Text/Zhou Yijun
Don't be afraid to see a doctor when there is a problem with your knee. You should go to orthopedics or rehabilitation department as soon as possible, and the doctor will diagnose and treat the symptoms and enjoy the happiness of free activities again. Treatment and nursing of common knee joint diseases are as follows:
Mild joint degeneration → hyaluronic acid, PRP, glucosamine
The cartilage of the knee has no nerves and blood vessels. When it is worn continuously, patients will not feel any discomfort and cannot regenerate themselves. If symptoms appear, you must receive appropriate treatment and rehabilitation to slow down the continuous wear and tear of cartilage. The following conservative treatments can be taken first:
■ Oral anti-inflammatory painkillers, but long-term consumption may harm the stomach and kidneys.
■ Take more rest and reduce the actions of going up and down stairs, climbing mountains, squatting and kneeling, so as to continue to wear cartilage.
■ Hot compress can increase blood circulation around the knee joint, and you can wear knee pads to keep warm.
■ Increase lower limb muscle training, such as leg lifting to train quadriceps femoris, disperse and concentrate knee joint strength, and increase knee joint stability.
■ Taking glucosamine can improve the ability of cartilage regeneration. According to clinical statistics, about 30% to 40% of patients taking glucosamine are effective, but there is still controversy in the medical field about the efficacy of glucosamine in treating degenerative arthritis. The American Association of Orthopaedic Medicine (AAOS) holds "different opinions" on whether to take glucosamine for treatment.
■ If the patient's condition can't meet the need to replace the artificial knee joint, but he has been hospitalized for more than half a year, and the pain can't be effectively relieved by painkillers and other treatments, hyaluronic acid injection can be used to increase the lubrication of the joint cavity and avoid direct bone friction. Because hyaluronic acid will be absorbed by the human body, it needs to be treated for another six months.
■ Autologous platelet plasma injection therapy (PRP) is a new treatment method in recent years, which is more familiar to many athletes such as Jeremy Lin and Masahiro Tanaka. PRP is to extract the patient's autologous blood first, then centrifuge to obtain high concentration of platelets, and then inject them into the knee joint to promote cartilage regeneration. The treatment effect is 70%, but there is no medical insurance payment at present, and the cost is higher than that of hyaluronic acid. The single limb pays about 15000 ~ 20000 yuan, and the average PRP treatment of both knees is about 30000 yuan.
Moderate and severe joint degeneration → arthroscopic minimally invasive surgery
After evaluation, doctors can take the following active surgical treatment for moderate and severe patients with severe knee cartilage wear:
■ Arthroscopic minimally invasive surgery: drilling holes in cartilage defects, using arthroscopy to reach joint cavity, removing inflamed tissue, repairing tissue and improving cartilage regeneration function. The therapeutic effect can reach 70-80%.
■ Minimally invasive artificial knee replacement surgery: replace the original cartilage with artificial wear-resistant pads, and keep healthy ligaments and muscles. Because it is minimally invasive surgery, you can get out of bed the next day after surgery, and you can leave the hospital in an average of 4-5 days, but you need to recover and restore your muscle strength after surgery. After artificial knee replacement, the knee joint can be used for 20 ~ 30 years.
But this kind of operation has a wound infection rate of about 2 ~ 3%. Once bacterial infection occurs, the implanted artificial joint must be removed and the patient needs to be injected with antibiotics. After the infection is controlled, the artificial joint must be implanted again. Older people with diabetes, hepatitis, renal dialysis or autoimmune diseases are prone to infection, so special attention should be paid to the occurrence of infection during artificial knee replacement.
■ Orthopedic osteotomy: For the treatment of patients with O-leg, in order to reduce the wear of medial cartilage, a triangular bone is removed from the long bone of lower limb. The clinical results show that the effect can be maintained for at least 5 years after operation, but this treatment method is rarely used now because it will cause difficulties and complications in future artificial joint replacement.
Meniscus rupture → repair operation
According to the type, size and location of meniscus rupture, there are two treatment methods: repair and resection.
■ Conservative treatment: In view of the stable rupture of the lateral meniscus (blood supply area) and the small wound, there is no need for surgical treatment. As long as you rest more, recover more and avoid strenuous exercise, the meniscus has the opportunity to regenerate and repair itself.
