Knee osteoarthritis: From biological factors to total joint replacement
The articular cartilage is a fairly durable tissue that covers the bones of the knee – it limits the friction of the bones and in combination with the menisci participates in the harmonious movement of the joint.
Unfortunately, however, the articular cartilage is an avascular element of the knee where in case of damage or wear it does not have a regenerative and healing capacity, unlike bone or skin, resulting in its progressive destruction.
A characteristic clinical picture of the disease in its final stages, where the articular cartilage has been destroyed, is the subchondral bone of the thigh and tibia coming into contact, resulting in severe pain and difficulty in movement.
What are the causes of knee osteoarthritis?
- Age: The normal wear and tear of cartilage as a person ages occurs at the age of 50 and above.
- Obesity: Dramatically increases the loads that the articular cartilage receives, resulting in early wear and tear.
- Gender: Women more often develop osteoarthritis than men, possibly due to hormonal factors and obesity.
- The development of early osteoarthritis is the result of injuries, such as ruptures of joint elements (menisci – ligaments – intra-articular fractures).
- Professional activity: There are professions that involve repetitive knee movements and intense strain, resulting in early wear and tear. cartilage.
- Systemic diseases such as rheumatoid arthritis – psoriatic arthritis – hematological diseases – autoimmune diseases.
What are the symptoms of osteoarthritis of the knee?
- Pain when moving the joint
- Swelling
- Morning stiffness of the joint
- Feeling of crepitus or joint involvement
- Change in the patient’s quality of life
The diagnosis of osteoarthritis is made by clinical examination, history, radiological examination and in some cases MRI.
What is the Treatment of Osteoarthritis of the Knee? knee?
Osteoarthritis of the knee is the progressive degeneration of articular cartilage in its early stages and the goal of treatment in this phase, in addition to relieving the patient from symptoms, is to try to inhibit and delay the progression of osteoarthritis.
In recent years, new treatment methods with biological agents have been developed through research and seem to have a significant effect on improving symptoms and delaying the development of osteoarthritis.
- Hyaluronic acid: It is a mucopolysaccharide that is an important element of human connective tissue and acts protectively against cartilage wear. It is also found in synovial fluid and in cases of osteoarthritis it shows a reduced content.
- The injection of hyaluronic acid increases the content of glucosamine in the synovial fluid and delays the progression of cartilage wear.
- PRP: It is plasma rich in platelets which are embryonic cells and exhibit healing and anti-inflammatory effects and seems to be beneficial in delaying the development of osteoarthritis.
- NSTRIDE APS is an autologous protein solution that is isolated from the patient’s blood and after centrifugation, white blood cells, platelets and proteins are concentrated in a small volume of plasma of 2-3ml which is injected intra-articularly into the knee. It seems that this product inhibits the progression of osteoarthritis and pain.
- Stem cells: They are embryonic stem cells that are obtained from abdominal fat or bone marrow and, after appropriate processing, are injected into the knee. They have very good results in focal cartilage lesions (bone defects) and in young people with intact menisci.
- The injection of corticosteroids in combination with hyaluronic acid helps significantly in relieving symptoms.
In advanced stages of the disease, the final radical solution is the replacement of the articular surface. This is achieved with total arthroplasty or monocompartmental arthroplasty of the knee.
In recent years, through biomechanical research, the materials we use have improved significantly, are more durable and more closely mimic the anatomical movement of the joint.
The most significant improvement in arthroplasty surgery, however, is the development of ‘Robotic Assisted’ knee arthroplasty. Robotic arthroplasty is a navigation system that guides the robotic arm to correctly position and with millimetre precision the metal knee prosthesis.
The results of this method, in addition to correct placement, are less blood loss, less hospitalization and rapid mobilization of the patient.
