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Arthrosis of the knee joint

Arthrosis of the knee joint (gonarthrosis, deforming osteoarthritis)

Osteoarthritis of the knee joint is a disease of the musculoskeletal system, which consists in 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, deforming osteoarthritis. The treatment of arthrosis of the knee joint does not have an unambiguous scheme or a single medicine that could help everyone who suffers from this problem in the same way. Since arthrosis is a disease with a progressive nature, it is observed more often in overweight women, venous disease, and the elderly. Treatment is made and appointed 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 resort to adequate treatment, since ignoring this problem can lead to the final destruction of cartilage and bone exposure and, as a result, disability of a 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, causing severe discomfort to the patient. The cartilage becomes rough, deformed, dries up, in the advanced stages of the disease - even covered with cracks.
  2. Due to the decrease in depreciation, bone deformation begins, which leads to the formation of osteophytes (growths on the surface of the bones) - this is the second stage of the disease. The synovial membrane of the joint and the capsule also undergo deformation, the knee joint gradually atrophies due to stiffness of movements. There is also a change in the density of the joint fluid (it becomes thicker, viscous), circulatory disorders, deterioration in the supply of nutrients to the knee joint. The thinning of the lining between the cartilaginous joints reduces the distance between the articulating bones.
  3. The disease progresses rapidly and quickly passes 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, leading to a person's disability.

Most often, arthrosis or gonarthrosis develops after an injury or bruise, while a person feels constant severe pain in the knee, which significantly hinders his movements.

Reasons for the development of arthrosis

Osteoarthritis of the knee joint, the treatment of which takes quite a long time, can manifest itself 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 unbend the leg for a certain time. This leads to a deterioration in blood circulation, which most often provokes the development of post-traumatic gonarthrosis.
  3. Removal of the meniscus.
  4. Excessive physical activity that does not correspond to the age of a person, leading to injuries or microtrauma, as well as hypothermia of the joints. For example, running on asphalt or squats is not recommended for older people, since during these exercises there is a significant pressure on the knee joint, which wears out with age and is not able to withstand such loads.
  5. Overweight and obesity. This factor leads to damage to the menisci, injuries of which provoke 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 provokes the destruction of the cartilaginous tissue of the knee, which leads to arthrosis 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 wrong structure of the foot shifts 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 occurs suddenly, depending on the physical load on the knee joint. Pain sensations can be of a different nature. At the initial stage, these are weak backaches, to which a person usually does not pay much attention. Periodic mild pain can be observed for months, and sometimes for years, until the disease moves into a more aggressive stage.
  2. Visible deformity of the knee. This symptom appears in the later stages. At first, the knee looks swollen or swollen.
  3. Accumulation of joint fluid in the joint cavity or Baker's cyst. This is a dense formation on the back wall of the knee joint.
  4. Cracking joints. Sharp crackling sounds, which are accompanied by pain, are observed in patients at the second and third stages of the development of the disease.
  5. Inflammatory reactions in the articular synovium, due to which the cartilage swells and increases 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, the knee may be completely immobilized. The movement of a person becomes difficult or completely impossible (some patients move on bent legs).

Diagnosis of osteoarthritis of the knees

If obvious or minor symptoms of arthrosis of the knee joint appear, it is better to immediately contact an orthopedist or rheumatologist. Diagnosis most often consists of taking a patient's history and analyzing their general health. For a more accurate conclusion, they also resort to X-ray examination or MRI of the knee. The patient also receives a referral for laboratory tests - a general blood and urine test. Based on the data obtained, 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 disorder. One of the most important conditions for successful treatment is a timely diagnosis. The earlier the treatment of knee arthrosis is started, the more likely it is to prolong the period of remission and prevent the destruction and deformation of cartilage and bone tissues.

