The osteoarthritis of the knee joint is a chronic (long -term) degenerative disease that causes the destruction of the cartilage in the joints.Symptoms include pain, rigidity and swelling.Treatment options to reduce pain and disability include changes in lifestyle (diet, physical exercises), physical and professional methods of treatment, medications and surgery.
Knee joint osteoarthrosis
The osteoarthrosis of the knee joint is a common disease, accompanied by chronic and exhausting pain.Recent clinical data showed that central awareness stimulates the deforming osteoarthrosis of the knee joint.A better understanding of how the osteoarthritis of the knee joints affects the central processing of pain is crucial for the identification of new analgesic objectives/new therapeutic strategies.
Inhibitory receptors weaken the function of peripheral immune cells and modulate central neuroimmune responses.The systemic introduction of the agonist of the receiver weakened the behavior of pain induced by the OA, and changes in circulating and anti -inflammatory cytokines manifested in this model.
Deforming osteoarthritis
The deforming osteoarthritis of the knee joint is the inflammation and wear of the cartilage in the bones that form the knee joint (osteo = bone, arthro = articulation, 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 the image of X -rays and magnetic resonance of magnetic resonance) and human symptoms.Around 14 million people have symptomatic osteoarthritis of knee.Although the most common in the elderly, 2 million of 14 million people with a symptomatic OA of the knee were under 45 years during the diagnosis, and more than half were under 65 years.
Osteoarthritis (OA knee) is a progressive disease caused by inflammation and degeneration of the knee joint, which 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 activity level.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.The most severe or expanded cases may require surgical intervention.
Symptoms
People who develop the OA of the knee may experience a wide range of symptoms and restrictions based on the development of the disease.The pain occurs when the cartilage that covers the bones of the knee joint is wearing up.The areas where the cartilage wears or damages, exposes the underlying bone.The effect of the bone allows you to increase stress and 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 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.
The symptoms of the knee joint can include:
- Pain deterioration during or after surgery, especially when walking, climbing, walking on the stairs or moving from a standing position to a standing position.
- Pain or rigidity after sitting with a bent or straight knee for a long period of time.Pain is the most common symptom of osteoarthritis.As disease and inflammation develop, pain can become constant.
- A feeling of jumping, cracks or grinding when moving the knee.
- Swelling after action.
- The stiffness of the affected joint was often observed in the first place in the morning and after resting.
- Edema, which is sometimes warm to touch, can be remarkable in the articulation with arthritis.
- Deformation can occur with osteoarthritis due to bone growth and cartilage loss.The growth of bones in the final fingers of the fingers is called Hyberden 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 (onion).
- You can notice a crunch sound or a grid sensation when arthritis moves.This is caused by cleaning the bone against bone or rough cartilage.
In general, these symptoms do not arise suddenly and everything at once, but gradually develop over time.Sometimes people do not admit that they have osteoarthritis, because they cannot remember a certain time or injury that caused their symptoms.If knee pain has deteriorated for several months, which does not respond to rest or change of activity, it is better to seek advice for a medical worker.
Diagnosis
Osteoarthritis can often be diagnosed with its characteristic symptoms of pain, reduced movement and/or deformation.Osteoarthritis can be confirmed by X -rays or magnetic resonance exploration.General data includes the narrowing of the joint space between the bones, the loss of cartilage and bone spur or the growth of the bones.Blood analysis can be used to exclude other possible conditions, but cannot diagnose osteoarthritis.
In the OA 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 perform a physical exam to measure the knee movement (movement range), strength, mobility and flexibility.They can also request several 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 that it will prescribe X -rays of the knee in several positions to verify the damage to the bone and cartilage of the knee joint.
If more serious damage to the joints is suspected, you can order a magnetic resonance to study the general status of joint and surrounding fabrics.
Blood analysis can also be ordered to help exclude other conditions that can cause symptoms similar to the 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 the osteoarthritis of the knee joints.The treatment may consist of operational or conservative methods, or their combinations.
The first line of arthritis treatment of the knee joint includes activity modification, anti -inflammatory medications and weight loss.
The rejection of actions that improve pain can make this condition acceptable for some people.Anti -inflammatory medications help relieve inflammation that can contribute to pain.
Physiotherapy to strengthen muscles around the knee can help absorb part of the clash given to the joint.This is especially true for arthritis with a knee glass (Pance-femoral).The special types of devices designed to transfer the load to the part of the knee joint, which is less than arthritis, can also relieve pain.Drug injections within the knee joint can also temporarily help.
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 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 to treat the knee joint arthritis.The exact type of operation depends on age, anatomy and the main state.Some examples of surgical options to treat arthritis include osteotomy, which consists of cutting the bone to align the joint.
Modern methods to treat the osteoarthritis of the knee joint include osteotomy, which is a good alternative if the patient is young and arthritis is limited by an area of the knee joint.This allows the surgeon to rebuild the knee to download 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 knee joint is preserved and can guarantee many years of pain relief without prosthetic knee deficiencies.Disadvantages include a longer rehabilitation course and the possibility of developing arthritis in a recently level 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, the lower part of the leg and the knee.Arthritic surfaces are eliminated, and bone ends are replaced by a prosthesis.The prosthetic component is usually made of metal and plastic surfaces, which are designed to slide soft.
