19 (46.3%) focused on diseases, while 22 (53.7%) focused on interventions such as physical therapy, physical activity and Chinese patent drug. The 41 included CPGs are detailed in table 1 and online supplemental additional file 2. In those patients in whom the disease progresses, pain is more continuous and begins to affect activities of daily living, eventually causing severe limitations in function. Patients may also experience bony swelling, joint deformity, and instability (patients complain that the joint is “giving way” or “buckling,” a sign of muscle weakness). Usually, the earliest changes that occur in OA are at the level of the articular cartilage that develops surface fibrillation, irregularity, and focal erosions.
Knee arthroscopy revealed an area of stage 4 cartilaginous damage in the anteromedial tibial plateau measuring 5 x 5 mm, as well as a radial tear of the medial meniscus (Figures 1 and and22). We searched six databases (PubMed, Embase, VIP Database for Chinese Technical Periodicals, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure) for CPGs published from 1 January 2017 to 4 December 2022. We searched using keywords including knee osteoarthritis, osteoarthritis, osteoarthritis of knee, knee joint osteoarthritis, knee OA, KOA, gonitis, gonarthritis, guideline, clinical guidance and evidence-based guideline. The official websites of 40 authoritative orthopaedic societies, rheumatology societies and guideline development organisations were additionally searched. We performed an updated search before submission (the detailed search strategy is provided in online supplemental additional file 1). The guideline does not contain any assessment of the individual conservative measures mentioned, nor does it contain stage-specific recommendations for conservative treatment.
Osteoarthritis of the knee is a common condition that affects millions of people worldwide. It is a degenerative joint disease that can cause pain, stiffness, and swelling in the knee joint. If left untreated, osteoarthritis of the knee can significantly impact a person’s quality of life.
The iPSCs, reprogrammed from somatic cells [73,74], provided a new opportunity to create a virtually unlimited number of patient-specific stem cells for OA for drug discovery. Thus, chondrogenic differentiation of iPSCs from patients with symptoms of OA may enable many studies of cartilage tissue [42,50,75]. Clinical studies using iPSCs in cell therapy for OA are still in the basic stage with an understanding of the cartilage regeneration mechanisms. IPSCs have proliferative and differentiation capabilities similar to those of other stem cells; however, do not have immune rejection reactions and ethical problems [76]. Additionally, studies on a new method of producing iPSCs without the use of viral vectors have been actively conducted in recent years to reduce the risk of tumorigenicity [77,78].
Causes of Osteoarthritis of the Knee
Table 2 shows the available treatment options from the Osteoarthritis Research Society International (OARSI), ACR, and the American Academy of Orthopedic Surgeons (AAOS) publications [24,25,26]. Cartilage degeneration and other skeletal changes can be examined radiographically and quantified using the semi-quantitative grading scale known as the KL scale [20], Ahlbäck classification [21], and knee osteoarthritis grading system (KOGS) [22]. The original definitions of the KL scale, Ahlbäck classification, and KOGS are shown in Table 1. Surgery is indicated only when all conservative measures have been tried without success, in patients with advanced osteoarthritis and severe subjective impairment from their symptoms (box 5).
Active range of motion (ROM), terminal knee extensions, straight leg raises, and muscle strengthening exercises begin postoperative day one. Among them, research priorities in 17 (41.5%) CPGs were oriented to the whole guidelines, while in 7 (17.1%) CPGs they were directed towards each clinical practice recommendation. Research priorities in 3 guidelines were included as part of the clinical practice recommendations, while in the other 21 guidelines they were independently presented.
It is regarded as a valuable intervention for patients who have severe daily pain along with radiographic evidence of knee osteoarthritis. Drug therapy is also the first-line treatment for patients with symptomatic osteoarthritis. A wide variety of NSAIDs are available, and the choice should be based on physician preference, patient acceptability, and cost. The duration of treatment with NSAIDs should be based on effectiveness, adverse effects, and past medical history. It is indicated in patients with symptomatic arthritis with a body mass index greater than 25. The best recommendation to achieve weight loss is diet control and low-impact aerobic exercise.
Osteoarthritis of the knee is typically caused by wear and tear on the joints over time. This can be due to age, genetics, obesity, or previous knee injuries. As the cartilage in the knee joint wears away, the bones may rub against each other, causing pain and inflammation.
For example, the rate of good or very good outcomes was 92% in a prospective clinical trial performed by Hangody et al. (evidence level II) (23). 81 of the 98 follow-up arthroscopies that were performed revealed congruent surfaces as well as the histologically verified survival of the transplanted osteochondral cylinders. Some patients initially do not want to accept these aids, but can be made more amenable to them by adequate patient education and the active involvement of orthopedic technicians and shoemakers.
Symptoms of Osteoarthritis of the Knee
The most common symptoms of osteoarthritis of the knee include pain, swelling, stiffness, and decreased range of motion in the affected knee. Some people may also experience a grating sensation when moving the knee joint. These symptoms can vary in severity and may worsen over time if left untreated.
Diagnosis of osteoarthritis of the knee is typically done through a physical examination, medical history review, and imaging tests such as X-rays or MRIs. Treatment options for osteoarthritis of the knee may include medications, physical therapy, weight management, and in severe cases, surgery.
Understanding the basics of osteoarthritis of the knee is essential in managing this condition effectively. By recognizing the causes, symptoms, and treatment options available, individuals can take proactive steps to improve their knee health and overall quality of life.