■ Active treatment: The medial meniscus is usually a bloodless area and will not heal itself. Arthroscopy must be used for repair. According to the size of meniscus rupture, the treatment methods are different. If the ruptured meniscus is large, repair surgery should be taken. If it is a small fragment, it must be removed surgically to prevent the meniscus from hanging in the joint cavity, resulting in a "click" feeling, and even symptoms of knee inflammation and leg weakness.
Cruciate ligament rupture → ligament reconstruction
The main functions of anterior cruciate ligament and posterior cruciate ligament are to maintain the stability of knee joint and prevent excessive torsion and anteroposterior displacement of thigh and calf. Arthroscopic reconstruction can be used when fracture occurs. After the old ligament is removed, a new ligament can be placed. Postoperative rehabilitation is very important to maintain the muscle strength and ligament elasticity of lower limbs. Generally speaking, if the cruciate ligament is broken in patients over 60 years old, it is recommended to directly perform artificial joint replacement if necessary because most of its cartilage has been worn out.
Placement of ligament source:
■ Autotransplantation of posterior femoral tendon: it is the mainstream treatment method at present. The tendon of the patient's posterior thigh was removed by surgery, placed in the reconstruction position of cruciate ligament, and gradually combined with bone. After about 3 months, the tendon will become a cruciate ligament, and the tissues inside will think that the tendon is a cruciate ligament, so it can begin to play its due role.
■ Tendons donated by others: Generally donated tendons are purchased from abroad. Because the tendon has high homogeneity and no blood circulation, there will be no rejection problem.
■ Artificial tendon: The advantage is high strength, but it will also lead to joint wear and tear due to excessive strength, leading to the problem of service life, which will be reimbursed in about 5 years.
Tendon inflammation → rest, ice compress and rehabilitation
Patients with mild tendinitis can be treated conservatively to improve inflammatory symptoms, while patients with severe tendinitis must be treated actively to improve.
■ Conservative treatment:
? Take more rest and avoid continuing strenuous exercise.
? Ice to relieve pain and swelling.
? Rehabilitation exercise can enhance muscle strength, and physical therapy such as ultrasound and shock wave therapy can improve tissue metabolism and accelerate circulation.
? In the case of goose foot tendinitis, patients with mild symptoms can be injected with small doses of steroids to improve the pain.
Active treatment: Take patellar tendinitis as an example. If conservative treatment still can't improve the inflammation, arthroscopic surgery can be considered to remove part of the patella to reduce the pressure on the tendon.
Synovitis → Reduce load and pump out joint fluid.
To reduce the load, increase the muscle strength of quadriceps femoris by lifting legs, promote blood circulation and facilitate the absorption of joint fluid. If the knee is swollen repeatedly, you can take too much joint fluid from the hospital to relieve synovial pressure. If the symptoms cannot be effectively improved, surgical drainage is the last resort.
Myofascial pain syndrome → rehabilitation and muscle strength exercise
Physical rehabilitation therapy, including electrotherapy and interference waves, can relieve pain and promote tissue regeneration. Combined with muscle strengthening exercise, myofascial pain syndrome can be effectively improved.
Gout → reasonable diet
Changing incorrect eating habits, avoiding eating high-purity food and taking medicine according to doctor's advice can effectively alleviate gout symptoms.
Rheumatoid arthritis → serious artificial joint replacement
Rheumatoid arthritis can invade one or more joints, causing severe joint distortion. If it has affected activities and life, it is recommended to have artificial joint replacement surgery.
Knee joint should be used for a long time, and daily maintenance is very important. Lin suggested that people should avoid too many sports that hurt their knees, such as excessive mountain climbing, triathlon and marathon. After each exercise, you should ice your knees to cool the inflamed tissues and avoid symptoms such as redness, swelling and heat pain in your knees.
Lin stressed that there are many kinds of sports, such as swimming and cycling. Swimming can not only improve the cardiopulmonary function, but also strengthen the muscle strength of knees, back and lumbar spine. Riding a bike is also a sport that can move all over the body. It won't put too much burden on your knees, and it is helpful to maintain your knees. Only by taking care of your knees, going out is no longer a burden.