Knee arthrosis by A.Griguolo

Generality

Knee arthrosis is the chronic inflammation of the knee, resulting from the degeneration of the cartilage layers typical of the joint in question and from the consequent abnormal rubbing of the femur on the tibia.

Generally, knee osteoarthritis is the result of a combination of circumstances; rarely, it depends on one cause only. Among the factors that favor the development of knee osteoarthritis, there are: advanced age, obesity, a past history of knee injuries and meniscus removal operations.

More often bilateral than unilateral, knee osteoarthritis typically causes: knee pain, joint stiffness, redness of the skin at the knee, issue of knee creaks, swelling and reduced joint mobility.

Unfortunately, at the present time, knee osteoarthritis is a condition with irreversible effects and for which there are only symptomatic cures.

Short anatomical reference of the knee

The knee is the important synovial joint of the human body, placed between the femur (superiorly), tibia (inferiorly) and patella (anteriorly).

Its anatomy is quite complex and includes:

The articular cartilage, which covers the lower surface of the femur, the inner side of the patella and the center of the upper surface of the tibia, protecting all these bones from mutual rubbing;

The synovial membrane, which covers the joint from the inside and produces synovial fluid, a fluid with a lubricating action for all the internal structures of the knee;
The tendons and ligaments, which guarantee the stability of the joint and the right alignment between the femur and tibia;
The synovial bags, which are small synovial membrane pockets, filled with a lubricating liquid very similar to the synovial fluid;
The inner meniscus (or medial meniscus ) and the external meniscus (or lateral meniscus ), which are cartilage pads with shock absorbing and anti-rubbing function, located on the upper surface of the tibia.

What is Knee Arthrosis?

Knee arthrosis is the chronic inflammation of the knee, which results from the degeneration of the articular cartilage and / or of the meniscus cartilage.

Arthrosis of the knee is, unfortunately, an irreversible and progressive condition ; it produces, in fact, injuries to the cartilage of the knee that are impossible to recover and with the tendency to worsen with time.

In the medical field, knee osteoarthritis is also known as knee gonarthrosis or osteoarthritis .

Did you know that ...

With its position and its structural components, the knee plays a fundamental role in supporting the weight of the body and in allowing the movements of extension and flexion of the leg, during a walk, a run, a jump etc.

Osteoarthritis or Osteoarthritis: what is it?

In medicine, the term arthritis refers to any inflammatory condition affecting one or more joints (usually synovial joints).

Osteoarthritis is a form of arthritis ; to be precise, it is a form of "wear" arthritis of the articular cartilages.

Of the many forms of existing arthritis, osteoarthritis is the most widespread: it affects only 27 million people in the United States!

To learn more: Knee arthrosis, Video »

Causes

Usually, knee osteoarthritis results from a combination of circumstances; in fact, it is very rare that it depends on a single cause.

Among the possible circumstances whose combination can lead to knee osteoarthritis include:

Advanced age . It is probably the most incident causal factor in the development of knee osteoarthritis.
The normal aging process produces the generalized degeneration of the cartilages of the human body and reduces the body's ability to counteract this degeneration;
Overweight and obesity . Excessive body weight is a significant stress for the knees, especially for joint cartilages and meniscus;
A past history of repeated injuries to one or both knees . Injuries to the knees are typical problems for those who practice sport or a job in which weight is continuously lifted.
Among the sports most at risk of knee arthrosis, stand out: football, rugby, basketball, running on poor roads, skiing, American football, volleyball and tennis:
Membership in the female sex . Statistics show that women over the age of 55 represent the category most likely to develop knee osteoarthritis;
Genetic predisposition to osteoarthritis . Some genetic diseases involve a particular inclination to arthrosis affecting the most important joints of the human body, including the knee;
The association with other forms of arthritis (eg, rheumatoid arthritis) or with some metabolic disease (eg, Paget's disease).
The medial or lateral meniscus removal surgery . Surgically removing part or a whole meniscus means partially or totally removing the cartilage that defends the tibia.

Pathophysiology: how does knee arthrosis originate?

