Arthrosis of the knee, like all arthrosis, is a chronic condition which is normally linked to ageing and it is characterised by a slow deterioraton of the cartilage of the joint.
Arthrosis is very common, especially in people over the age of 50, although the reasons for its appearance, and the circumstances, can vary considerably.
When the cause is not known, the arthrosis is described as primary. “This type normally affects several joints and is mostly found in women,” says Dr Andrés Valentí Azcárate, a specialist in Orthopaedic Surgery and Traumatology at the Clínica Universidad hospital in Navarra.
“It is thought that its appearance is linked to enzyme or metabolic changes in the cartilage of the joint, due to a genetic variability which is not yet clear but which causes some people to develop arthrosis,” he explains.
Dr Valentí is part of the team at the Knee Unit of the Clínica Universidad in Navarro, together with Dr Juan Ramón Valentí Nin and Dr José Lamo de Espinosa, who are the director and a specialist of the Trauma Department of the hospital, respectively.
There is also another type of arthrosis, which is called secondary arthrosis.
“It appears following a previous anomaly which affects the cartilage of the joint and causes it to deteriorate, to a greater or lesser degree,” says Dr Valentí. Case of secondary arthrosis are often due to joint fractures, infections of the joints, metabolic alterations or anomalies in development, among other principal causes. Others include overuse of a joint, excess weight (obesity), excessive physical work in terms of intensity as well as time, and the exaggerated practise of sport.
Manifestion and diagnosis
“Arthrosis increases with age, so that by the age of 75 nearly everybody’s X-rays will show arthrosis to a greater or lesser extent, but that doesn’t mean that everyone of this age will suffer with it,” stresses Dr Valentí.
The most habitual and characteristic symptom of this condition is pain, “which may begin insidiously and then become progressively more noticeable and bothersome until it becomes incapacitating,” says the specialist, who warns that pain of this type is always associated with movement, until the final phases, and is accompanied by stiffness.
“After sitting down for a while, the patient finds it difficult to start moving again and experiences pain when they stand up. This is the start of the most troublesome phase,” explains the traumatologist. When the person has walked a few metres the knee “warms up” and the patient feels better, although after walking for a varying amount of time the pain comes back.
Some everyday activities such as going up and down stairs or walking on irregular ground can be especially painful.
“Sometimes, the patients even say their symptoms can become more or less intense if there is a change in the atmospheric conditions,” says Dr Valentí.
In order to diagnose arthrosis, a patient’s medical history is looked at and a physical examination is necessary; the condition can normally be confirmed through a simple X-ray.
Prevention and treatment
The aim of every treatment for arthrosis is to alleviate or cure the principal symptoms such as pain, restricted movement, the inability to carry out certain everyday activities and, on occasion, lameness.
“To make sure that the degenerative process progresses as slowly as possible, we have to ensure that the everyday activities of arthrosis patients are suitable for their condition,” stresses Dr Valentí.
This means that the patients have to learn certain methods of postural care. To start with, they should not remain sitting down all day, but nor should they walk too much. “The best thing is to alternate periods of activity with periods of rest, so it is a good idea to take short, frequent walks without exceeding the pain threshold,” he recommends.
It is also necessary to avoid too much physical exertion such as carrying heavy weights or intensive physical activity. Being overweight is an issue that also needs to be tackled in order to prevent and reduce the effects of arthrosis.
“Patients need to keep to their ideal weight, which is different for each person and every constitution,” says Dr Valentí.
“It is a good idea to do gentle, frequent knee exercises, trying to maintain mobility, especially stretching the leg out full length, and strengthening muscles by toning the quadriceps (muscles of the thigh). Doing this exercise in water (hydrotherapy) can be a great help,” stresses th e expert, who also advises keeping an inflamed knee cool but never applying anything cold directly to the skin.
Medication and surgery
The usual treatment for the symptoms is the administration of medication for pain relief, normally based on non-steroid anti-inflammatories and their variants. Numerous analgesics and anti-inflammatory products can be used for this purpose. “The latest ones are the COX-2 inhibitors, which can have interesting applications and fewer side effects,” says Dr Valentí.
Another type of pharmaceutical product which can be used is a medication based on hyaluronic acid and its derivatives which, the doctor says, is applied intra-articularlyas a joint ‘lubricant’, or other medications such as chondroitin sulfate and glucosamine given orally, as these are habitual components of the cartilage and joint liquid, and their medium and long term effects are producing promising results.
With regard to surgical treatment, there is a wide range of possibilities depending on where the arthrosis is, what phase it is in and how it is evolving. Dr Valentí says that surgery is used when the illness is progressing despite all the measures taken to combat it previously, especially when it is clear that it is causing pain and hampering a patient’s ability to carry out everyday activities.
The simplest and most common form of knee surgery consists of cleaning out the joint by an arthroscopy with minimal incisions. This procedure is recommended in situations where there is a low or medium degree of arthrosis.
It regularises the joint cartilage and the menisci, the flushing of the joint fluid, etc. When the knee arthrosis is advanced and other treatments have failed, the surgical option is to fit a replacement knee. This technique replaces the affected joint with an artificial one which is produced from modern materials and this procedure has more satisfactory effects in the medium and long term.
“The aim of a replacement knee is to reduce pain, correct angular deformities and also increase the mobility of the knee as much as possible,” explains Dr Valentí.