Knee joint arthrosis is a chronic (long -term) degenerative disease that causes the destruction of the cartilage in the joints.Symptoms include pain, stiffness and swelling.Treatment options to reduce pain and disability include changes in lifestyle (diet, exercise), physical methods and professional treatment, medicine and surgery.
Knee joint osteoarthritis
Knee joint osteoarthrosis is a common disease, accompanied by chronic and exhaustive pain.Recent clinical data showed that central sensitization stimulates deformed osteoarthritis of knee joint.An enhanced understanding of how knee joint arthrosis affects the central processing of pain is crucial for identifying new analgesic targets/new therapeutic strategies.
Inhibitory receptors weaken the function of peripheral immune cells and modulate the central neuro-intimacy responses.The systemic introduction of the receptor agonist weakened the behavior of OA-induced pain, and changes in circulating and anti-inflammatory cytokines were manifested in this model.
Deforming arthrosis
The deforming arthrosis of the knee joint is inflammation and the wear of the cartilage in the bones that form the knee joint (osteo = bone, artro = joint, itis = inflammation).The diagnosis of knee joint osteoarthritis is based on two main results: radiographic data on bone health changes (using medical images such as x-rays and magnetic resonance imaging of magnetic resonance imaging) and human symptoms.About 14 million people have symptomatic knee arthrosis.Although the most common in the elderly, 2 million 14 million people with a symptomatic knee OA were under 45 during the diagnosis and more than half were less than 65 years old.
Osteoarthritis (OA knee) is a progressive disease caused by inflammation and degeneration of the knee joint, which over time worsens.
This affects the entire joint, including bones, cartilage, ligaments and muscles.Its development is affected by age, body mass index (BMI), bone structure, genetic, muscle strength and level of activity.The OA knee can also develop as a secondary state after knee injury.Depending on the stage of the disease and the presence of injuries or conditions associated with it, the OA knee can be controlled using physical therapy.More serious or expanded cases may require surgical intervention.
Symptoms
People who develop knee OA may experience a wide range of symptoms and restrictions based on disease development.The pain occurs when the cartilage covers the knee joint bones.The areas where the cartilage gets in or damaged, exposes the underlying bone.The effect of bone allows to increase stress and compression of the cartilage and sometimes bone contact when moving, which can cause pain.As the knee is an articulation, the activity level, the activity level, as well as the type and duration of actions, as a rule, have a direct effect on symptoms.Symptoms may deteriorate with weight activity, for example when walking with a heavy object.
Knee joint symptoms may include:
- Dentry of pain during or after surgery, especially when walking, rising, descending the stairs or moves from a position sitting to a standing position.
- Pain or rigidity after sitting with a folded or straight knee for a long period of time.Pain is the most common symptom of osteoarthritis.As the disease develops and inflammation, pain can become constant.
- A feeling of jumping, cracking or grinding as you move your knee.
- Swelling after action.
- The stiffness of the affected joint was often seen first of all in the morning and after rest.
- Edema, which is sometimes hot to touch, can be noticeable in articulation with arthritis.
- Deformation can occur with osteoarthritis due to bone growth and cartilage loss.The growth of bones in the final joints of the fingers is called Hyberden's nodes.Bushar nodes are the growth of bones in the middle joints of the fingers.The degeneration of the knee joint cartilage can lead to the outer curvature of the knees (onion).
- A cracker sound or a grid sensation can be noted when arthritis moves.This is caused by cleaning the bone against bone or rough cartilage.
Generally, these symptoms do not appear suddenly and at once, but gradually develop over time.Sometimes people do not admit that they have osteoarthritis because they cannot remember a certain time or injury that has caused their symptoms.If knee pain has deteriorated for several months, which does not respond to rest or change activity, it is better to seek counseling to a medical worker.
Diagnosis
Osteoarthritis can usually be diagnosed by its characteristic symptoms of pain, reduced movement and/or deformation.Osteoarthritis can be confirmed by x-rays or magnetic resonance imaging.General data include narrowing of the joint space between bones, losing cartilage and bone spurs or bone growth.Blood tests may be used to exclude other possible conditions, but cannot diagnose osteoarthritis.
In the OA of the knee, 2 primary process is diagnosed.The first is based on a report on symptoms and clinical examination.The physiotherapist will ask questions about the history and medical activity.The therapist will lead a physical examination to measure knee movement (amplitude of motion), strength, mobility and flexibility.They can also order various movements to see, increase or decrease pain.