In knee osteoarthritis, inflammation depends on degeneration and consequent thinning of the cartilages of the knee. In fact, with the degeneration and thinning of the aforementioned cartilages, the inferior surface of the femur and the upper surface of the tibia collide and, thanks to the continuous rubbing due to the movements of the lower limb, they give each other the damage from which it springs the inflammatory condition in question.

Substantially, therefore, in gonarthrosis, inflammation is the result of the repeated and damaging rubbing of the femur on the tibia, after the protective cartilage layer has thinned on the lower surface of the first and on the upper surface of the second one.

Symptoms and Complications

The typical symptoms and signs of knee osteoarthritis are:

Knee pain . It is the predominant symptom of knee osteoarthritis; it consists of a sensation that increases with excessive movement and physical activity, and that is attenuated with rest.
Usually, a very intense pain is indicative of a very severe inflammation and a significant degeneration of the articular cartilage;

Joint stiffness and reduced joint mobility . They are present especially in the morning, just after waking up, and after long periods of immobility (eg after a several-hour car journey).
The stiffness of the knee and the reduction of its mobility make it difficult activities such as climbing stairs, getting up from a chair, getting in and out of the car, etc.
Redness and heat at the knee.
Knee swelling ;
Emission from the knee of sounds, such as creaking or crackling, with each movement of the lower limb;
Osteophyte formation within the knee. Similar to a rose thorn, a beak or a claw, osteophytes are small bony growths, which develop on the articular surfaces of bones subjected to erosive and irritative processes with a chronic character.
In slang language, osteophytes are also known as bone spurs;
Unstable knee ;
Atrophy of the muscles of the thigh (ie reduction of muscle tone in the thigh). This happens because, due to pain, stiffness and reduced joint mobility, the patient tends increasingly to be sedentary.

Did you know that ...

According to some experts in the field of knee osteoarthritis, the humid climate and low pressure would cause a worsening of knee pain and joint stiffness.

This phenomenon would be attributable to a marked sensitivity on the part of the nerve fibers that reach the joint capsule against changes in atmospheric pressure and humidity.

Osteoarthritis in the Knee: Mono- or Bilateral?

Arthrosis of the knee may affect one ( arthrosis of the unilateral knee ) or both knees ( bilateral knee arthrosis ). However, it is good to point out that, in more than half of the clinical cases, it is bilateral.

Complications

In its most advanced stages, knee osteoarthritis can cause deformation of the lower limbs ( varus knee ).

Moreover, when the associated symptomatology is very severe, it is an obstacle to the most banal daily activities, which often leads to a state of depression and discouragement in the patient.

When should I go to the doctor?

An individual with suspected knee osteoarthritis should contact their doctor or orthopedic surgeon experienced in knee diseases, when pain and joint stiffness are such as to prevent the performance of the simplest daily activities (eg climbing stairs, getting into the car etc.).

Diagnosis

As a rule, the diagnostic procedure for the detection of osteoarthritis of the knee starts from the objective examination and from the anamnesis ; therefore, it continues with an evaluation of family history, to understand if there is a recurrence of gonarthrosis in the patient's family; finally, it ends with X-rays and nuclear magnetic resonance ( NMR ) at the knees.

X-rays: what are they for?

In the diagnosis of knee osteoarthritis, X-rays serve to clarify whether the aforementioned inflammatory condition is associated with osteophytosis . In the medical field, the term osteophytosis indicates the process of formation of the aforementioned osteophytes at the joint level.

Magnetic Resonance: what is it for?

Among the various investigations necessary for the diagnosis of gonarthrosis, the nuclear magnetic resonance in the knee is, most probably, the most significant and reliable . In fact, it not only ascertains what emerged in the previous diagnostic tests, but also allows to clarify the extent of degeneration and thinning of the cartilage of the femur and tibia.

Information derived from nuclear magnetic resonance to the knees allows the attending physician to establish the most appropriate treatment.

Therapy

Unfortunately, at the present time, those suffering from knee osteoarthritis can only rely on symptomatic treatments (ie treatments aimed exclusively at symptom management), since, despite their numerous efforts, doctors and pathologists have not identified a specific cure (where the term "specific" means "capable of healing").

