Today we are talking about osteoarthritis of the knee, a very common disease among the elderly that does not spare some young people. Let's take a closer look at what it consists of.
Knee arthrosis is a degenerative disease that affects the cartilages of the femur and tibia. I remind you briefly that the femur is the thigh bone, while the tibia is one of the two bones of the leg. Inside the knee joint, the bony ends of the femur and tibia are lined with cartilage; it is a special one. protective tissue that decreases friction avoiding wear problems. In addition to the cartilage, the synovial fluid, which wets and nourishes the cartilages, and the menisci participate in the reduction of friction, while muscles, ligaments, tendons and other structures take care of stabilizing the " entire joint during movements. Osteoarthritis of the knee is therefore a disease of the articular cartilage of the tibia and fibula. Gradually this cartilage wears out, exposing the underlying bones. The consequent friction creates joint damage, which tends inexorably to worsen over the years All this can end up causing pain and impairing the functionality of the knee, limiting movement. This is why treatment must be early and targeted, in order to limit the consequences of the disease as much as possible.
When the cartilage is damaged, the increase in friction with movement causes pain and inflammation. The joint therefore tries to defend itself by increasing the production of synovial fluid, which ends up causing swelling of the knee, limiting its movements and causing pain. The bones of the knee also try to adapt, forming bone spurs called osteophytes. In the more advanced stages of the knee joint. disease, the knee is globular due to the thickening of the joint capsule, while the thigh muscles retract to determine a rigid knee, which tends to remain flexed and curved. The ligaments are also involved and are damaged, causing sensations of yielding or a real instability In conclusion, osteoarthritis can be defined just as a sort of "wear" of the joints, in the specific case of the knee.
The various forms of osteoarthritis can be classified into primary and secondary forms. Primary osteoarthritis is essentially linked to joint wear resulting from aging and excessive joint overload. Often it involves several joints, such as the knee, hands, hips and spine. a consequence of trauma, surgery or other pathological conditions. The most common causes are skeletal deformities, fractures, infections and rheumatological diseases. Other times, systemic causes are involved, such as some dysmetabolic diseases. Osteoarthritis of the knee is a typical disease of old age, which mainly affects people over 60 and prefers female sex.In the absence of predisposing diseases or conditions, the most important and common risk factor is the patient's overweight. Other risk elements must also be considered, such as certain work activities, genetic predisposition and misalignment of the knee, such as excessive valgus or varus.
The main symptom with which osteoarthritis of the knee occurs is pain in the joint. In the initial stages, the pain is occasional, increases during movement and is relieved by rest. Unfortunately, over time, as the joint damage it tends to get worse, even the pain gets worse, until it becomes permanent and occurs even at rest. Joint damage, in addition to causing pain in the knee, can reduce the mobility of the joint and make it stiff and swollen. The appearance of nocturnal pain, such as to awaken the patient, is typical of an advanced stage of the disease.
Osteoarthritis of the knee is easily recognizable on X-rays, so radiological investigations are often sufficient to diagnose the disease. Radiographs of the affected joints, to be taken preferably with the patient standing, show a reduction in joint space; thickening of the bone below the worn or suffering cartilage. Furthermore, in the more advanced stages, osteophytes, geoids and irregularities at the bone margins can be found.
The most effective therapeutic solution for knee osteoarthritis is the replacement of the damaged joint with an artificial prosthesis. Clearly, the intervention has its limits and must be considered case by case, choosing the most suitable type of prosthesis. An important role is also played by arthroscopy, a procedure that allows cleaning of the joint, removing any friction elements. It should be noted, however, that the outcome of joint cleaning is variable and, in many cases, this type of intervention does nothing but delay the implantation of a prosthesis. Drug treatments can also temporarily relieve symptoms, but are not a cure. In the case of knee arthrosis, in fact, pain relieving or anti-inflammatory drugs are essentially supportive. In the early stages of the disease, when cartilage degeneration is only partial, hyaluronic acid infiltrations can help. This substance represents an essential component of the synovial fluid contained in the joint space, with a lubricating, shock-absorbing and protective function against the cartilage. The infiltrative therapy with hyaluronic acid, therefore, improves the symptoms and slows the progression of osteoarthritis. In addition to hyaluronic acid, the infiltrations can also be performed with cortisone; however, this intervention is indicated only occasionally to resolve acute inflammatory situations. In fact, in the case of prolonged therapies, cortisone can deteriorate the cartilage itself, aggravating the damage. In young patients, under 30/40 years of age, innovative treatments may be considered, such as transplantation of chondrocytes or stem cells or the use of growth factors. The aim of these treatments is to rebuild damaged cartilage, a goal which clearly represents the future of osteoarthritis therapy. It should also be added that in case of overweight, losing excess kg means slowing down cartilage degeneration and reducing the overload on the joint. In addition, moderate physical exercise allows you to maintain joint mobility for longer and maintain good muscle tone. Obviously, running, traumatic activities and all contact sports should be avoided, as they could accelerate the progression of cartilage damage.
