In recent years, there has been significant progress in terms of the therapeutic arsenal for treating knee osteoarthritis. This progress has been achieved in both conservative, i.e. non-surgical, and surgical treatments. Depending on the age and functional status of the patient, in addition to limb deaxation, it is decided which of these two treatments is the most suitable.
Among the main non-surgical treatments there are two basic elements: platelet growth factors and hyaluronic acid. Growth factors are proteins that play a key role in the process of tissue repair and regeneration. Their application stimulates and accelerates the healing and regeneration process of most of the body’s tissues. These factors are located inside platelets and in serum. Platelets, due to their property of secreting a set of proteins, can act by regenerating and repairing tissues, as well as regenerating the cellular matrix.
We follow a strict protocol: 4 hours fasting. Under strict aseptic measures, blood is collected from the patient. These tubes are centrifuged at 1,800 rpm for 8 minutes, to obtain the separation of the different components of the blood. In this way we obtain the lower platelet zone, which is the one with more cellularity, we activate it with calcium chloride and it is ready to be introduced into the knee, by means of an articular puncture. The treatment is done with three infiltrations, each one spaced two weeks apart, and the patient can walk without problems after the infiltration, with a slight discomfort, due to a slight swelling of the knee.
On the other hand, hyaluronic acid is a substance found in our load-bearing joints whose function is to lubricate and cushion. In osteoarthritis of the knee, the hyaluronic acid content of the synovial fluid decreases. Injections of this acid increase its concentration again, thus decreasing the friction between the bones and the patient notices considerable pain relief. The treatment is usually carried out with a weekly injection for five weeks.
For osteoarthritis of the knee, our surgical treatment options are knee osteotomies for young people with osteoarthritis and prosthetic surgery. The osteotomy consists of realigning the axis of the leg, and this is where our modern fixation plates are clearly different from the old ones.
As for the prostheses, they can be unicompartmental, advisable in those knees that preserve a correct ligamentous balance and a small axial deviation, or total prostheses, which consist of two or three pieces, depending on whether the patellar component is to be replaced or not.
Prostheses are providing a positive result. The materials and designs are constantly evolving, they are becoming more resistant and anatomical, which leads to a more physiological movement, and the patient has a better gait and better functionality on stairs and uneven terrain. The degree of knee flexion has also been improved, giving the patient more agility.
The progress made in knee prostheses has been enormous and constant over the last twenty years, so it is to be expected that advances will continue at least at the same pace, which will guarantee our patients with degenerative knee pathology even greater security in the treatment of their ailment.