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Arthrosis of the knee joint

Arthrosis of the knee joint (gonarthrosis, deformed osteoarthritis)

Osteoarthritis of the knee joint is a disease of the musculoskeletal system, which involves the deformation and destruction of the cartilage tissue of the joint, as a result of which the structure and functions of the cartilage are disturbed. The disease has several names - gonarthrosis, deformed osteoarthritis. The treatment of osteoarthritis of the knee joint does not have a single scheme or a single drug that can help everyone who suffers from this problem. Since arthrosis is a progressive disease, it is more often observed in overweight women, venous diseases and the elderly. Treatment is prepared and prescribed individually for each patient.

Osteoarthritis of the knee joint can be unilateral or bilateral (depending on whether the disease develops on one or both legs). At the first symptoms, it is necessary to apply for adequate treatment, because neglecting this problem can lead to the final destruction of cartilage and bone exposure and, as a result, disability of the person.

There are three stages of the disease:

  1. The initial stage of knee arthrosis is characterized by the loss of cushioning properties and, as a result, the cartilage rubs against each other during movement, which causes severe discomfort to the patient. Cartilage becomes rough, deformed, dries up, in the advanced stage of the disease - it is even covered with cracks.
  2. Due to the decrease in cushioning, bone deformation begins, which leads to the formation of osteophytes (growths on the surface of bones) - this is the second stage of the disease. The synovial membrane and capsule of the joint also undergo deformation, the knee joint gradually atrophies due to stiffness of movement. There is also a change in the density of the joint fluid (it becomes thicker, more viscous), blood circulation disorders, deterioration of the supply of nutrients to the knee joint. Thinning of the membrane between the cartilaginous joints reduces the distance between the articulating bones.
  3. The disease progresses rapidly and quickly moves into the third stage, when the patient is practically unable to move due to constant pain in the knee. Global and irreversible changes occur in the cartilage tissue, which causes a person's disability.

Most often, arthrosis or gonarthrosis develops after an injury or hemorrhage, and a person feels constant severe pain in the knee area, which significantly hinders his movement.

Causes of arthrosis

Osteoarthritis of the knee joint, the treatment of which takes a long time, can be detected due to such factors:

  1. genetic predisposition.
  2. Injuries: dislocations, bruises, fractures. When treating an injured knee, the joint is fixed and the person cannot bend and lift the leg for a certain period of time. This leads to the deterioration of blood circulation, which most often leads to the development of post-traumatic gonarthrosis.
  3. Meniscus removal.
  4. Excessive physical exertion that does not correspond to the age of the person, which causes injuries or microtraumas, as well as hypothermia of the joints. For example, jogging or squatting on the asphalt is not recommended for the elderly, since during these exercises there is a significant pressure on the knee joint, which wears out with age and cannot withstand such a load.
  5. Overweight and obesity. This factor causes damage to the menisci, the damage of which provokes the development of arthrosis of the knees.
  6. Loose ligaments or weak ligaments.
  7. Arthritis or other acquired joint diseases. The inflammatory process can cause accumulation of synovial fluid in the joint cavity or swelling. This leads to the destruction of the cartilage tissue of the knee, which leads to osteoarthritis of the knee joints.
  8. Metabolic disorders in the human body. An insufficient amount of calcium significantly worsens the condition of bone and cartilage tissues in the human body.
  9. flat feet. The incorrect structure of the foot changes the center of gravity and the load on the joint becomes greater.
  10. Stress and nervous tension.

Symptoms of knee osteoarthritis

The clinical picture of the disease has the following symptoms:

  1. pain sensations. The pain appears suddenly, depending on the physical load on the knee joint. Pain can be of different nature. At the initial stage, these are weak back pains that people usually do not pay much attention to. Periodic mild pain can be observed for months, and sometimes years, until the disease progresses to a more aggressive stage.
  2. Visible deformity of the knee. This symptom appears in later stages. Initially, the knee appears swollen or swollen.
  3. Accumulation of joint fluid in the joint cavity or Baker's cyst. It is a dense growth on the back wall of the knee joint.
  4. Cracked joints. In the second and third stages of the disease, sharp crackling sounds accompanied by pain are observed in patients.
  5. Inflammatory reactions in the articular synovium, causing the cartilage to swell and increase in volume.
  6. Decreased joint mobility. seen in later stages. Bending the knee becomes almost impossible and is accompanied by severe pain. In the last stage, complete immobilization of the knee is possible. Human movement becomes difficult or completely impossible (some patients move on bent legs).

