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Some Suggestions from Orthopaedic Surgeons on "Knee Osteoarthritis" are Worth a Look

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[Abstract]:
Some Suggestions from Orthopaedic Surgeons on "Knee Osteoarthritis" are Worth a Look
 
Many people will have knee pain and swelling when they are older. In severe cases, it can affect daily life such as walking, but few people know why. So outpatients often hear such patients asking various questions.
 
such as:
 
Ⅰ. I didn't get hurt, why my joint hurts for no reason?
 
Ⅱ. My joints are swollen. Is there some fluid?
 
Ⅲ. They say that joint fluid cannot be pumped. Will it be pumped more and more?
 
Ⅳ. Is not to say swollen should heat compress, how more apply more swollen?
 
Ⅴ. Shouldn't anti-inflammatory take antibiotics?
 
Ⅵ. Shouldn't knee joints have knee pads?
 
Ⅶ. Can this disease be completely cured?
 
1. Folk Theory vs. Expert Advice
 
However, the first reaction of many patients after hearing the doctor ’s explanation was not to suddenly realize, but to look at the doctor with skeptical eyes, and then to say the "theory" spread through various channels, as well as various solutions collected by the folk, and then questioned Why the doctor said something different from these "theories" I heard before.
 
Although these "folk theories" are very ridiculous to professionals (not listed here), they have a large audience. Patients are desperately in need of medical treatment. They would rather believe in the "advice" of their neighbors than go to the hospital for formal treatment. They would rather go to the "old Chinese medicine" of an unlicensed massage shop for acupuncture, rather than talk to their old friends for many years. I went to the park to "squat together and shake two". I would rather carry my child secretly to try the plaster called the "Battle and Cure" which is set up on the stall in front of the community, rather than believe that I have more than 10 years or even 20 or 30 years of related professional Experienced specialist.
 
Therefore, we need to do some popular science here to explain the problems related to this disease.
 
2. What You Should Know About "Knee Osteoarthritis"
 
First of all, what is this disease? I don’t want to use very professional terms to explain it. In fact, I only need to know a little bit. This disease is due to the aging of the knee joint due to long-term wear. It is the natural process of human aging.
 
Osteoarthritis will occur in everyone, only sooner or later. It's a natural law just like old age, sickness and death, so no matter whether it's the world's top athlete, the richest man, or the president, they can’t escape.
 
Osteoarthritis is incurable. No matter how rich or poor you are, no matter how beautiful or smart you are, you can't change this fact (at least the current medical technology is not working), so don't trust the "ancestral secret recipe" that some people advocate, or Injecting, taking some medicine, pasting plaster, acupuncture and massage can "fully cure" and so on.
 
Osteoarthritis occurs in middle-aged and elderly people, but it does not occur in young people. At least we've seen very young athletes with articular cartilage wear due to long-term high-intensity and high-load training. Therefore, the wear and aging of joints is not only related to age, but also the way, frequency and intensity of your joint use. It's like a car, the more you drive, the faster it breaks.
 
3. About "Knee Osteoarthritis" Treatment
 
Although osteoarthritis cannot be cured, it can be postponed and the treatment can usually be divided into three parts.
 
Ⅰ.
The first part is conservative treatment. This is the preferred treatment for osteoarthritis, which includes weight control, exercise management, changes in lifestyle and more. For symptomatic osteoarthritis can be targeted drug treatment.
 
The first thing to mention here is weight control. Because the heavier the body is, the greater the force on the knee joint and the faster the wear and tear, so the latest bone joint treatment released by the American Academy of Orthopaedic Surgeons (AAOS) The guidelines recommend that anyone with a body mass index greater than 25 should lose weight, which is also the most direct way to protect the joints.
 
However, the BMI of 25 is a white standard. Due to the difference between races, the Chinese standard issued by China is that the BMI generally does not exceed 24. Here we mainly use our own standards. It is recommended that all BMIs exceed 24 of them should lose weight.
 
(Body Mass Index (BMI) = weight (kg) ÷ height ^ 2 (m), everyone who is interested can calculate their own BMI)
 
For the management of sports, the guidelines issued by AAOS (American Academy of Orthopaedic Physicians) are also "highly recommended" (highest level). It suggests that patients with symptomatic osteoarthritis should participate in strength training, low-intensity aerobic exercise, and neuromuscular training. Because the improvement of muscle condition can help slow down the wear of articular cartilage.
 
All the exercises mentioned above are recommended to be carried out with a minimum load to avoid the joints from aggravating the wear of the joints. For example, when performing lower limb strength training, straight leg lifting is often used, or straight leg training is performed under a rehabilitation belt load, and squats or weight-bearing squats are avoided. Aerobics recommend swimming or jogging. It is not recommended to perform training on a treadmill or load power bicycle training.
 
Changing life habits is mainly to abandon the lifestyle that was easy to damage the joints, such as avoiding repeated squatting exercises or squatting for a long time, avoiding climbing mountains or going up and down stairs, and avoiding excessive use of knee joints, such as running a marathon.
 
