common type of arthritis in middle-aged and elderly people. The occurrence of knee arthritis is generally caused by degenerative knee lesions, trauma, and overwork. Knee arthritis is often found in middle-aged and elderly people, and is the main cause of leg pain in the elderly. Most patients with knee arthritis have mild initial symptoms, and their condition will gradually worsen if they are not treated. Common symptoms include knee pain, swelling of the knee joint, and knee joint blinking. Stiffness and chills of knee joints are also one of the symptoms of knee arthritis, which are often aggravated by fatigue or minor trauma. In severe cases, limited movement will occur.
There are currently more than 300 million osteoarthritis patients around the world, and the overall prevalence of primary osteoarthritis among people over 50 years old in my country has reached 46.3%. Among them, the incidence of knee arthritis is about 8%, and the prevalence of knee arthritis among people over 75 years old is 80%. Among the multiple joints of the human body, knee joint is the most complex and has the largest load. At present, the incidence of knee arthritis continues to rise. Moreover, with the increasing aging of my country's population, the prevalence of knee arthritis is gradually increasing. Therefore, the diagnosis and treatment of knee arthritis are of great significance to elderly patients.
Here, in combination with the latest "China's Clinical Diagnosis and Treatment Guidelines" (2021 Edition), we will answer some common questions in knee arthritis to patients.
1 What are the common occurrences of knee arthritis?
People with age 50 and above, obesity or overweight, and a history of joint trauma are at high risk of knee arthritis. Muscle atrophy around the joint, long-term engagement in special occupations such as weight-bearing labor, and family history of knee arthritis will also increase the risk of knee arthritis. Early identification of people at high risk of knee arthritis based on risk factors, early intervention on alterable risk factors can help delay the onset of knee arthritis and disease progression.
2 What kind of disease is knee arthritis?
Knee arthritis usually manifests as knee pain and discomfort when going up and down stairs and squatting. The knees feel stiff after getting up or sitting for a long time. As the condition worsens, the patient may have symptoms such as pain in walking on the ground, or even joint deformation. If the knees feel stiff after getting up or sitting for a long time, severe knee arthritis may cause persistent pain or nighttime pain. In addition, some patients may experience knee stiffness, which often occurs when they wake up in the morning or after a long period of time. However, knee stiffness usually lasts for a short period of time, often from a few minutes to more than ten minutes, and rarely exceeding 30 minutes. This can be distinguished from rheumatoid arthritis.
Tenderness and joint deformities are common signs during physical examinations in patients with knee arthritis. The knee joint may become enlarged due to osteophyte formation or synovial inflammatory effusion. In addition, due to the damage to the joint cartilage of the knee arthritis, the joint surface is uneven, so friction sounds (sensation) may appear during movement. Patients with moderate to severe knee arthritis may also experience abnormal gait.
3 What are the common imaging tests for knee arthritis?
Patients with suspected knee arthritis should choose X-ray examination first. If necessary, CT, MRI and ultrasound can further clarify the degeneration site, degree of degeneration, and make differential diagnosis. Among them, X-ray examination is the preferred imaging examination for patients with knee arthritis. Three typical manifestations of the involved joints of knee arthritis on X-rays are asymmetric narrowing of joint space, osteophyte formation at the edge of the joint, subchondral bone sclerosis and/or cystic changes.
MRI can observe thinning of the cartilage thickness, defects, bone marrow edema, joint effusion, , knee meniscus degeneration, injury, and popliteal cyst , etc., which is of certain value for the clinical diagnosis of early knee arthritis.Knee arthritis is often manifested in CT as involved joint space stenosis, subchondral osteosclerosis, cystic changes and osteophyte proliferation, etc., and is mostly used for the differential diagnosis of knee arthritis and pre-arthroplasty evaluation. Ultrasound recognition of osteophytes and synovitis and is highly sensitive, and is of great reference value for early diagnosis of knee arthritis, small joint evaluation and evaluation of knee arthritis-related synovitis.
4 Knee arthritis is often "recognized" and
So how to correctly identify the disease?
When diagnosing knee arthritis, it should be distinguished from other diseases that can cause joint pain and dysfunction, including autoimmune diseases such as arthritis (such as rheumatoid arthritis, ankylosing spondylitis, etc.), infectious arthritis, gout, pseudogout, and joint damage.
The onset age of rheumatoid arthritis is mostly 30-50 years old, and is more common in the small joints of both hands, and can also involve large joints such as hips and knees. It is characterized by symmetrical multi-joint involvement at the same time. Morning stiffness usually exceeds 30 minutes. Laboratory examinations can find changes such as positive rheumatoid factor.
Ankylosing spondylitis is common in male youth. Low back and buttock pain is the main symptom, and it is often accompanied by aggravation of nighttime pain. Morning stiffness in the waist and back can last for more than 30 minutes. X-rays can show sacroiliac arthritis, and spinal bone-like changes may occur in the late stage of the disease. Infectious arthritis usually starts acutely, and may experience redness, swelling, heat, and pain in the affected joints in a short period of time, accompanied by obvious restriction of flexion and extension movement. After the progression of sepsis, it may be accompanied by systemic symptoms. Laboratory examinations can find obvious elevations in joint fluid inflammation indicators and neutrophils.
gout arthritis is more common in the first metatarsophalal joint and knee joint, and is usually manifested as asymmetric and acute joint severe pain. Typical gout stone can be seen in the involved joints of some patients. Laboratory examinations can detect hyperuricemia.
Calcium pyrophosphate deposition disease is also called pseudogout. The clinical symptoms during acute attacks are similar to acute gout arthritis, which are more common in the knee joint and wrist. X-ray examination shows calcification of cartilage in the joint space, and pyrophosphate crystals can be detected by joint effusion.
