Arthrosis of the knee joint is a chronic (long -term) degenerative disease that causes the destruction of cartilage in the joints.Symptoms include pain, stiffness and swelling.Treatment options to reduce pain and disability include changes in lifestyle (diet, physical exercises), physical and professional methods of treatment, medicines and surgery.
Osteoarthrosis of the knee joint
Osteoarthrosis of the knee joint is a common disease, accompanied by chronic, exhausting pain.Recent clinical data showed that the central sensitization stimulates deforming osteoarthrosis of the knee joint.An improved understanding of how arthrosis of the knee joints affects the central processing of pain is crucial for the identification of new analgesic targets/new therapeutic strategies.
Inhibitory receptors weaken the function of peripheral immune cells and modulate central neuro-immune answers.The systemic introduction of the receptor agonist weakened OA-induced pain behavior, and changes in circulating and anti-inflammatory cytokines were manifested in this model.
Deforming arthrosis
The deforming arthrosis of the knee joint is inflammation and wear of the cartilage on the bones that form the knee joint (osteo = bone, artro = joint, itis = inflammation).The diagnosis of osteoarthritis of the knee joint is based on two main results: radiographic data on changes in bone health (using medical images, such as X-ray and magnetic resonance image of MRI), and human symptoms.About 14 million people have symptomatic knee arthrosis.Although the more common in older people, 2 million out of 14 million people with a symptomatic OA of the knee were younger than 45 years old during the diagnosis, and more than half were younger than 65 years.
Osteoarthritis (OA knee) is a progressive disease caused by inflammation and degeneration of the knee joint, which over time worsens.
This affects the entire joint, including bones, cartilage, ligaments and muscles.Its development is affected by age, body mass index (BMI), bone structure, genetics, muscle strength and level of activity.The OA knee can also develop as a secondary state after the knee injury.Depending on the stage of the disease and the presence of injuries or conditions associated with it, the OA knee can be controlled using physical therapy.More severe or expanded cases may require surgical intervention.
Symptoms
Persons who develop the Knee OA may experience a wide range of symptoms and restrictions based on the development of the disease.The pain occurs when the cartilage covering the bones of the knee joint wear out.The areas where the cartilage wears out or damaged, exposes the bone underlying.The effect of the bone allows you to increase stress and the compression of the cartilage, and sometimes bone contact when moving, which can cause pain.Since the knee is a joint, the level of activity, the level of activity, as well as the type and duration of actions, as a rule, have a direct effect on the symptoms.Symptoms can deteriorate with weight activity, for example, when walking with a heavy object.
Symptoms of the knee joint may include:
- Deterioration of pain during or after surgery, especially when walking, climbing, walking down the stairs or moving from a sitting to a standing position.
- Pain or stiffness after sitting with a bent or straight knee for a long period of time.Pain is the most common symptom of osteoarthritis.As the disease develops and inflammation, pain can become constant.
- A feeling of jumping out, cracks or grinding when moving the knee.
- Swelling after action.
- The rigidity of the affected joint was often seen first of all in the morning and after rest.
- Edema, which is sometimes warm to the touch, can be noticeable in the joint with arthritis.
- Deformation can occur with osteoarthritis due to bone growth and cartilage loss.The growth of bones in the end joints of the fingers is called Hyberden’s nodes.Bushar nodes are the growth of bones in the middle joints of the fingers.The degeneration of the cartilage of the knee joint can lead to the external curvature of the knees (onions-foot).
- A crackering sound or a grate sensation can be noticed when the arthritis moves.This is caused by wiping the bone against bone or rough cartilage.
Usually these symptoms do not arise suddenly and all at once, but gradually develop over time.Sometimes people do not admit that they have osteoarthritis, because they cannot recall a certain time or injury that caused their symptoms.If the knee pain has deteriorated for several months, which does not respond to rest or change in activity, it is better to seek advice to a medical worker.
Diagnostics
Osteoarthritis can often be diagnosed by its characteristic symptoms of pain, reduced movement and/or deformation.Osteoarthritis can be confirmed by x-ray or MRI scanning.General data include narrowing of the articular space between the bones, the loss of cartilage and bone spurs or the growth of bones.Blood tests can be used to exclude other possible conditions, but they cannot diagnose osteoarthritis.
In the knee OA, 2 primary process is diagnosed.The first is based on a report on the symptoms and clinical examination.The physiotherapist will ask questions about the medical history and activity.The therapist will conduct a physical examination to measure the movement of the knee (range of movement), strength, mobility and flexibility.They can also ask for various movements to see, increase or decrease the pain.