For osteoarthritis with pain or joint effusion symptoms, non-steroidal anti-inflammatory analgesics (such as celecoxib, ibuprofen, meloxicam, etc.) can be used, which is also highly recommended by AAOS .
 
Ⅱ.
The second part is arthroscopic minimally invasive treatment. The AAOS treatment guidelines do not recommend arthroscopic joint lavage for simple symptomatic osteoarthritis, but for osteoarthritis mainly meniscus rupture or intra-articular free body, arthroscopic minimally invasive To treat under joint cleansing.
 
Of course, this treatment scheme is only for patients with articular cartilage wear that is not too heavy, and it should be noted that arthroscopic treatment can only deal with broken meniscus and free body, and has no therapeutic effect on already worn cartilage, in other words, It does not solve the problems of aging and wear of the knee joint.
 
Ⅲ.
The third part is joint replacement surgery. Many people shook their heads when they heard of joint replacement and refused to undergo this operation. However, joint replacement is the most effective treatment for end-stage osteoarthritis. Take the car as an example. If one part of the car is completely broken and cannot be repaired, but the other parts are still good, do you choose to give up completely and stop driving, or choose a replacement part so that the car can continue to run How about?
 
 
4. What needs to be added
 
As for osteoarthritis, there are still many people who have some misunderstandings, and the important points are explained below.
 
Ⅰ. Can't take painkillers casually?
 
It should be noted that many people refer to the painkillers as opioids, and a large number of them are addictive, but we are using non-steroidal drugs, whose main function is "anti-inflammatory and analgesic", which has an anti-inflammatory effect It also takes into account the analgesic effect, so non-steroidal drugs are mainly for inflammatory pain, and are not addictive, and can be used under the guidance of a doctor.
 
Ⅱ. Do I have to use antibiotics?
 
The inflammation of osteoarthritis is actually two different things from what we usually call "inflammation". What we call pneumonia and wound inflammation is infections in nature, so they can be treated with antibiotics. But the inflammation of osteoarthritis is aseptic and it is the body's inflammatory response. This kind of inflammation does not require the use of antibiotics. It is mainly controlled by our non-steroidal anti-inflammatory analgesics.
 
Ⅲ. Does joint effusion draw more and more?
 
Many patients experience joint swelling and fluid accumulation. When there is a lot of fluid in the joint, the doctor will choose to perform a joint puncture to extract the fluid. Many people think that joint effusions cannot be pumped, and they will pump more and more. It can be said responsibly that fluid withdrawal will not cause an increase in fluid accumulation!
 
First, the joint effusion is only related to inflammation. When inflammation occurs, the joint may have fluid accumulation, which has nothing to do with puncture.
 
Second, after the joint puncture releases the joint effusion containing a large number of inflammatory mediators, the inflammation control will become much easier, and the disease course will be greatly shortened.
 
Third, some patients need several punctures to slowly control inflammation.
 
Ⅳ. Do I need a knee pad?
 
In many cases, knee pads can provide protection, but when the patellofemoral joints are worn, wearing knee pads will aggravate knee pain, because the elasticity of the knee pads increases the pressure on the patellofemoral joints, which will cause the Faster wear and tear. Therefore, do not wear knee pads blindly when the knee joint is painful, and choose the treatment plan under the guidance of a specialist whenever possible.
 
Ⅴ. Timing of exercise?
 
Although AAOS (American Academy of Orthopaedic Physicians) guidelines recommend that patients exercise moderately, we should emphasize the timing of exercise here. During an osteoarthritis attack, please do not perform exercise therapy. Excessive exercise will aggravate the inflammatory response and lead to the delay of the disease course. The best way is to reduce the activity as much as possible during the onset of inflammation. After the symptoms disappear, exercise slowly and gradually.
 
Ⅵ. Should I put a cold compress or a hot compress?
 
Many patients tend to take a hot compress to reduce swelling during an osteoarthritis attack. General swelling with hot compress can promote blood circulation and reduce swelling quickly. In fact, this sentence is half right, because the swelling of osteoarthritis is not a general swelling, but an inflammatory swelling, which is essentially the expansion of capillaries, and the hot compress will further expand the capillaries and further increase the inflammatory response.
 
Therefore, for swelling caused by this inflammatory response, cold compresses should be used to shrink capillaries to reduce this local inflammatory congestion. Please rest assured that cold compresses will not cause "rheum". If it is really impossible for patients to receive cold compress treatment, neither cold compress nor hot compress can be used.
 
Ⅶ. Can acupuncture, massage, physiotherapy be used?
 
AAOS (American Academy of Orthopaedic Physicians) 's attitude towards acupuncture, massage, and physiotherapy for osteoarthritis is neither recommended nor opposed. This means that the effectiveness of this treatment plan is uncertain, so they are not recommended, but if you insist on trying, they will not object. But our experience in clinical work tells us that we do not advocate acupuncture or massage for osteoarthritis in the attack. Acupuncture destroys the integrity of the local skin, which may cause infections around the joints and even in the joint cavity. Massage may increase the expansion of local capillaries, leading to further swelling.
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