Cartilage is a cushion that covers the joints, facilitating friction and absorbing the impact generated. Knee osteoarthritis or gonarthrosis is a very prevalent pathology in orthopedic practices and is caused by wear and tear of the cartilage that covers the joint and causes it to malfunction. This wear can be generalized in all the knee or localized in a part of it, being the symptomatology similar in both cases. This problem leads to a progressive loss of the quality of life of the person, who often has to modify their routines due to the limitations associated with this pathology.
Symptoms of osteoarthritis of the knee
The main symptoms of this pathology are pain, joint stiffness, joint deformity and functional limitation:
- Pain is one of the first symptoms to manifest itself and is established progressively as the joint degenerates. The onset is usually cyclical with periods free of pain and periods with more pain or periods of crisis, which are associated with inflammatory processes of the joint. Initially it should be treated with analgesics, leaving anti-inflammatory drugs for acute crisis episodes. When oral treatments are not effective, they can be treated with joint infiltrations (corticosteroids, hyaluronic acid, PRP…).
- Stiffness is another symptom associated with osteoarthritis of the knee. It is characterized by difficulty in the mobility of the knee after periods of inactivity, such as getting up from a chair or getting out of bed in the morning. In early stages, these symptoms disappear after a short period of activity, as if the joint needed to warm up before the activity, but they may reappear if we perform long activities. In advanced stages the stiffness is felt constantly.
- In situations where the wear of the knee occurs asymmetrically, the wear being greater in one area of the knee than in another, joint deformity may occur. In these cases a deviation of the knee is appreciated and a bowing of the leg (genu varum) or a disposition in “X” of the legs (genu valgus).
- Functional limitation involves both a limitation of the range of motion of the knee, preventing activities such as squatting, and a progressive decrease in gait circumference. This can lead to a decrease in daily activity and the abandonment of routines and other activities.
The onset of these symptoms occurs progressively as the joint undergoes further degeneration of the cartilage. The patient will notice greater stiffness, limited mobility, pain at a shorter walking distance or greater intensity that eventually can no longer be relieved with regular painkillers.
Causes of osteoarthritis of the knee and how to get better
There is a certain group of factors that favor the appearance of osteoarthritis of the knee:
- Excess weight
- History of injury in the knee, either traumatic, previous surgeries or own diseases of the cartilage of the knee.
- Female sex
- Rheumatic diseases
- Elite sports or jobs with heavy loads on the knees either by weight bearing or squatting.
The only variables that have been shown to be effective in slowing the progression of osteoarthritis are weight control and weight loss and moderate physical activity.
The cartilage receives all the loads of the body and if we decrease the body weight, this cartilage that is degenerated will have to support less loads, thus improving the symptomatology. It has been described that a 10% decrease in body weight can improve knee pain by about 50%. With regard to moderate physical activity, there is an improvement in muscle tone. This favors the stability of the joint and that the patella and the knee extensor apparatus work correctly. Activities that do not have excessive impact such as walking, trekking (according to level), exercises in swimming pool, bicycle or directed classes adapted to age and physical condition are recommended.
Treatment of osteoarthritis of the knee
Both oral and intra-articular treatments of collagen and/or hyaluronic acid should be aimed at improving the symptoms, being effective especially in the initial stages of osteoarthritis. These treatments have no cartilage regeneration capacity, since cartilage is a tissue that has no regenerative capacity. They are considered adjuncts to treatment without clear evidence of their efficacy, but can sometimes help to improve symptomatology.
When we cannot control the symptoms with standard analgesics and joint infiltrations and the patient’s quality of life deteriorates, it is time to consider surgical intervention. The intervention to be performed may vary depending on the cause and the age at which it occurs:
- Osteotomy: At younger ages with a deformity of the legs and monocompartmental osteoarthritis the indication may be an osteotomy, with the intention of aligning the limb and lengthen the life of the knee.
- Knee prosthesis. In case of a more advanced age, a knee prosthesis will be recommended, which depending on the type of osteoarthritis can be, unicompartmental if the osteoarthritis affects only one area of the knee or total prosthesis if it affects 2 or 3 compartments of the knee. It is a surgery with good short and long term results. It requires a correct and intensive postoperative rehabilitation and realistic expectations of result that your specialist must explain to you before the surgery.