Knee osteoarthritis is painful and more and more frequent as they get older.
Arthritis is reflected in premature wear of cartilage, the gelatinous structure which lines the bone ends allowing them to slide one over the other without friction. In case of osteoarthritis, cartilage is thinning and cracks. The destruction of the cartilage can extend to the remains of the joint, the bones but also the synovial membrane which lubricates the joint, then causing pain. Gonarthrosis is osteoarthritis that touches the knee. It would concern 30% of 65-75 year olds. Its prevalence increases in women at the time of menopause. It is bilateral (the two knees affected) in 75% of cases.
What are the causes of gonarthrosis?
► Aging: while 3% of under 45s are affected by osteoarthritis, the 65 year olds and over are around 65% to suffer from it and after 80 years, more than 80%.
► Genetics: Scientific literature suggests that people would be genetically predisposed to osteoarthritis of the knee.
► A trauma: osteoarthritis of the knee would be more observed in patients who had a badly treated sprain, a removal of the meniscus …
► An excess weight: “Overweight is an important factor because it is over-sucking the joint. Moderate loss of a few pounds improves or even prevent, the appearance of this joint disease“, Indicates Professor Aleth Perdridge, Rheumatology Service of the Rennes University Hospital.
► The heavy load port at work increases mechanical constraints and damages the knee cartilage.
► The intensive practice of certain sports is also pointed out (football, rugby, skiing, etc.).
Osteoarthritis of the knee (on the left, normal joint, on the right, joint with osteoarthritis)
What are the symptoms of knee osteoarthritis?
Osteoarthritis can go unnoticed and be fortunately discovered during imaging examination. When it manifests itself, it leads to mechanical pain (induced by movement), which will gradually prevent the patient from walking, mounting the stairs … painful thrusts can occur. They are generally associated with swelling and stiffness of the joint. Over the years, deformation of the joint may appear.
Diagnosis: radio or ultrasound?
Symptoms of knee osteoarthritis may be sufficient to diagnose osteoarthritis. But the doctor can confirm the diagnosis thanks to a radiological examination which makes it possible to visualize the joint pinch, the bone growths around the joint (called osteophytes) or localized rarefactions of bone (called geodes). It may be useful to carry out this radiological examination regularly to follow the evolution of the disease and decide a possible surgical treatment. Ultrasounds, MRIs or CT scan are unnecessary examinations to diagnose osteoarthritis. Likewise, no blood marker makes it possible to establish the diagnosis.
What are the treatments to treat osteoarthritis from the knee?
There is no remedy, only symptomatic treatments aimed at relieving pain are available. “”The treatment of the arthritis crisis is based on analgesics. In case of inflammatory thrusts, non-steroidal anti-inflammatory drugs (NSAIDs) are useful. You can also make local corticosteroid infiltrations“, describes Professor Aleth Perdierger. Hyaluronic acid injections (Visco-Supplementation) can be offered to patients (not reimbursed by Social Security).
Physiotherapist?
Rehabilitation sessions in physiotherapist are strongly recommended to maintain the flexibility and stability of the joint. The exercises made to strengthen the quadriceps and allow the amplitudes of the joint. During surgery, pre-operative rehabilitation is considered before the intervention.
What sport when you have knee osteoarthritis?
The practice of a gentle physical activity is recommended for the articulation such as swimming, walking or cycling, apart from inflammatory thrusts. The activity makes it possible to strengthen the muscles of the leg. It also helps people overweight to lose the few extra pounds who weigh on their joints: profits are visible from 5 lost kilos.
Knee, splint …
A kneever or a splint can relieve the joint by improving the sensations of the knee positioning The wearing of orthopedic soles can relieve the pressure on the painful compartment, correct a defect in posture of the foot or absorb part of the shock waves. The use of a cane held in the hand of the opposite side to the reached knee can help relieve the knee joint.
When to operate the knee?
If despite treatments and rehabilitation, pain persists and a handicap sets up, the doctor will be able to propose surgery and the installation of a total or partial prosthesis to replace the joint. Surgical intervention practiced under arthroscopy does not require opening the knee joint. The surgeon performs two small incisions of about 3 mm to insert into the knee a camera in optical fibers connected to a camera, allowing to visualize all the structures of the knee joint. On the other hand, a prosthesis is indicated during a significant wear of the cartilage most often caused by osteoarthritis or during rheumatoid arthritis. The intervention, practiced under general or local anesthesia, lasts between 1h30 and 2 hours. Knee rehabilitation sessions are required for about two months.
If osteoarthritis is linked to a deformation of the joint, the surgeon can straighten the tibia or the femur, while retaining the joint. This is called osteotomy, a technique which consists in cutting the bone and straightening it and then maintaining this modification. This makes it possible to align the lower limb and rebalance the pressures carried out at the knee. This surgery is notably intended for patients with a genu valgum (knees inside). This intervention relieves pain and allows stabilization of osteoarthritis. Finally, the total arthroplasty of the knee is to replace the parts of the handicapped knee with artificial implants which allow flexion and a knee extension as well as an improvement in the walking and the scope of walking. The indication of an arthroplasty of the knee depends on pain, functional discomfort and the drop in quality of life.
Thank you to Professor Aleth Perdriger, Rheumatology Service of the Rennes University Hospital, for its details and its validation.