Diagnosis of knee osteoarthritis

If obvious or slight symptoms of arthrosis of the knee joint appear, it is better to immediately consult an orthopedist or a rheumatologist. Diagnosis most often involves taking a patient's history and analyzing their general health. For a more accurate conclusion, an X-ray examination or MRI of the knee is also used. The patient also receives a referral for laboratory tests - general analysis of blood and urine. Based on the received data, the doctor makes a conclusion and prescribes the necessary treatment.

Treatment of arthrosis of the knee joint

Treatment of arthrosis of the knee joint should be comprehensive. To date, there is no medical drug that relieves this disease. One of the important conditions for successful treatment is timely diagnosis. The earlier the treatment of knee arthrosis begins, the more likely it is to prolong the remission period and prevent the destruction and deformation of cartilage and bone tissues.

During the treatment, the doctor and the patient face several tasks:

  1. elimination or reduction of pain;
  2. establishing the supply of nutrients to the knee joint and thereby increasing its regenerative function;
  3. activation of blood circulation in the area of the knee joint;
  4. strengthening of the muscles around the joint;
  5. increasing joint mobility;
  6. Try to increase the distance between the articulated bones.

Treatment of the disease, depending on the stage of its development, can be conservative and operative.

Conservative treatment of arthrosis of the knee joint

Anti-inflammatory pain relievers

To relieve or reduce the pain, the patient is usually prescribed a course of non-steroidal anti-inflammatory drugs (NSAIDs). It can be tablets, ointments and injections. The most common painkillers can be used in two ways - inside or locally.

Usually, patients prefer local treatment in the form of gels, ointments, and heating patches. The effect of these painkillers does not come immediately, but after a few days (about 3-4 days). The maximum effect is achieved after a week of regular use of the drug. Such drugs do not treat the disease as such, but only relieve the pain syndrome, since it is impossible to start the treatment of pain.

Painkillers should be taken strictly according to the doctor's prescription, they should be used only in case of severe pain, because their long-term and frequent use can cause side effects and even accelerate the destruction of cartilage tissue of the joint. In addition, long-term use of these drugs increases the risk of side effects, including stomach ulcers, duodenal ulcers, liver and kidney dysfunction, and allergic manifestations in the form of dermatitis.

Given the limited range of use, NSAIDs are prescribed with great caution, especially in elderly patients. The average course of taking NSAIDs is about fourteen days. As an alternative to non-steroids, doctors sometimes suggest selective medications. They are usually prescribed for long-term use over a period of several weeks to several years. They do not cause complications and do not affect the structure of the cartilage tissue of the knee joint.

hormones

Sometimes, in the treatment of arthrosis of the knee joint, a course of taking hormonal drugs is prescribed. They are prescribed if non-steroidal anti-inflammatory drugs are already ineffective and the disease itself begins to progress. Most often, hormonal drugs are used in the form of injections to treat this disease.

The course of treatment with hormonal drugs is usually short-term and is prescribed during severe exacerbations, when inflammatory fluid accumulates in the joint. The hormone is injected into the joint about once every ten days.

Chondroprotectors

At the initial stage of the disease, glucosamine and chondroitin sulfate, e. g. yearIt is the most effective treatment for osteoarthritis. They have almost no contraindications and side effects occur in rare cases.