In order to heal from arthritis to the knee (and so from all other forms of osteoarthritis) the degenerative process of the cartilage of the femur and tibia should be stopped, and the thickness of these cartilages restored, as before the onset of the disease.

Aims of Symptomatic Therapy for Knee Arthrosis

Briefly, the main goals of symptomatic treatments for knee osteoarthritis are:

Reduce pain when using the knees (ie during flexion or extension movements);
Re-establish a part of joint mobility that generally characterizes healthy knees.

Which medical figure does the Osteoarthritis of the Knee follow?

Osteoarthritis of the knee is a matter for orthopedic doctors, or doctors specialized in the diagnosis, treatment and prevention of diseases that can affect the musculoskeletal system.

Symptomatic Therapy for Knee Arthrosis: what does it consist of?

Symptomatic therapy for knee osteoarthritis may be conservative (or non-surgical ) or surgical .

In general, doctors give precedence to symptomatic treatments of a conservative nature, reserving the right to resort to surgery only if the conservative practice has not provided any result (or the results provided are unsatisfactory and the patient continues to show intense pain, joint stiffness, swelling, etc.) .

CONSERVATIVE SYMPTOMATIC THERAPY

Among the conservative symptomatic treatments for knee osteoarthritis, include:

A diet plan aimed at reducing body weight . This obviously applies when an overweight / obesity condition has contributed to the onset of gonarthrosis;
Physiotherapy exercises aimed at strengthening the muscles of the lower limbs (thigh in particular) and increasing the joint mobility of the knee.
A stronger thigh musculature relieves the burden of body weight on the knee, with enormous benefits for the latter.

The administration of pain medication and non-steroidal anti-inflammatory drugs (ie NSAIDs ). Among the most used painkillers and NSAIDs in case of knee arthrosis, paracetamol, ibuprofen and naproxen sodium are reported.
The use of these medicines is beneficial in a good number of patients.
Injections in the knee of corticosteroids and / or hyaluronic acid . Corticosteroids are powerful anti-inflammatories, whose prolonged or inappropriate use can cause serious side effects (hypertension, obesity, glaucoma, etc.); for this reason, doctors prescribe them only in cases of real need and only when NSAIDs are ineffective.
Hyaluronic acid, on the other hand, is a lubricating substance, physiologically present within the synovial joints such as the knee; with its administration, the doctors intend to restore part of the normal joint structure, which has failed due to arthrosis.
The practice of a moderate but constant physical exercise for the lower limbs . The purposes of this physical exercise are, in fact, the same as in physiotherapy.
Contrary to what one might think, immobility and sedentary life are only a source of benefits for the knee osteoarthritis patient.
Clearly, physical exercise must be targeted and must not in any way cause further damage to the knees.
Use of a specific brace for the sick knee . There are various types of braces for the knee affected by arthrosis; the choice of the most suitable type of guardian is up to the treating orthopedist and generally depends on the health status of the joint involved.

SURGICAL SYMPTOMATIC THERAPY

There are at least three different surgical approaches to dealing with knee osteoarthritis; these approaches are:

The "cleaning" of the cartilages of the knee performed in arthroscopy . It is the least invasive option, but also less effective. In general, orthopedists reserve it for younger patients with early knee arthritis.
Osteotomy of the femur or tibia . The osteotomy is a surgical procedure that involves the remodeling of a particularly deteriorated joint bone, with the final aim of better redistributing the body weight within the joint.
In general, knee osteotomy is reserved for patients with cartilage damage of only one of the two bone portions forming the joint.
The installation of a prosthesis in place of the true knee . The installation of a knee prosthesis is a very invasive and delicate surgery; however, if it is successful, the benefits for the patient are more than appreciable.
Although nowadays the most modern knee implants last even 20 years, even today orthopedists recommend them only to elderly patients (aged 55 and over).

Prognosis

Arthrosis of the knee is a chronic condition, destined to worsen over time and from which it is impossible to heal. Therefore, in his presence the prognosis can never be positive.

However, it is right to point out that, by now, today's medicine makes very effective symptomatic treatments available to the wearers of knee arthrosis.