Knee osteoarthritis (gonarthrosis) or knee arthritis is practically unavoidable condition in the knee joint. Over the years the cartilage wears out. You can say that life takes its tax in the form of cartilage wear. It is a painful disease which limits mobility of the knee and often requires surgical intervention.
Knee osteoarthritis can be treated with physiotherapy, hyaluronic injections, anti-inflammatory drugs, etc. All these might help, but not for long. Do you know what is the best solution for an active life without knee pain? Read more below.
What is osteoarthritis of the knee and why does it occur?
Older people suffer from knee osteoarthritis
Knee osteoarthritis is a degenerative process or more likely a progressive inflammatory disease. It starts on the cartilage and progresses to the final appearance of the joint and the sensation of pain through the whole series of changes.
24% of the population feel the changes acutely. Therefore, the pain isn’t always present in such a strong form. As the life expectancy of people increases, there are more and more patients with this type of pain.
After the age of 50, the incidence of knee pain and knee osteoarthritis sharply increases. The most people with severe knee problems are 70 years old or older.
Several factors are important for the development of the knee arthritis. Much depends on:
- our (active / inactive) way of life from a young age onwards,
- existing injuries,
- congenital deformities (deprivation),
- previous knee surgeries,
- associated autoimmune diseases,
Present of pain and impaired mobility indicate the condition of a knee osteoarthritis.
Do we know the cause for gonarthrosis?
In primary knee osteoarthritis play an important role hereditary factors, sex, age, hormonal status, obesity, climatic conditions and diet.
In 80% of cases, the cause of primary osteoarthritis is unknown.
Secondary osteoarthritis is the result of a different conditions:
- congenital deformed conditions (loose ligaments or deformity of the joint)
- metabolic diseases,
- joint injuries,
- avascular necrosis,
- muscles overload.
Degeneration of articular cartilage it’s typical for knee osteoarthritis
Loss of articular cartilage leads to changes in the tissues around the joint. In the affected knee, calcium crystals are starting to form around the joint and cause pain. By nature, the knee joint is very susceptible to degenerative changes.
Osteoarthritis in such joints is worse and progresses rapidly. After s while, you can also feel creaking, joint effusion, muscle weakness, joint stiffness and deformed joint.
Knee osteoarthritis is determined by X-ray, where the tibia and femur are in direct contact.
Constant pain in the knee and morning stiffness
People with knee osteoarthritis feel constant pain in the knee, morning stiffness and reduced function. That makes it difficult for a person to walk and to withstand loads.
Pain occurs during walking up the stairs and getting out of the bed. Some also complain about an unstable knee when standing or waking. As already described, crepitations, limited mobility and bone thickening occur.
In a degenerated knee, full flexion and extension of the knee are most often limited. People are always looking for a leg position in which they feel comfortable and the pain is kept to a minimum. This is the position in which the knee is gently padded with a pillow.
Putting pillow under your knee isn’t the best choice one can make. Because of the knee flexion, contractures can appear and the hamstring muscles become more rigid.
Joint crepitation aren’t just characteristics of gonarthrosis because they can also occur in a healthy joint. It is the result of sliding tendons over the bones bulges.
Knee osteoarthritis treatment
Knee osteoarthritis is a condition in which individual treatment cause immediate improvement and alleviate pain, but can’t prevent disease progression.
Pain can be relieved with the help of physiotherapy or medication. The only realistic and long-term solution (in case of severe problems) is surgical replacement of the knee. Or otherwise the insertion of a total endoprosthesis or artoplasty.
Physiotherapy – knee osteoarthritis
Exercises and body posture
Physiotherapy is a science that deals with the establishment, maintenance and strengthening of health and functionality of the locomotor system in humans. It is important to mention health promotion, as physiotherapists are great promoters of health and a healthy lifestyle.
They motivate people and remind them to maintain their body weight and to demonstrate muscle strengthening exercises.
Therefore, we can say it’s physiotherapist job to reduce pain and improve function. They also educate patient to perform exercises correctly and have a proper diet.
The difficulty of the exercises must be adapted to the abilities of the individual and increase over time as patient progress. Only the muscles are those who keep the joint stable and functional, therefore don’t forget to strengthen them.