A segunda ferramenta usada para diagnosticar a articulação do joelho é uma visualização de diagnóstico.The physiotherapist can send to the doctor who will prescribe X -rays of the knee in various positions to verify the damage to the knee joint bone and cartilage.
If more severe joint damage is suspected, you can request magnetic resonance imaging to study more carefully the general status of joint and surrounding tissues.
Blood tests can also be ordered to help exclude other conditions that may cause symptoms similar to knee joint osteoarthritis.
Treatment
Depending on the severity of the patient's arthritis and age, it will be chosen how to treat knee joint arthrosis.Treatment may consist of operational or conservative methods or their combinations.
The first line of knee joint arthritis treatment includes modification of activity, anti -inflammatory drugs and weight loss.
Rejection of actions that improve pain can make this condition acceptable to some people.Anti -inflammatory drugs help relieve inflammation that can contribute to pain.
Physiotherapy to strengthen the muscles around the knee can help absorb part of the shock given to the joint.This is especially true for arthritis with a knee glass (patello-femoral).Special types of appliances designed to transfer the load to the knee joint part, which is less than arthritis, can also relieve pain.Drug injections within the knee joint can also temporarily help.
Also, walking with a cane in the opposite side, since a painful knee can help distribute part of the load, reduces pain.Finally, weight loss helps reduce the strength that goes through the knee articulation.The combination of these conservative measures can help relieve pain and prevent disability.
If these methods do not allow you to make the tolerant of conditions, the operation may be the best option to treat knee joint arthritis.The exact type of operation depends on age, anatomy and main state.Some examples of surgical options for the treatment of arthritis include osteotomy, which consists of cutting the bone to align the joint.
Modern methods for the treatment of knee joint arthrosis include osteotomy, which is a good alternative if the patient is young and arthritis is limited by an area of the knee joint.This allows the surgeon to rebuild the knee to unload the arthritis area and perform the load relatively not involved in parts of the knee joint.For example, the patient can be rebuilt to redistribute the load through the joint.The advantage of this type of surgery is that the patient's knee articulation itself is preserved and can guarantee many years of pain relief without prosthetic knee deficiencies.Disadvantages include a longer rehabilitation course and the possibility of developing a recently level knee arthritis.
The operation to replace the knee joint includes cutting the arthritic bone and the insertion of the prosthetic articulation.All arthritic surfaces are replaced, including femur, leg and knee glass.Arthritic surfaces are removed and bone ends are replaced by a prosthesis.The prosthetic component is usually made of metal and plastic surfaces, designed to slide soft against each other.
Replacing the knee joint
The general operation to replace knee articulation was first performed in 1968 and over the years have evolved in a reliable and effective way to get rid of pain when turning off and allows patients to resume their active life.Improvements in the field of surgical methods and implants have helped make this one of the most successful orthopedic procedures today.As the population gets older and remains more active, the need for a general knee replacement continues to grow.Many of the operations to replace knee joint occurred at the Special Surgery Hospital.Improvements in surgical technology and new implant design are some of the contributions that surgeons have made.
People often wonder when and why they should replace the knee.This is an individual issue that depends on the level of human activity and functional needs.Many people with arthrosis live with pain, which prevents them from participating in activities;Others are so weakened that it is difficult for them to wear shoes and socks.A complete replacement of the knee joint offers the solution to the arthrosis problem and is performed to relieve pain and resume activity.After rehabilitation of the successful successful replacement of knee joint, the patient can expect surgery, without pain.A complete knee joint replacement significantly improves the patient's condition and significantly reduces his long -term treatment costs.This study showed that not only the overall replacement of knee joint is economically effective, but also provides greater functionality and the best quality of life.
A complete replacement of knee joint is considered an important operation and the solution is not trivial.Generally, people decide to undergo an operation when they feel they can no longer live with their arthritis.
The implant consists of 4 parts: tibia, femoral parts, plastic insertion and a pattern.The components of tibia and femur are made of metal, usually cobalt chromium, are used to close the ends of the thigh and leg after removing the arthritic bone.Plastic insertion is made of ultra -altate molecular mass polyethylene and fits the component of the tibia, so that the polished thigh surface slides along the plastic.The knee glass component also slides against the front of the femoral component.Usually they are attached to bone cement.
