As we turn years old, our knees accumulate effort and may suffer a wear and tear process; cartilage, a layer of bone lining in the joints has a great buffering capacity, but when it disappears or is damaged, it leaves the subchondral bone unprotected and results in the symptoms of the well-known “arthrosis”, see pain, inflammation and progressive deformity; meniscuses and ligaments also weaken over time and add to the overall deterioration of the knee; osteoarthritis is more common in older people, especially women, but it can also affect people with a history of knee injury, overweight, overserage or family history; it is estimated that one in 10 people will develop symptomatic osteoarthritis in the knee.
“On the other hand, having a wear of cartilage, focal or diffuse, does not necessarily imply being condemned to pain or having to undergo an intervention; there’s a lot we can do to minimize symptoms, says Dr. Gonzalo Samitier, a specialist in Knee Surgery at the Cugat Institute.”
Weight management and a proper diet
It looks like a topic, but weight has a direct mechanical effect on our knees.
“Every kilo of more translates into 4kg of additional pressure on our loading joints,” says Dr Samitier.
Eliminating overweight can make arthrosic pain disappear or minimize pain, while simply improving our diet and the nutrients we provide to our body to achieve this goal will improve the quality of our tissues, including cartilage, and our overall health, which is highly advisable if we ultimately need surgery.
Working for strength and mobility
A specific work of the thigh muscles, especially the quadriceps and hamstrings, plays a protective role in our knees; Exercises such as knee extensions with resistance from sitting position, half squat or activities such as walking in the water and bike, are a simple thing that we can do daily to improve our knees. A rehabilitator, physical therapist or physical trainer can initially help us perform the exercises correctly and find those that best suit us.
The arthrosic knee loses range of motion progressively and although this is not completely reversible, we must strive to maintain as much mobility and flexibility of our joints as possible.
“The loss of some bending degrees in the knee is not as relevant, but a knee in “flexo”, which does not fully stretch, is especially spelling in the long term for the kneecap and knee as a whole and should try to correct itself” says the expert, Dr. Gonzalo Samitier.
Physical exercise YES, but with intelligence.
The patient with cartilage problems, must know how to adapt to what is best for him in the long term and prioritize activities without impact such as the bicycle, elliptical or the pool against other impacts such as the stroke, jumping or lifting of extreme weights; a particularly counterproductive knee position is the bulky hyperflection or the position of “squat”, very common in certain professions or activities; the pressure on the meniscus and cartilage is enormous and in the long run can lead to deterioration; Choose to sit on a low stool or on the floor when doing such activities.
Better to sit or stand?
Patients with osteoarthritis often accuse a prolonged standing position or the fact of walking for a long time, especially if the terrain is uneven, so try not to reach the point where the pain occurs; inactivity on the other hand, avoids the efforts that can trigger pain and makes osteoarthritis patients feel better seated or lying down, but if that results in excessive sedentaryism then we lose all the advantages mentioned above, maintaining a good muscle tone, weight management and deteriorating our overall health, so we have to look for an intermediate point.
The effect of templates
If you are going to walk or stand for a long time, wear suitable, comfortable, soft-soled shoes; a template is not essential but can help you find greater comfort in our most active hours. Nor does correcting small dysmetry, below 1.5cm, often change greatly the symptoms we might have from arthrotic disease.
“In patients with genuine varo (arched legs) or genu valgo (knees in “X”) the pressure in the compartment affection, medial or lateral respectively, can be lowered by placing an over-elevated wedge +5-7mm, on the insole or sole of the shoe; its surgical equivalent is the osteotomy of tibia or femur realignment, and is indicated in those relatively young patients, <50-55 years, with axle alterations and symptomatic arthropathy of a knee compartment, internal or external,” says Dr Samitier.
The solution is NOT in medicines or infiltrations
Diet, exercise, giving up certain sports, all this requires dedication, perseverance and willpower so it is understandable that we try to look for “magic” and immediate solutions through the specialist but, “to this day, there is no product, medicine or infiltration that regenerates the damaged cartilage”. Excessive dependence on NSABs or painkillers is not advisable if it is not accompanied by other measures such as those mentioned as the arthrotic process continues to progress while we keep the symptoms masked. Infiltrations of hyaluronic acid, ozone, growth factors, stem cells or mesenchymals, in themselves have also not demonstrated the ability to regenerate cartilage and there is controversy over whether they are able to reduce symptoms effectively, it is true that they do not seem to have a negative effect either, so if in their particular case they have been effective in the past to alleviate symptoms and thus be able to work on the rest of measures , may be an option to explore by your specialist doctor. Infiltrations with corticoid and local anesthesia can also provide immediate but rarely symptomatic relief in the long run and are also not advised as a baseline treatment, but as a measure of pain management in especially symptomatic periods.
Using knee pads
Although it is a resource little used by specialists, there are knee pads created for the management of arthrotic symptoms. There are discharge knee pads that potentially reduce pressure in the compartment with greater affectation, especially when it is the medial, while other knee pads provide a global knee support through a system of articulated metal side bars and a support at thigh and leg level. Not all patients are good candidates for this type of knee pads, some consider them uncomfortable, and especially it can be irritating in those patients more obese, with skin or vascular problems, besides that they can create a certain dependence; but for certain patients it may be an alternative to consider preferably in conjunction with other measures.
IF Surgery, when conservative measures fail
The ultimate solution in the patient with diffuse symptomatic and limiting knee osteoarthritis is the knee prosthesis; the prosthesis is a device with metal and plastic components that partially or completely replaces damaged cartilage and bone. This is major surgery, and although it may present complications, these are rare; its results in expert hands are consistent, with survival of the implant above 80-90% to 15 years, being considered one of the surgeries that further improves the quality of life of patients.
In the patient under the age of 50 it is unusual to find a diffuse osteoarthritis like that of the elderly, so there is usually talk of “condral or cartilage injury”. For these patients the surgical solution is “young adult knee preservation surgery”, where severe and symptomatic cartilage problems are resolved in up to 85-90% of cases using transplant techniques; these patients often also have combined ligament, meniscus or misalignment injuries so each case should be analyzed individually.
“Dr. Samitier is a specialist in this type of procedure and a reference in ligament surgery and meniscus or knee cartilage transplantation.”