Supporting devices in physiotherapy for knee osteoarthritis
Best physical therapy methods to relieve knee pain are:
- Tecar therapy (Device that works as a stimulator of biological processes. Tecar therapy is an innovative therapy that triggers natural and restorative processes. By conducting heat, it performs a deep soft tissue massage and allow easier mobility in the joint.)
- Ultrasound therapy (Ultrasound therapy causes micromassage and cavitation of the affected tissue, thereby accelerating the local metabolism and healing process.)
- Medium frequency electrotherapy (The most commonly used physiotherapeutic method that has anti-inflammatory and analgesic effects.)
- Hydrotherapy (Specific exercises in water have a great effect on the joints. Water relieves the pain and gives support to the body.)
- Dynamic vacuum (Cupping causes a circular skin motions, which relaxes the fascia.)
- Magnetic therapy
Taking painkillers and anti-inflammatory drugs
Most doctors immediately prescribe painkillers. Drug treatment should be only after other measures (physiotherapy) no longer help.
In the first stage, people take paracetamol, which is an effective and safe medicine to relieve the symptoms. NSAIDs (non-steroidal anti-inflammatory drugs) can be prescribed too. However, dosages should be considered as they may have side effects on the cardiovascular system and gastrointestinal tract.
In addition, using corticosteroid blockade applications have increased during the years. These can only be applied under the supervision of a physician, because the risk of increased cartilage damage and the development of aseptic bone necrosis is quite high.
Let’s not forget the exceptional hyaluronic acid. Injecting hyaluronic acid supports the joint and thus protects the joint cartilage and soft tissues from injury. Applications take effect for 6 to 9 months, after that period of time they should be repeated.
A life without pain and the only option for an active life, is the insertion of a total knee endoprosthesis.
An endoprosthesis is a solution to end knee pain
As the body ages, we can only expect a gradual deterioration of the already started condition in the knee and never a complete improvement.
Except in cases where people opt for the best solution for a completely worn knee – total endoprosthesis or arthroplasty.
When to consider a knee replacement?
After other non-operative (conservative) methods no longer help, people decide to insert a total knee endoprosthesis. This decision must be supported by X-rays showing progressive osteoarthritis of the knee.
People can insist on taking painkillers and help themselves to walk with different aids. But for all who want an active life, the only solution is a total endoprosthesis. Most knee endoprostheses have a lifespan of at least 15 years and more.
Recovery – physiotherapy after knee surgery with insertion of an endoprosthesis
Immediate rehabilitation after knee arthroplasty surgery
Immediately after the surgery, a rehabilitation program begins. That means that the physiotherapist educate the patient how to get out of bed, sit and walk with crutches.
Physiotherapist’s duty is to show the patient proper exercises. These exercises are focused on regaining the mobility of the knee and muscle strength. The patient usually remains hospitalized for another 6 days and then returns to the home environment, if no other complications are present.
First control after approx. 1 month
The doctor removes stitches or staples after 14 days. As soon as the wounds heal, the patient visits a physiotherapist. All start by performing analgesic physiotherapy and continue with slowly softening the soft tissue in order to prevent scarring. We shouldn’t forget on increasing the range of motion with the help of manual therapy.
Up to 1-2 months after the operation, the leg should be fully relieved with the help of walking aids (crutches). This usually apply until the first examination by an orthopedist.
In practice, the knee swells for quite some time. This is normal due to the forced increase in joint mobility and muscle loads. After each activity (in case of swelling), doctors recommend cooling knee with ice and raising the limb above the height of the heart.
Treatment methods used after insertion of an endoprosthesis in the knee
The most important role has kinesiotherapy or exercises. With physical therapy devices such as analgesic medium frequency electrotherapy, ultrasound and Tecar therapy (if the material allows it) we increase the ability of joint function.
Equally important as all of the above is manual therapy, in which the mobilization of the joint in 3D movement is performed with the help of the therapist’s hands.
When can you go back to normal everyday life?
Patients are usually able to perform daily tasks 3 to 6 months after surgery. This figure varies due to many potential complications, including more difficult body adjustments to the new metal material.
In reality, however, most people say that only after a year they feel that perfect knee without a strange, foreign feeling.
In any case, after the operation, the knee is painless and ready for new adventures. So, don’t hesitate and get things done. Don’t let the pain overcome you.