Knee joint replacement
The general operation to replace the knee joint was performed for the first time in 1968 and over the years evolved in a reliable and effective way to get rid of pain when turning off and allows patients to resume their active life.The improvements in the field of surgical methods and implants helped make this one of the most successful orthopedic procedures today.As the population ages and remains more active, the need for a general knee replacement continues to grow.Many of the operations to replace the knee joint took place at the Special Surgery Hospital.The improvements in surgical technology and the design of new implants are some of the contributions made by surgeons.
People often ask 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 osteoarthritis live with pain, which prevents them from participating in activities;Others are so weakened that they find it difficult to wear shoes and socks.A complete replacement for the knee joint offers the solution to the problem of osteoarthritis and is performed to relieve pain and resume the activity.After the rehabilitation of the successful complete replacement of the knee joint, the patient can expect surgery, without pain.A complete replacement for the knee joint significantly improves the patient's condition and significantly reduces its long -term treatment costs.This study showed that not only the general replacement for the knee joint is economically effective, but also provides greater functionality and the best quality of life.
A complete replacement for the knee joint is considered an important operation, and the solution is not trivial.In general, people decide to undergo an operation when they feel they can no longer live with their arthritis.
The implant consists of 4 parts: warm, femoral pieces, plastic insert and a pattern.The components of the tibia and the femur are made of metal, usually cobalt chrome, are used to close the ends of the thigh and the lower part of the leg after eliminating the arthritic bone.The plastic insert is made of ultra high molecular mass polyethylene and fits the tibia component, so that the polished surface of the thigh slides along the plastic.The knee cup component also slides against the front of the femoral component.They are usually united to bone cement.
The full knee replacement is performed in the operating room with a special laminar air flow system, which helps reduce the probability of infection.Your surgeon will use a "space suit", also designed to reduce the probability of infection.The entire surgical team will consist of its surgeon, two to three attendees and nannies.
Anesthesia is administered through an epidural catheter, which is a small tube inserted in the back.During the operation, the patient may be awake and sleepy.
After the introduction of the epidural block around its thigh, a tourniquet or sleeve will be placed.The horizontal bar will be exaggerated during the operation to reduce blood loss.The cut for complete knee replacement is done along the front knee.The incision will be measured from 4 to 10 inches depending on the anatomy.
The arthritic surfaces of the femur, the lower part of the legs and the kneecap are exposed and eliminated 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, and then a prosthesis is inserted.During the closure, two drains are installed around the work area to help in the evacuation of the blood.Stepers are used to close the skin.
The entire operation will take 1 to 2 hours.After that, the patient will be taken to the recovery room where the tests will be verified.Most patients can be taken to a regular room for several hours;Others will have to stay in the hall to recover, as defined by a surgeon and an anesthetist.
Patients usually remain in the hospital for 3-4 days after a complete operation to replace the knee
Risks during surgery
Some of the risks of the surgical procedure include blood loss, the formation of a leg clot and the probability of infection.The general prevalence of these risks is very small.They must 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 pieces can weaken or wear out over time, or the prosthesis can be 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 enter a regular room after a few hours, when the sensation returns to the legs.A pain pump will be administered associated with an epidural catheter, 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 the reduction of the quadriceps and the movement of 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 the first day of it.The patient will be allowed to take ice after surgery to moisten the mouth, but drink liquids or can cause nausea.The patient will have a catheter in the bladder, so he does not need to worry about urination.As soon as the leg movement is restored, it will be allowed to sit, get up and take a few steps with a walker and a therapist.
The first day after the operation will be active, developed to help be more mobile.
The patient will meet with physiotherapists who will instruct additional exercises.In addition, they will help stand up and take a few steps with a walk.As a general rule, the patient can 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.The pain treatment will be administered in the form of tablets.The second day after the operation, if there are signs of recovery in the intestines, it will be allowed to eat common foods.
Depending on their age, preoperative physical condition and insurance coating, the patient can be a candidate for short -term accommodation in a rehabilitation institution.Otherwise, the patient will be discharged home, and the physiotherapist will come home to continue rehabilitation.The dispatcher will discuss these options with the patient and help him plan his return home.
A return to the activity will be guided by a surgeon and therapists.As a general 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 physiotherapists are prepared through education and clinical experience for the treatment of various conditions or injuries:
- A physiotherapist who has experience in the treatment of people with an osteoarthritis of the knee joint and after surgery to replace the knee joint.Some physiotherapists have a practice with an orthopedic approach.
- 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 that have these and other accounting data using a magnetic resonance, an online tool to help find physiotherapists with specific clinical knowledge.
General advice when you can find a physiotherapist (or any other medical services provider):
- Obtain recommendations from family and friends or other medical service providers;
- As for the physiotherapy clinic for admission, you must ask about the experience of physiotherapists to help people with arthritis.
During the first visit to the physiotherapist, you must be prepared to describe symptoms as in more detail and inform about activities that worsen the condition.