Treatment of degenerative arthritis includes: drugs, rehabilitation, hyaluronic acid, PRP injection, use of protective gear, etc. In the past, the health insurance coverage of hyaluronic acid injection was 3~5 injections every six months. From May 2020 1, the annual long-acting hyaluronic acid injection began to be included in the health insurance coverage.
Sun Shufen, Chief Physician of Rehabilitation Department of Kaohsiung Veterans General Hospital, published 20 17 in the top international orthopedic journals. According to the research, the long-acting once-injection hyaluronic acid made in Taiwan Province Province (No.004511made by the Ministry of Health) is superior to the long-acting once-injection hyaluronic acid made in the United States, which can achieve better pain relief and knee joint function index, and is the first-class certification of empirical medicine. This health insurance covers long-acting hyaluronic acid for injection and has EU ce certification.
According to the results of other clinical trials, it is pointed out that the long-acting injection of hyaluronic acid paid by this health insurance has the maximum efficacy of 1 year, and only needs to be given 1 time a year, while the long-acting injection of hyaluronic acid made in the United States has a validity period of only half a year. (Refer to the medical journal J Osteoarthrosis Surgery 2017 MAR15; 99(6):462-47 1.)
Hyaluronic acid generally exists in the joint fluid of movable joints. When it degenerates, the body produces less hyaluronic acid. Therefore, intra-articular injection of hyaluronic acid can continue to provide joint lubrication, shock absorption, protect chondrocytes and induce endogenous hyaluronic acid production itself.
Where can I have long-acting injection of hyaluronic acid? Compared with multiple injections of hyaluronic acid, the long-acting one-time injection of hyaluronic acid is made by a new cross-linking technology, which can last longer in the joint cavity and is more resistant to body weight extrusion and biodegradation. Compared with traditional hyaluronic acid, long-term one-time injection of hyaluronic acid can reduce the number of injections, reduce the return visit time and the risk of infection during injection, and improve the convenience and safety of patients.
(Hyaluronic acid can be injected in the rehabilitation clinic. Provided by Dr. Liu Yixiu)
Precautions after hyaluronic acid injection: rest in a sitting position after injection, slowly straighten out and bend your knees several times. If you don't feel uncomfortable, you can move and exercise normally, but you should avoid excessive knee movement and repeated squats. Traditional 3 ~ 5 injections of hyaluronic acid will swell after 2 days, and the first injection of hyaluronic acid may swell for a long time. If you feel uncomfortable, you can take oral painkillers or ice to relieve discomfort. The maximum period of curative effect of hyaluronic acid injection for injection is 1 year. /kloc-After 0/year, you can continue to beat the protective joints. Long-term injection of hyaluronic acid once a year is made by bacterial fermentation. Compared with the extraction of hyaluronic acid by comb, there is no allergic problem. When injecting, the injection site should be carefully disinfected to avoid the risk of infection. Early treatment of the disease has a good effect. X-ray examination arranged by doctors is helpful to judge whether the course of degenerative arthritis of knee joint is mild, moderate or severe. Studies have shown that hyaluronic acid can play a greater role in the early and middle stages of arthritis (Kellgren Lawrence II-III), and the therapeutic effect of hyaluronic acid on severe knee arthritis will be discounted.
X-ray examination confirmed degenerative arthritis: hyperosteogeny of the medial knee joint and wear of hyaline cartilage. Provided by Dr. Liu Yixiu)
Hyaluronic acid plus rehabilitation exercise is more effective in treating knees. Hyaluronic acid can be injected immediately in the outpatient department, which can be completed in about 1 ~ 3 minutes. To treat degenerative knee arthritis, it is necessary to lose weight, strengthen knee joint exercise and quadriceps strength training.
Muscle strength training of quadriceps femoris: slowly straighten your knees when sitting, and count 1 ~ 10 in your mouth, then put it down and change to the other foot. You can practice many times a day. The goal is 100. If the situation of acute inflammatory pain may not be suitable, or there will be pain when performing this action, please ask a rehabilitation expert to evaluate the suggestion.
(Drawing provided by Dr. Liu Yixiu: clinical psychologist Lin)
The hyaline cartilage of the knee itself has no blood vessels, and the joint activity of the knee joint can cause pressure difference, and then the joint fluid can nourish the hyaline cartilage. Research shows that quadriceps femoris training can strengthen the front thigh muscles and reduce the occurrence of degeneration; Stretching the knee is an isometric contraction exercise, which will increase blood pressure. Patients with hypertension or the elderly had better exercise 1, 2, 3 to avoid instantaneous hypertension.
The rehabilitation department has many instruments such as light, electricity and hyperthermia, which can be used to treat degenerative arthritis to reduce inflammation and pain. There are many joint protection skills that can be taught in rehabilitation department, which can reduce unnecessary movements and prevent injuries in daily life.
Sports suitable for knee joint degeneration include walking, cycling, swimming, trunk core muscle group training and so on. Sports that bring too much burden to the knees, such as climbing mountains or skipping ropes, should be reduced appropriately. The bicycle itself will also train the quadriceps, but it should be noted that the height of the chair should not be too low when riding. When one foot is up, the knee will bend more than 90 degrees, which is not suitable. At this time, the cushion should be raised a little to prevent the knee from being easily worn and degraded behind the patella.
Adjustment of life & rehabilitation AIDS: Don't sit in a low chair, and be careful of falls, fractures and knee joint degeneration. It is easy to have difficulties from sitting to standing, so you can make more adjustments in your daily life:
1. Don't sit on the sofa or low chair, otherwise it will be difficult to stand up. Please choose a hard and high chair, and it is best to have armrests on both sides to help stabilize and prop up the sitting position. If you don't want to change chairs, you can add cushions to the sofa or low chair. Generally, the toilets at home are relatively low, so you can consider installing auxiliary devices such as toilet heightening pads.
For people who are weak but want to go to the toilet, there is even an electric toilet booster to choose from. At the touch of a button, you can support your body from sitting position to standing position.
Most patients with degenerative arthritis of knee joint are middle-aged and elderly people, who are prone to osteoporosis. When standing up, it is often easy to fall down because of weakness or pain, so be especially careful to loosen the fracture. Therefore, good rehabilitation treatment of knee joint degeneration can also prevent fractures. (Recommended reading: Osteoporosis fractures can be fatal. College teaches you to keep "secret" and prevent "falling")
2. Make good use of crutches or walkers: using single crutches, four-legged crutches or walkers will help to share part of the weight, reduce the weight and directly compress the painful knee joint. Using a walker can also help balance and prevent falls. Don't use it just because you are afraid of ugliness. Use it when you need it. First, give priority to preventing falls and avoiding the occurrence of osteoporotic fractures. There are many kinds of walkers. You can choose to consult a rehabilitation expert.
Regulations on payment of health insurance
? (provided by Dr. Liu Yixiu)
Conservative treatment and general drug treatment were ineffective for more than 6 months (inclusive), until they failed to meet the standards of artificial knee replacement, and were diagnosed as degenerative knee arthritis.
Joint team medical treatment of degenerative knee arthritis requires the cooperation of several expert teams, and long-acting injection of hyaluronic acid is usually used in rehabilitation and orthopedics. If conservative treatment fails or joint degeneration is serious, arthroscopy or joint replacement surgery should be considered, and then the rehabilitation team will perform postoperative joint.
? (provided by Dr. Liu Yixiu)
(The author is Liu Yixiu, the attending physician of the Department of Rehabilitation Medicine, Kaohsiung Veterans General Hospital. )