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Knee Arthritis

Arthrosis of the knee, or gonarthrosis, is a prevalent degenerative and progressive disease. It consists of the weakening and degeneration of the articular cartilage between femur and patella or between femur and tibia. It is classified as unilateral or bilateral, depending on whether it affects one or both knees. It concerns middle-aged and older people, but it can involve a younger age group as well. When it affects young people, the triggering factors can be varied: hereditary, obesity, gout, inactivity, X-shaped or arched knees (an axis variation of the valgus and varus), including joint injuries and bone fractures. Progressive cartilage damage may lead to pain, movement limitation and in the most advanced forms, the joint’s deformation.

Age group

The condition usually affects people over 50 years old, with higher incidence in the female population.

Anatomy of the knee

The knee is a complex joint located between the femur (the thigh bone), the tibia (the leg bone) and the patella (the kneecap); it supports the body’s weight and allows leg extension and flexion movements. Its surface is covered with articular cartilage, which protects the bones from friction. Further protection to its structure is provided by the presence of two cartilage pads, the medial meniscus and the lateral meniscus, which act as shock absorbers which facilitate movements and protect the knee. The inside of the joint is entirely covered by the synovial membrane where the synovial fluid is produced. This fluid is capable of lubricating the knee’s structures. To provide further stability to the joint, there are four strong ligaments: two lateral, the medial collateral (MCL) and the lateral collateral (LCL)), and two internal, the anterior cruciate (ACL) and the posterior cruciate (PCL).

Symptoms

At the initial stage, knee arthrosis manifests itself with intermittent problems, i.e., it comes and goes. For a long while, osteoarthritis can present itself as a localized discomfort at the beginning of each movement (for example, after sitting or lying down for a long time) or while going up and down the stairs. In some cases, noises similar to clicks or squeaks are heard when the knee joint is moved. As the disease progresses, the pain gradually increases until the joint stiffens completely. When osteoarthritis is at an advanced stage, the knee becomes unstable and the person can suddenly fail.

When should you call a doctor?

You should call a doctor if there is a  recurring pain in the knee over an extended period of time.

Diagnostic tools

After reconstructing the anamnestic overview, the knee joint is examined using tests to evaluate mobility and function. The primary diagnostic evaluation is a radiograph of a weight-bearing knee in anterior-posterior view, lateral and axial views of the patella, and Rosenberg view. These tests are excellent methods to examine the knee even in the initial stages of the disease. Nuclear Magnetic Resonance (NMR) spectroscopy is indicated as a second level exam for a more accurate assessment of the menisci, articular cartilage, and ligaments. Computed Tomography (CT) is useful for an in-depth study of knee rotations and deformities and possible planning of surgery.

What to do in the meantime

Just rest well and take painkillers and non-steroidal anti-inflammatory medicines as prescribed by a doctor. Apply ice cubes but not directly on the skin for 5 minutes every 3-4 hours. High impact physical activities are not recommended.

How to prevent osteoarthritis of the knee

The right physical activity that is purposed for strengthening the supporting muscles can help prevent osteoarthritis in the knee. If possible, it is necessary to reduce (or avoid) excessive and repeated loads on the knee, keep your body weight under control and correct postural defects, especially if you play sports at competitive levels.

Conservative therapies

Cartilage damage is irreversible, but conservative therapies may slow its course with anti-inflammatory drugs. Careful weight control and, if necessary, the use of orthopaedic braces may be combined with the intake of drugs. Infiltrative therapies with cortisones, hyaluronic acid, regenerative treatment with PRP (Platelet Rich Plasma), and mesenchymal cells are also useful.

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