The second tool used to diagnose the knee joint is a diagnostic visualization.The physiotherapist can send to the doctor who will prescribe x -rays of the knee in various positions to check damage to the bone and cartilage of the knee joint.
If more serious damage to the joints is suspected, you can order an MRI in order to more carefully study the overall status of articular and surrounding fabrics.
Blood tests can also be ordered to help exclude other conditions that can cause symptoms similar to osteoarthritis of the knee joints.
Treatment
Depending on the severity of arthritis and the age of the patient, it will be chosen how to treat arthrosis of the knee joints.Treatment may consist of operational or conservative methods, or their combinations.
The first treatment line of arthritis of the knee joint includes modification of activity, anti -inflammatory drugs and weight loss.
The rejection of actions that enhance pain can make this condition acceptable to some people.Anti -inflammatory drugs help alleviate inflammation that can contribute to pain.
Physical therapy to strengthen the muscles around the knee can help absorb part of the shock given to the joint.This is especially true for arthritis with a knee cup (Patello-Femoral).Special types of braces designed to transfer the load to the part of the knee joint, which is less than arthritis, can also relieve pain.Injections of drugs inside the knee joint can also help temporarily.
In addition, walking with a cane in the hand on the opposite side, since a painful knee can help distribute part of the load, reduces pain.Finally, weight loss helps to reduce the force that passes through the knee joint.The combination of these conservative measures can help relieve pain and prevent disability.
If these methods do not allow you to make the condition tolerant, the operation may be the best option for treating arthritis of the knee joint.The exact type of operation depends on the age, anatomy and the main state.Some examples of surgical options for treating arthritis include osteotomy, which consists in cutting the bone to align the joint.
Modern methods of treating arthrosis of the knee joint include osteotomy, which is a good alternative if the patient is young and arthritis is limited by one area of the knee joint.This allows the surgeon to rebuild the knee in order to unload the arthritis area and carry out the load relatively not involved parts of the knee joint.For example, the patient can be rebuilt to redistribute the load through the joint.The advantage of this type of surgery is that the patient’s own knee joint is preserved and can potentially ensure many years of relief of pain without the shortcomings of the prosthetic knee.The disadvantages include a longer rehabilitation course and the possibility of developing arthritis in a recently leveled knee.
The operation to replace the knee joint includes cutting the arthritic bone and the insertion of the prosthetic joint.All arthritic surfaces are replaced, including the femur, lower leg and knee cup.Arthritic surfaces are removed, and the ends of the bone are replaced by a prosthesis.The prosthetic component is usually made of metal and plastic surfaces, which are designed for smooth sliding against each other.
Replacing the knee joint
The overall operation to replace the knee joint was first performed in 1968 and over the years evolved on a reliable and effective way to get rid of pain when turning off and allows patients to resume their active life.Improvements in the field of surgical methods and implants helped to make this one of the most successful orthopedic procedures today.As the population becomes older and remains more active, the need for a general replacement of the knee continues to grow.Many of the operations to replace the knee joint took place in the hospital of special surgery.Improvements in surgical technology and the design of new implants are some of the contributions that surgeons made.
People often wonder when and why they should replace their knee.This is an individual question that depends on the level of human activity and functional needs.Many people with arthrosis live with pain, which prevents them from participating in activities;Others are so weakened that it is difficult for them to wear shoes and socks.A complete replacement of the knee joint offers the solution to the problem of arthrosis and is performed in order to relieve pain and resume activity.After rehabilitation from the successful complete replacement of the knee joint, the patient may expect surgery, without pain.A complete replacement of the knee joint significantly improves the patient's condition, and significantly reduces its long -term treatment costs.This study showed that not only the overall replacement of the knee joint is economically effective, but also provides greater functionality and the best quality of life.
A complete replacement of the knee joint is considered a major operation, and the solution is not trivial.Usually people decide to undergo an operation when they feel that they can no longer live with their arthritis.
The implant consists of 4 parts: tibia, femoral parts, plastic insert and a pattern.The components of the tibia and femur are made of metal, usually cobalt chromium, are used to close the ends of the thigh and lower leg after removing the arthritic bone.The plastic insert is made of polyethylene of ultra -high molecular mass and fits into the tibia component, so that the polished thigh surface slides along the plastic.The component of the knee cup also glides against the front of the femoral component.Usually they are attached to the bone cement.
