Professor Lu Kexiu, director of the Department of Orthopedic Sports Medicine, Affiliated Hospital of Sun Yat-sen University of Medical Sciences, said that in 100, a man aged 1 85 who went to see a doctor for medial pain of his left knee was diagnosed with osteonecrosis of the medial femoral condyle of his left knee and degenerative arthritis of the medial patellofemoral joint, so he thought that the joint would be reimbursed. Unexpectedly, after 7 years of minimally invasive arthroscopic surgery, even if the patient is 92 years old, the left knee joint is still intact. In addition to seeing a doctor regularly, taking hyaluronic acid and moderately training the quadriceps muscle strength, there is no need to use any analgesic drugs.
How does osteonecrosis of knee joint occur? Beware of 5 possible pathogenic factors
What is osteonecrosis of knee joint and how does it happen? Professor Lu Kexiu said that osteonecrosis of the knee joint, also known as "ischemic necrosis", often leads to degenerative knee arthritis in clinic.
As for the causes of disease and pain, the blood supply of a bone in femur (thigh bone) or tibia (calf bone) was interrupted for some reason, and proper nutrition was not provided to the bone cells, so that the bone cells died and the health of the knee joint could not be maintained, resulting in the gradual collapse of the bone and the collapse of the cartilage covering it. Eventually, the surface of the knee joint is destroyed, which leads to inflammation and edema of the knee joint, forming severe knee arthritis and inducing joint disability.
As for the risk factors of osteonecrosis of the knee joint, there is no conclusion in the medical field at present, and it is only speculated that it may be related to the following five factors:
① Injury: For example, compression fracture and dislocation of knee joint, partial knee joint injury, injury to blood vessels, reduction of blood flow and influence on bones. Or meniscus rupture, excessive pressure changes have taken place on the articular surface, reducing the blood flow to bones and affecting bone cells.
② Oral steroids: Some patients who take oral steroids for a long time are easy to be accompanied by osteonecrosis of knee joint. Although the relationship between them cannot be understood exactly, steroid-induced osteonecrosis often occurs in many joints.
③ Physical condition: It may be related to osteonecrosis, obesity, sickle cell anemia and lupus.
④ Organ transplantation: Sometimes it is related to bone necrosis, especially kidney transplantation.
⑤ Alcoholism: Long-term intake of excessive alcohol will make fat deposit in blood vessels, increase cortisol and decrease blood flow to bones.
The treatment of osteonecrosis of knee joint can be divided into surgical treatment and non-surgical treatment.
However, it is worth noting that although the exact cause of osteonecrosis of knee joint is unknown, the clinical symptoms caused include: knee joint pain, difficulty in standing, walking and moving, muscle atrophy and weakness (especially quadriceps femoris), knee joint swelling, hydrops, limited joint movement angle and other uncomfortable symptoms, which have a great impact on patients' daily walking.
Therefore, Professor Lu Kexiu suggested that once people find that they have symptoms such as knee pain, swelling and gait change, they should actively seek medical treatment and arrange X-ray, magnetic resonance imaging (﹙MRI﹚) or bone scanning in nuclear medicine to confirm that early treatment is more secure. Once osteonecrosis of knee joint is diagnosed, the treatment methods are mainly divided into surgical treatment and non-surgical treatment.
◆ Non-surgical treatment:
1. There are drugs: non-steroidal anti-inflammatory painkillers, which can help relieve pain and swelling.
2. Reduce the load: reduce the pressure on the joints, which may delay the injury and help heal.
3. Exercise: strengthen the exercise of thigh muscle strength and joint range of motion. It is recommended to exercise in water to avoid joint compression.
4. Activity modification: avoid activities that bring knee pain.
◆ Surgical treatment:
There are arthroscopic surgery, medullary decompression surgery, osteochondral transplantation surgery, autologous chondrocyte implantation surgery, bone cutting surgery, total or single condyle (partial) knee replacement surgery and so on.
Minimally invasive arthroscopic surgery has the advantages of less trauma, faster recovery and less postoperative discomfort.
Compared with the past surgical methods, most of them replace the original joint by replacing the artificial knee joint, which is not only traumatic, but also takes a long time to recover. Fortunately, with the development of medical technology, there are new minimally invasive arthroscopic surgery options.
Because it can directly see the affected part and make a correct diagnosis. In addition to the general treatment of degenerative arthritis, for example, the removal of loose bodies, scraping and shaping of cartilage worn by ulcers, drilling, cutting or suturing of ruptured meniscus, cutting of hyperplastic synovium, bone spurs and pathological synovial folds, activation of viscous contracture joints and inflammation of knee lateral branches.
At the same time, it can also damage the articular surface of osteonecrosis ulcer and scrape (plastic) the subchondral bone to regenerate osteochondrosis. Most importantly, it can not only deal with the problems in the knee joint one by one, but also improve the condition and let patients continue to use their own knee joint. Arthroscopic surgery usually leaves only three small wounds without stitches (generally less than 1 cm). It is different from ordinary knee surgery (the wound may exceed 10 cm), which is naturally beneficial to relieve postoperative pain and recover faster.
However, Professor Lu Kexiu, the director, also reminded that arthroscopic surgery must master the golden treatment period of early diagnosis and early treatment. If the patient is dragged to the whole articular surface, the ulcer is damaged, worn, the joint is severely deformed and extremely unstable, then major surgery-artificial knee replacement is the only choice for treatment. Therefore, it is very important to actively seek medical treatment!
Osteonecrosis of knee joint, also known as "ischemic necrosis", usually leads to degenerative knee arthritis in patients. Some patients who take steroids orally for a long time are also prone to knee osteonecrosis. Although the relationship between them cannot be understood exactly, steroid-induced osteonecrosis often occurs in many joints. Professor Lu Kexiu, director of the Department of Orthopedic Sports Medicine, also reminded that arthroscopic surgery must master the golden treatment period of early diagnosis and early treatment. (Photo/Provided by the Affiliated Hospital of Sun Yat-sen Medical University)