Osteoarthritis of the knee joint is a chronic degenerative disease (long -term) which 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 treatment methods, drugs and surgery.
Knee joint osteoarthrosis
Osteoarthrosis of the knee joint is a common disease, accompanied by chronic and exhausting pain.Recent clinical data have shown that central awareness stimulates the deformation of osteoarthrosis of the knee joint.A better understanding of the way in which osteoarthritis of the knee joints affects the central treatment 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 responses.The systemic introduction of the receptor agonist weakened the behavior of the Pain induced by the OA, and changes in circulating and anti-inflammatory cytokines have manifested in this model.
Distorting osteoarthritis
The deforming osteoarthritis of the knee joint is inflammation and wear of the cartilage on the bones which 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 -rays and MRI magnetic resonance image) and human symptoms.About 14 million people have symptomatic knee osteoarthritis.Although the most frequent in the elderly, 2 million out of 14 million people with a knee symptomatic OA were under 45 during the diagnosis, and more than half were less than 65 years old.
Arthrosis (OA knee) is a progressive disease caused by inflammation and degeneration of the knee joint, which over time is getting worse.
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 activity level.The OA knee can also develop as a secondary state after 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 physiotherapy.More serious or enlarged cases may require surgery.
Symptoms
People who develop knee osteoarthritis can feel a wide range of symptoms and restrictions depending on the development of the disease.The pain occurs when the cartilage covering the bones of the knee joint wears out.The areas where the cartilage wears out or damaged exposes the underlying bone.The effect of the bone allows you to increase stress and compression of cartilage, and sometimes bone contact during movement, which can cause pain.Since the knee is an articulation, the level of activity, the level of activity, as well as the type and duration of the 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 knee joint may include:
- Damage of pain during or after surgery, especially on the move, by climbing, walking on the stairs or by moving a position sitting to a standing position.
- Pain or stiffness after sitting with a folded or straight knee for a long time.Pain is the most common symptom of osteoarthritis.As the disease develops and inflammation, pain can become constant.
- A feeling of jumping, cracking or grinding when moving the knee.
- Swelling after action.
- The rigidity of the affected joint has often been observed first in the morning and after rest.
- Edema, which is sometimes hot to the touch, can be noticeable in the joint with arthritis.
- Deformation can occur with osteoarthritis due to bone growth and loss of cartilage.The growth of bones in the final joints of the fingers is called Hyberden's nodes.Bushar nodes are bone growth in joints in the middle of the fingers.The degeneration of the cartilage of the knee joint can cause the external curvature of the knees (onions).
- A graft sound or a grid feeling can be noticed when arthritis moves.This is caused by wiping the bone against bone or rough cartilage.
Usually these symptoms do not suddenly occur and at the same time, but are gradually developing over time.Sometimes people do not admit that they suffer from osteoarthritis because they do not remember a certain time or an injury that has caused their symptoms.If the knee pain has deteriorated for several months, which does not respond to rest or a change of activity, it is preferable to seek advice from a medical worker.
Diagnosis
Osteoarthritis can often be diagnosed by its symptoms characteristic of pain, reduces movement and / or deformation.Osteoarthritis can be confirmed by radiography or MRI.General data include narrowing of the joint space between bones, loss of cartilage and bone spurs or bone growth.Blood tests can be used to exclude other possible conditions, but they cannot diagnose osteoarthritis.
In the OA of the knee, 2 primary processes are diagnosed.The first is based on a report on symptoms and clinical examination.The physiotherapist will ask questions about medical history and activity.The therapist will carry out a physical examination to measure the knee movement (movement beach), strength, mobility and flexibility.They can also ask for various movements to see, increase or decrease 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 the bone damage and the knee joint cartilage.
If more serious damage to the joints are suspected, you can order an MRI in order to study the general status of joint and surrounding tissues more carefully.
Blood tests can also be ordered to help exclude other conditions which 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 osteoarthritis of the knee joints.The treatment can be made up of operational or conservative methods, or their combinations.
The first line of articulation of the knee articulation includes the modification of the activity, anti-inflammatory drugs and weight loss.
The rejection of actions that improve pain can make this condition acceptable for certain people.Anti-inflammatory drugs help to alleviate inflammation that can contribute to pain.
Physiotherapy to strengthen the muscles around the knee can help absorb part of the shock given to the joint.This is particularly true for arthritis with a knee cup (rotum-femoral).Special types of bracing designed to transfer the load into the part of the knee joint, which is lower than arthritis, can also relieve pain.Drug injections inside the knee joint can also temporarily help.
In addition, walking with a cane in hand on the opposite side, because a painful knee can help distribute part of the load, reduces pain.Finally, weight loss helps reduce the force that goes 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 tolerant condition, the operation may be the best option to treat articulation of the knee.The exact type of exploitation depends on the age, anatomy and the main state.Certain examples of surgical options to treat arthritis include osteotomy, which consists in cutting the bone to align the joint.
Modern methods of processing osteoarthritis of the knee joint include osteotomy, which is a good alternative if the patient is young and that arthritis is limited by an area of the knee joint.This allows the surgeon to rebuild the knee in order to unload the area of arthritis and to carry out the relatively not involved load in the parts of the knee joint.For example, the patient can be rebuilt to redistribute the load via the joint.The advantage of this type of surgery is that the patient's knee joint is preserved and can potentially ensure many years of pain relief without gaps in the prosthetic knee.The drawbacks include a longer rehabilitation course and the possibility of developing arthritis in a recently leveled knee.