Glucosamine stimulates cartilage restoration, improves metabolism, protects cartilage tissue from further destruction, provides it with normal nutrition. Chondroitin sulfate neutralizes enzymes that destroy cartilage tissue, stimulates the production of collagen protein, helps to saturate the cartilage with water, and also helps to keep it inside. Chondroprotectors are not effective in the last stages of the disease, since the cartilage tissue is practically destroyed and cannot be restored. The daily dose of glucosamine is 1500 milligrams, chondroitin sulfate is 1000 milligrams. Taking these drugs should be strictly systematic in order to achieve the desired result. The course of treatment should be repeated 2-3 times a year. Both tools should be used in combination.

Glucosamine is available in pharmacies in the form of injections, powder, capsules, gel; Chondroitin - in ampoules, tablets, ointments, gels. There are also combined drugs that include both chondroprotectors. There are also so-called third-generation chondroprotectors, which combine chondroprotector and one of the non-steroidal agents.

Vasodilator drugs

Vasodilators are prescribed to relieve spasm of small blood vessels, improve blood circulation and supply nutrients to the knee joint area, as well as to eliminate vascular pain. They are used together with chondroprotectors. If knee arthrosis is not accompanied by fluid accumulation, it is also recommended to use warming ointments, gels, liquids.

Hyaluronic acid

Another name for this drug is intra-articular fluid prosthesis. The composition of hyaluronic acid is very similar to the composition of synovial fluid. When the drug is injected into the joint, it forms a membrane that prevents the cartilage from moving against each other. A course of treatment with hyaluronic acid is prescribed only after the removal of pain and elimination of exacerbations.

Physiotherapy

A course of exercise therapy can be very useful and bring good results only under the prescription and supervision of a doctor, with the recommendation of a specialist or trainer. Self-medication is dangerous for health. Exercise therapy is used as a further prevention of the destruction of cartilage tissue, slowing down the development of stiffness, relaxing muscle spasms that cause pain. During exacerbation, exercise therapy is contraindicated. A course of special individual exercises, which takes into account not only the stage of the disease and the condition of the cartilage, but also the age of the patient, should be developed by a competent specialist in this field.

Physiotherapy

Physiotherapy - electrophoresis, laser therapy, acupuncture, diadynamic currents, UHF is used as one of the methods of conservative therapy. A local massage course also gives positive results. Compresses based on dimethyl sulfoxide or bishofit, medical bile, are widely used. Physiotherapy methods work in several directions - relieve pain, reduce inflammation, normalize metabolism inside the joint and restore its normal functions. The method and duration of the course of physiotherapy treatment is determined by the patient's anamnesis and is prescribed only after a thorough diagnosis and study of the condition of the joints.

The patient needs to strictly control his diet, because excess weight puts additional stress on the knee joint and accelerates the progression of the disease. Excessive physical activity is dangerous, they should be avoided, but at the same time, exercise therapy is simply necessary. Orthopedists recommend wearing comfortable shoes with special soles, using a cane to facilitate movement. There are many techniques developed by specialists in rheumatology and orthopedics to treat osteoarthritis of the knee.

Pain-relieving physiotherapy includes:

  1. Medium wave ultraviolet radiation (SUV radiation). The contact of ultraviolet radiation with the skin of the knee lasts until a slight redness. Substances are produced in the tissues that reduce the sensitivity of nerve fibers, due to which the pain-relieving effect is achieved. The duration of the treatment course is determined by the doctor depending on the symptoms, frequency and intensity of the pain. On average, the course of treatment is about 7-8 sessions.
  2. Local magnetotherapy aimed at general recovery of the patient's body. This procedure relieves inflammation, relieves pain, neutralizes muscle spasm. It is effectively used in the initial stages of arthrosis of the knee joint. The course of treatment is usually limited to 20-25 procedures, each of which lasts about half an hour.
  3. Infrared laser therapy, low intensity UHF therapy, centimeter wave therapy (CMW therapy).
  4. Ultrasound, darsonvalization, therapeutic baths, interference therapy prescribed to improve blood circulation in the joint.

Treatment at a sanitary resort is equally important. Such treatment is prescribed for deformed and dystrophic osteoarthritis. Such treatment, as well as the previously listed, has its contraindications, so the attending physician carefully studies the patient's history before recommending the sanitary-spa method.