5 What are the purposes and principles of treatment of knee arthritis?
should adopt step-by-step and individualized treatment plans based on the patient's age, gender, body mass index (body mass index, BMI), lesion location and degree, so as to achieve the purpose of reducing pain, improving or restoring joint function, improving patient's quality of life, delaying disease progression and correcting deformities. The step-by-step treatment plan includes basic treatment, drug treatment, restorative surgical treatment and reconstruction surgical treatment.
6 What are the basic treatments for knee arthritis?
7 Which knee joints are the most recommended?
aerobic exercise and aquatic exercise can improve the pain and function of patients with knee arthritis. It is recommended that patients seek medical treatment in a timely manner. Under the guidance of clinicians, an individualized exercise treatment plan will be formulated according to the patient's condition to conduct intervention. Swimming and walking are the best exercises, followed by sit-ups, push-ups, bridge-shaped arches, imitation bicycle pedals and other exercises to avoid excessive weight bearing on the knees aggravate the condition. When participating in physical exercise, prepare for activities to stretch the knees. Here we have prepared 4 movements for the patients to maintain their knee joints for early exercise.
8 What are the applications of physical therapy in knee arthritis treatment?
Patients with knee arthritis may consider using interfering current stimulation therapy and pulsed ultrasound therapy to relieve pain symptoms. Physical therapy methods such as hydrotherapy, cold therapy, heat therapy, mud bath therapy, radiofrequency ablation and other percutaneous electrical nerve stimulation therapy also have certain effects on the treatment of knee arthritis.
9 What are the common drugs for treating knee arthritis?
It is recommended to use topical non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for knee arthritis pain, especially for patients with gastrointestinal diseases, cardiovascular diseases or physical weakness. Oral NSAIDs can be chosen for patients with knee arthritis who have persistent pain symptoms or moderate to severe pain, but they should be wary of gastrointestinal and cardiovascular adverse events. It is not recommended to use strong opioids for analgesic management of knee arthritis, and use weak opioids such as tramadol with caution.For patients with long-term, chronic, generalized pain and/or depression, anti-anxiety drugs such as deloxetine can be used.
10 Why do we choose the joint cavity injection drug
for the treatment of knee arthritis?
In clinical treatment, careful consideration should be given to the joint cavity injection of glucocorticoid to treat knee arthritis. Although it can relieve pain faster and improve joint function, long-term multiple use can accelerate the loss of knee cartilage. The joint cavity injection of sodium hyaluronate and medical chitin can be used to treat knee arthritis, which can relieve pain in the short term, improve joint function, and reduce the dosage of analgesic drugs, and is safer.
11 What are the common imaging tests for knee arthritis?
Arthroscopic surgery treatment can significantly improve knee arthritis, which is mainly complained of pain symptoms, and can be considered clinically as appropriate. Arthroscopic cleaning is recommended for the treatment of knee arthritis with strangulation symptoms (such as intra-articular free bodies).
12 Why do we choose PRP (platelet-rich plasma)
for knee arthritis?
PRP (platelet-rich plasma) treatment is to extract high-concentration platelet plasma from whole blood through centrifugation, containing high-concentration platelet , leukocyte and fibrin. It promotes tissue repair by initiating and accelerating the autologous repair mechanism. It is mainly used to treat diseases such as osteoarthritis, bone non-union, and tendonitis . For example, knee arthritis is injecting PRP into the knee joint cavity, which then releases growth factors, stimulates chondrocyte regeneration, relieves pain, and restores function.
13 Why do we choose osteotomy to treat knee arthritis?
For single-compartment osteoarthritis of the tibia femoral joint with poor knee force, especially in middle-aged and high-mobile patients, high-tibial osteotomy, supracondylar osteotomy or proximal fibula can be chosen as appropriate to improve joint function and relieve pain.
14 Why do we choose artificial joint replacement
for the treatment of knee arthritis?
is recommended for patients with severe knee arthritis whose efficacy is not obvious in other interventions. At the same time, the specific situation, subjective intention and expectations of the patient should be considered. The 10-year survival rate of the prosthesis after knee arthroplasty was 96.1%, and the 20-year survival rate was 89.7%. Compared with conservative treatment, knee arthroplasty can significantly improve the pain and function of severe knee arthritis. However, although arthroplasty is a treatment plan with accurate efficacy and mature technology, some patients still have poor treatment results. In addition to continuously optimizing the design of implants, we need to focus on the formulation of personalized treatment plans for patients and the optimization of perioperative management.
In addition, in terms of knee replacement, some patients with single-room degeneration, such as patellofemoral arthritis and tibiafemoral osteoarthritis, can also choose to perform corresponding single-room artificial joint replacement surgery under the conditions of meeting the corresponding surgical indications.
\ Expert name /
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Associate Chief Physician of Orthopedics
Expert clinic: Tuesday, Friday afternoon, Thursday morning
Teacher was a master of orthopedic science in my country and founder of joint surgery Dai Rong Academician. Super postdoctoral fellow in Shanghai, postdoctoral fellow in Tongji University, visiting scholar in biomedical engineering at the University of California, Berkeley, young member of the Digital Medicine Branch of the Chinese Medical Association, and researcher in the Key Laboratory of Spinal and Spinal Cord Injury of the Ministry of Education.
is good at periarthritis of shoulder , shoulder freezing, hip and knee joint pain, meniscus injury , cruciate ligament injury and shoulder and knee joint effusion (conservative and surgical treatment).
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text | Orthopedics Wan Daqian
edit | Zhao Sisi Wang Beimo
review | Xie Zhuangli