The operation to replace the knee joint includes the cut of the arthritis OS and the insertion of the prosthetic joint.All arthritic surfaces are replaced, including the femur, the lower leg and the knee.Arthritic surfaces are removed and the ends of the bone are replaced by a prosthesis.The prosthetic component is generally composed of metallic and plastic surfaces, which are designed to slide gently against each other.
Replacement of the knee joint
The overall operation to replace the knee joint was carried out for the first time in 1968 and over the years, has evolved on a reliable and effective way to get rid of pain when deactivating and allows patients to resume their active life.Improvements in the field of surgical methods and implants have contributed to one of the most successful orthopedic procedures today.As the population ages and remains more active, the need for a general replacement of the knee continues to grow.Many operations to replace the knee joint took place at the special surgery hospital.Surgical technology improvements and the design of new implants are some of the contributions made by surgeons.
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 suffering from osteoarthritis 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 osteoarthritis and is carried out in order to relieve the pain and to resume activity.After rehabilitation of the complete replacement of the knee joint, the patient can expect surgery, painless.A complete replacement of the knee joint considerably improves the patient's condition and considerably reduces his long -term treatment costs.This study has shown that not only is the overall replacement of the knee articulation, but also offers 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 believe they can no longer live with their arthritis.
The implant consists of 4 parts: tibia, femoral parts, plastic insert and pattern.The components of the tibia and the femur are made of metal, generally cobalt chrome, are used to close the ends of the thigh and the bottom of the leg after removing the arthritic OS.The plastic insert is made of ultra-high molecular mass polyethylene and integrates into the component of the tibia, so that the surface of the polished thigh slides along the plastic.The component of the knee cut also slides against the front of the femoral component.Usually they are attached to bone cement.
The complete replacement of the knee is carried out in the operating room by a special laminar air flow system, which contributes to reducing the probability of infection.Your surgeon will wear a "space combination", also designed to reduce the probability of infection.The entire surgical team will be made up of your surgeon, two to three assistants and nannies.
Anesthesia is given by an epidural catheter, which is a small tube inserted in the back.During the operation, the patient can be awake and sleepy.
After the introduction of the epidural block around your thigh, a tourniquet or an armband will be placed.The horizontal bar will be overestimated during the operation to reduce blood loss.The cutting for the complete replacement of the knee is carried out along the front knee.The incision will be measured by 4 to 10 inches depending on the anatomy.
The arthritic surfaces of the femur, the lower legs and the ball joint are exposed and removed using resistance tools.At the same time, knee deformations are corrected, and after the operation, the knee becomes more straight.The bone is ready to take an artificial knee joint, then a prosthesis is inserted.During the closure, two drainages are installed around the work area to help the evacuation of blood.Sapres are used to close the skin.
The whole operation will take 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 an ordinary room for several hours;Others will have to stay in the recovery room, as defined by a surgeon and an anesthesiologist.
Patients generally remain in 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 low.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 probability that the parts can weaken or use over time, or the prosthesis can be infected.Again, these questions 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 enter an ordinary service after a few hours, when the feeling returns in the legs.A pain pump associated with an epidural catheter will be given, which will allow you to control when a remedy against pain will be given.
On the day of the operation, you can perform exercises, as the physiotherapist indicates, including the reduction of quadriceps and the displacement of legs from top to bottom.Depending on the surgeon's preference, you can start to fold your new knee immediately after the operation or the first day.The patient will be allowed to take ice after surgery to wet his mouth, but drink liquids or you can cause nausea.The patient will have a catheter in the bladder, so you don't have to worry about urination.As soon as the movement of the legs is restored, it will be allowed to sit, to get up and to take a few steps with a walker and a therapist.
The first day after the operation will be active, developed to help become more mobile.
The patient will meet physiotherapists who instruct additional exercises.In addition, they will help get up and take a few steps with a walk.As a rule, the patient will be allowed to drink pure liquid.
In the coming days, it will be easier to move.The patient will be released from the pain and the urinary catheter.Pain treatment will be given in the form of tablets.The second day after the operation, if signs of recovery are in the intestines, it will be authorized to eat ordinary foods.
Depending on your age, your preoperative physical condition and your insurance coating, the patient can be a candidate for short -term housing in a rehabilitation institution.Otherwise, the patient will have returned home and the physiotherapist will come to him to continue rehabilitation.The distributor will discuss these options with the patient and help him plan his return home.
A return to activity will be guided by a surgeon and therapists.As a rule, patients can walk as much as they wish 6 weeks after surgery.Patients can resume movement after 6 weeks.After 8 weeks, patients can go back to golf and swim;At 12 weeks, they can play tennis.The surgeon will help decide which actions can resume.
What the physiotherapist is necessary
All physiotherapists are prepared by education and clinical experience for the treatment of various conditions or injuries:
- A physiotherapist who has experience in the treatment of people by osteoarthritis of the knee joint and after surgery to replace the knee joint.Some physiotherapists have a practice with orthopedic orientation.
- A physiotherapist who is a certified orthopedic clinical specialist.This physiotherapist will have knowledge, experience and advanced skills that can be applied to a state.
- You can find physiotherapists who have this accounting data and others 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 medical service provider):
- Obtain recommendations from family and friends or other medical service providers;
- By turning to the clinic for physiotherapy for admission, you must ask yourself questions about the experience of physiotherapists to help people with arthritis.
During the first visit to the physiotherapist, you must be ready to describe the symptoms as in detail and to point out the activities that worsen the condition.