The full replacement of the knee is performed in the operating room with a special laminar air flow system, which helps reduce the likelihood of infection.Your surgeon will wear a “spacesuit”, also designed to reduce the likelihood of infection.The entire surgical team will consist of your surgeon, from two to three assistants and nannies.
Anesthesia is given through an epidural catheter, which is a small tube inserted into the back.During the operation, the patient can be both awake and sleepy.
After the introduction of the epidural block around your thigh, a tourniquet or a cuff will be placed.The horizontal bar will be overstated during the operation to reduce blood loss.The cutout for the complete replacement of the knee is made along the front knee.The incision will be measured from 4 to 10 inches depending on the anatomy.
Arthritic surfaces of the femur, lower legs and patella are exposed and removed using strength tools.At the same time, the deformations of the knee are corrected, and after the operation, the knee becomes more straight.The bone is ready to take an artificial knee joint, and then a prosthesis is inserted.During the closure, two drainage are installed around the working area to help in the evacuation of blood.Sapers are used to close the skin.
The whole operation will take from 1 to 2 hours.After that, the patient will be taken to the recovery room where the tests will be checked.Most patients can be taken to a regular room for several hours;Others will have to stay in the hall for recovery, as defined by a surgeon and an anesthetist.
Patients usually remain in the hospital for 3-4 days after a full operation to replace the knee
Risks during surgery
Some of the risks of the surgical procedure include blood loss, the formation of a clot in the leg and the probability of infection.The general prevalence of these risks is very small.They should be discussed with the surgeon before the start of the operation.
Some of the risks of the presence of a prosthetic knee include the likelihood that parts can weaken or wear out over time, or the prosthesis may become infected.Again, these issues will be discussed with the surgeon.
Postoperative course
Immediately after a complete operation to replace the knee joint, the patient will fall into the recovery room.Most patients can get into a regular ward after a few hours, when the sensation returns in the legs.A pain pump associated with an epidural catheter will be given, which will allow you to control when a cure for pain is given.
On the day of the operation, you can perform some exercises, as indicated by the physiotherapist, including reduction of quadriceps and moving the legs up and down.Depending on the preference of the surgeon, you can begin to bend your new knee immediately after the operation or on the first day of it.The patient will be allowed to take ice after surgery to wet his mouth, but drink fluids or you can cause nausea.The patient will have a catheter in the bladder, so you do not need to worry about urination.As soon as the movement in the legs is restored, it will be allowed to sit down, get up and take a few steps with a walker and therapist.
The first day after the operation will be active, developed to help become more mobile.
The patient will meet with physiotherapists who will instruct additional exercises.In addition, they will help to get on their feet and take a few steps with a walk.As a rule, the patient will be allowed to drink pure liquid.
In the next few days it will be easier and easier to move.The patient will be released from pain and urinary catheter.Treatment of pain will be given in the form of tablets.On the second day after the operation, if signs of recovery are found in the intestines, it will be allowed to eat ordinary food.
Depending on your age, preoperative physical condition and insurance coating, the patient may be a candidate for short -term accommodation in a rehabilitation institution.Otherwise, the patient will be discharged home, and the physiotherapist will come to his house to continue rehabilitation.The dispatcher will discuss these options with the patient and will help him plan his return home.
A return to the activity will be guided by a surgeon and therapists.As a rule, patients can walk as much as they want 6 weeks after surgery.Patients can resume movement after 6 weeks.After 8 weeks, patients can resume the game in golf and swimming;At 12 weeks they can play tennis.The surgeon will help decide what actions can be resumed.
What physiotherapist is needed
All physical therapists are prepared through education and clinical experience for the treatment of various conditions or injuries:
- A physiotherapist who has experience in treating people with an osteoarthritis of the knee joint and after surgery to replace the knee joint.Some physiotherapists have a practice with an orthopedic focus.
- A physiotherapist who is a certified orthopedic clinical specialist.This physiotherapist will have advanced knowledge, experience and skills that can be applied to a state.
- You can find physiotherapists who have these and other accounting data using an MRI, an online tool to help find physiotherapists with specific clinical knowledge.
General advice when you can find a physiotherapist (or any other supplier of medical services):
- Get recommendations from family and friends or from other suppliers of medical services;
- Turning to the clinic for physiotherapy for admission, you need to ask about the experience of physiotherapists in assisting people with arthritis.
During the first visit with the physiotherapist, you need to be prepared to describe the symptoms as in more detail, and report on activities that worsen the condition.