Progressive cartilage loss is often accompanied by a progressive onset of knee discomfort to the point of pain (gonalgia) resulting in knee osteoarthritis or gonarthrosis.
Knee pain may be present initially at periods, depending on the weather or type of physical activity; later, in the more advanced stages of chondral wear, the pain may become constant and of medium to high intensity.
Knee pain is typically localized in the inner (medial) and posterior areas, although it can also affect the anterior and lateral areas.
Depending on age, knee characteristics, and the extent of cartilage damage, one can rely on various conservative or surgical treatments.
Arthrosis and effusion in the knee
The knee joint is contained by a fibrous capsule lined on the inside with a membrane, called the synovial membrane. Normally, the synovial membrane produces a small amount of fluid that provides nourishment for the cartilage and lubrication of the joint; in cases of major trauma or arthrotic degeneration, the synovial membrane may produce fluid that “bulges” the knee (endoarticular effusion).
Thus, in the absence of trauma, it is highly likely that an effusion is due to arthrotic degeneration of the knee.
Diagnosis of knee osteoarthritis
Diagnosis is made with X-rays preferably under load (standing) and MRI.
Why does a knee become arthritic?
Cartilage’s wear of the knee occurs, primarily, physiologically; in fact, as the years go by, this natural joint surface.
There may be some factors that promote cartilage wear such as:
- weight gain;
- Absence of part of the menisci due to previous surgery;
- previous fracture;
- Alteration of the knee axis: a varus or valgus knee.
How is knee osteoarthritis treated?
To decrease the pain, it is necessary to change one’s lifestyle by losing weight and, perhaps, associating low-gravity exercise (biking, gym exercises, swimming, water exercises, Yoga, etc.).
If the knee has a joint effusion, its aspiration may benefit (arthrocentesis).
Subsequently, a role in improving knee pain and function is played by the use of oral pain relievers or hyaluronic acid and/or PRP (“platelet-rich-plasma”) infiltrative therapies in the knee.
If conservative (non surgical) treatments do not allow for pain improvement, we will turn to surgical treatments.
Arthrosis of the knee and surgery
If the cartilage is worn but its wear and tear has not reached the bone (gonarthrosis) to preserve and regenerate it, the Patient may benefit from non-prosthesis knee surgery.
In addition to knee arthroscopy, which will allow treatment of accessory joint problems, the two main nonprosthetic surgeries to preserve cartilage are corrective knee osteotomy combined or not with meniscus transplantation:
- If a load-bearing axis deviation ( varus knee or valgus knee) is present , benefit can be had by correcting the pathologic axis by performing a CORRECTIVE OSTEOTOMY.
- If the cartilage’s wear is due to the lack of a previously removed part of the meniscus, you may benefit from a MENISCUS ALLOGRAFT TRANSPLANTATION.
If cartilage wear has reached the bone, I cannot benefit for a long time from osteotomy surgery, meniscus transplantation, or infiltrative therapies.
So in cases of complete disappearance of cartilage, the intervention to achieve pain benefit and recovery of knee function is the KNEE REPLACEMENT.
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