Surgical treatment of arthrosis of the knee joint

This is a radical method of treating arthrosis of the knee joint, which partially or completely restores the function of the joint. Methods and forms of surgical intervention depend on the degree of joint damage, as well as the patient's history.

Late arthrosis of the knee joint is treated only surgically - the knee joint is completely or partially replaced with an endoprosthesis. Surgical treatment allows not only to improve well-being, but also to restore the patient's ability to work in the last stages of knee arthrosis. A significant disadvantage of the operation, many consider a long recovery period using exercise therapy, mechanotherapy and other means.

There are several types of knee osteoarthritis surgery:

  1. Arthrodesis of the joint. The principle of the operation is to fix the lower limb in the most functional position and immobilize it in the area of the knee joint. The damaged cartilage is completely removed. This is a radical method used in extreme cases. The result is the elimination of pain, but the patient becomes viable.
  2. Arthroscopic debridement. This method of surgical intervention has a temporary but long-lasting effect. It is used mainly in the second stage of disease development. During the operation, the damaged parts of the cartilage tissue are removed, thus relieving the pain. After the operation, the effectiveness is maintained for two to three years.
  3. Endoprosthesis. The most popular treatment for this disease. The knee joint is completely or partially removed. And in its place is an endoprosthesis made of ceramic, metal or plastic. As a result, the patient recovers motor activity, eliminates pain. The effectiveness of the operation is maintained for more than fifteen to twenty years.

recovery period

After such an operation, the rehabilitation period lasts about three months. The goal of rehabilitation is:

  1. Restoration of motor activity.
  2. Improving the functioning of muscles and joints.
  3. protection of the prosthesis.

The drain is removed on the second or third day after surgery. To eliminate pain, special drugs with a cooling effect are used. Motor activity is recommended to begin as soon as the drain is removed. A week later, the patient was transferred to a rehabilitation center. The physiotherapist monitors the patient's condition.

For some time after the operation (about a year), the patient still experiences pain, this is caused by the implantation of the prosthesis. The older the patient, the longer the prosthesis implantation process. Nonsteroidal anti-inflammatory drugs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that provide a stable effect.

A course of exercise therapy is mandatory. Classes should be developed individually for each patient and strictly conducted every day. Physical activity is gradually increased to prevent injury.

After being discharged from the clinic, the patient must follow certain guidelines regarding further lifestyle. Physical activities such as dancing or yoga are allowed six months after surgery. Loads that can damage the prosthesis (fast running, jumping, power sports) are strictly prohibited. After the operation, it is not recommended to lift more than twenty five kilograms. In the house where the patient will live, it is necessary to strengthen all the railings of the stairs, equip the shower room with a railing, and carefully check all the chairs and other furniture for serviceability. By following these simple recommendations, the prosthesis will last a long time.

Despite the recommendations and compliance with the prescription, postoperative arthrosis of the knee joint is most often observed after such surgical interventions (after about 2-3 years).

Prevention of arthrosis of the knee joint

To prevent this disease, people at risk (athletes, elderly, overweight, employees of enterprises) should follow certain requirements:

  1. Proper nutrition and weight loss. It is necessary to exclude harmful foods from the diet - fatty, fried, alcohol, but it is better to consult a nutritionist who will individually help you choose the right diet.
  2. When playing sports, monitor the load on the joints, reduce it if necessary.
  3. Monitor your health and treat infectious diseases in time to prevent them from becoming chronic.
  4. Timely and adequate treatment of spine diseases, if any, development of correct posture.
  5. Sports activities (cycling, swimming, walking, special joint gymnastics exercises).
  6. No self-medication! At the first symptoms of arthrosis of the knee joint, contact the clinic.
  7. Avoid stress, sleep well.
  8. Systematically increase your immunity (strengthen it or take a course of vitamins 2-3 times a year).
  9. Avoid hypothermia of the body, especially the lower extremities.

A healthy lifestyle and timely treatment is the best way to prevent arthrosis of the knee joints.