Total knee replacement is performed in the operating room with a special laminar air flow system, which helps reduce the likelihood of infection.Your surgeon will use a "space suit", also designed to reduce the likelihood of infection.The entire surgical team will consist of their surgeon from two to three assistants and babysitters.
Anesthesia is given through a epidural catheter, which is a small tube inserted in the back.During operation, the patient may be awake and sleepy.
After the introduction of the epidural block around the thigh, a tourniquet or a cuff will be placed.The horizontal bar will be exaggerated during operation to reduce blood loss.The clipping for complete knee replacement is done along the front knee.The incision will be measured 4 to 10 inches, depending on the anatomy.
The arthritic surfaces of the femur, legs and patella are exposed and removed using strength tools.At the same time, knee deformations are corrected and, after the operation, the knee becomes more straight.The bone is ready to take an artificial knee articulation and then a prosthesis is inserted.During closing, two drainage are installed around the desktop to help evacuate the blood.Sapers are used to close the skin.
The entire operation will take 1 to 2 hours.After that, the patient will be taken to the recovery room where the tests will be checked.Most patients can be taken to a regular room for several hours;Others will have to stay in the hall for recovery, as defined by a surgeon and an anesthetist.
Patients usually remain in the hospital for 3-4 days after a complete operation to replace the knee
Risks during surgery
Some of the risks of the surgical procedure include blood loss, the formation of a clot in the leg and the likelihood of infection.The overall prevalence of these risks is very small.They should be discussed with the surgeon before the start of the operation.
Some of the risks of the presence of a prosthetic knee include the probability that the parties may weaken or wear out over time, or the prosthesis may be infected.Again, these issues will be discussed with the surgeon.
Post -operative course
Immediately after a complete operation to replace the knee joint, the patient will fall into the recovery room.Most patients can enter a regular ward after a few hours when the sensation returns in the legs.A pain pump associated with an epidural catheter will be administered, which will allow you to control when a cure for pain is given.
On the day of the operation, you can perform some exercises as indicated by the physiotherapist, including the reduction of quadriceps and moving the legs up and down.Depending on the surgeon's preference, you can start folding your new knee immediately after the operation or on its first day.The patient may take ice after surgery to wet the mouth, but drink fluids or you can cause nausea.The patient will have a bladder catheter so you don't have to worry about urination.Once the movement on the legs is restored, he can sit, get up and take a few steps with a walker and therapist.
The first day after the operation will be active, designed to help become more mobile.
The patient will meet with physiotherapists who will instruct additional exercises.Also, they will help get up and take a few steps with a walk.As a rule, the patient may drink pure liquid.
In the coming days, it will be easier to move.The patient will be released from pain and urinary catheter.The treatment of pain will be given in the form of tablets.On the second day after the operation, if the recovery signs are found in the intestine, it can eat ordinary foods.
Depending on your age, pre -operative physical condition and insurance coating, the patient may be a candidate for short -term accommodation at a rehabilitation institution.Otherwise, the patient will be discharged home and the physical therapist will come to his home to continue rehab.The dispatcher will discuss these options with the patient and help you plan your return home.
A return to activity will be guided by a surgeon and therapists.As a rule, patients can walk as they want 6 weeks after surgery.Patients can resume movement after 6 weeks.After 8 weeks, patients can resume the game in golf and swimming;At 12 weeks, they can play tennis.The surgeon will help decide which actions can be resumed.
That physiotherapist is necessary
All physiotherapists are prepared through education and clinical experience for the treatment of various conditions or injuries:
- A physical therapist who has experience in treating people with knee joint osteoarthritis and after surgery to replace knee joint.Some physiotherapists have a practice with an orthopedic focus.
- A physiotherapist who is a certified orthopedic clinical specialist.This physiotherapist will have knowledge, experience and advanced skills that can be applied to a state.
- You can find physiotherapists who have these and other accounting data using magnetic resonance imaging, an on -line tool to help find physiotherapists with specific clinical knowledge.
General Council When you can find a physiotherapist (or any other medical service supplier):
- Get recommendations from family and friends or other medical service suppliers;
- Returning to the clinic for physiotherapy for admission, you need to ask about the experience of physiotherapists to help people with arthritis.
During the first visit to the physiotherapist, you need to be prepared to describe the symptoms as in more detail and report activities that worsen the condition.