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

  1. Eliminate or reduce pain;
  2. To establish the supply of nutrients to the knee joint and thereby increase its restorative function;
  3. Activate blood circulation in the knee joint area;
  4. Strengthen the muscles around the joint;
  5. Increase joint mobility;
  6. Strive 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

Pain-relieving anti-inflammatory drugs

To relieve or reduce 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 pain medications can be used in two ways - inside or locally.

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

Painkillers should be taken strictly according to the doctor's prescription, they should be used only for severe pain, since their prolonged and frequent use can lead to side effects and even accelerate the destruction of the cartilage tissue of the joint. In addition, with prolonged use of these drugs, the risk of adverse reactions increases, including stomach ulcers, duodenal ulcers, impaired normal functioning of the liver, kidneys, and allergic manifestations in the form of dermatitis are also possible.

Given the limited spectrum of use, NSAIDs are prescribed with great caution, especially in elderly patients. The average course of taking NSAIDs is approximately fourteen days. As an alternative to non-steroids, doctors sometimes offer selective drugs. They are usually prescribed for long-term use for a period of several weeks to several years. They do not cause complications and do not affect the structure of the cartilaginous 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 NSAIDs are already becoming ineffective, and the disease itself begins to progress. Most often, hormonal drugs for the treatment of this disease are used in the form of injections.

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

Chondroprotectors

To restore and nourish cartilage tissue in the initial stages of the disease, a course of glucosamine and chondroitin sulfate, the so-called chondroprotectors, is prescribed. It is by far the most effective treatment for osteoarthritis. They have almost no contraindications, and side effects appear in rare cases.

Glucosamine stimulates the restoration of cartilage, improves metabolism, protecting cartilage tissue from further destruction, providing it with normal nutrition. Chondroitin sulfate neutralizes enzymes that destroy cartilage tissue, stimulates the production of collagen protein, helps saturate cartilage with water, and also helps to keep it inside. The effectiveness of chondroprotectors is absent 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. The intake of these drugs must be strictly systematic in order to achieve the desired result. The course of treatment should be repeated 2-3 times a year. Both tools must be used in combination.

In pharmacies, glucosamine is presented in the form of injections, powder, capsules, gel; chondroitin - in ampoules, tablets, ointments, gels. There are also combined preparations that include both chondroprotectors. There are also so-called third-generation chondroprotectors, which combine a chondroprotector and one of the NSAIDs.

Vasodilator drugs

To relieve spasm of small vessels, improve blood circulation and delivery of nutrients to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. 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

The second name of this drug is intra-articular fluid prosthesis. The composition of hyaluronic acid is very similar to the composition of intraarticular fluid. When the drug is injected into the joint, it forms a film that prevents the cartilage from rubbing against each other during movement. The course of treatment with hyaluronic acid is prescribed only after the removal of pain and elimination of exacerbation.

Physiotherapy

A course of exercise therapy can be very useful and bring good results only when prescribed by a doctor and carried out under supervision, on the recommendations of a specialist or trainer. Self-medication is dangerous to health. Exercise therapy is used as a further prevention of the destruction of cartilaginous tissue, slowing down the development of stiffness, relaxing muscle spasm that causes pain. During the exacerbation of exercise therapy is contraindicated. A course of special individual exercises that take 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 specialist competent in this field.

Physiotherapy

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

The patient needs to strictly control his diet, as 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 insoles, using a cane to facilitate movement. There are many techniques developed by specialists in the field of rheumatology and orthopedics for the treatment of osteoarthritis of the knee.

Pain relief physical therapy includes:

  1. Medium wave ultraviolet irradiation (SUV irradiation). Contact of ultraviolet radiation with the skin of the knee continues until a slight reddening appears. Substances are formed in the tissues that dull the sensitivity of nerve fibers, due to which an analgesic effect is achieved. The duration of the course of treatment is prescribed by the doctor depending on the symptoms, frequency and strength of pain. On average, the course of treatment is approximately 7-8 sessions.
  2. Local magnetotherapy aimed at the general recovery of the patient's body. This procedure relieves inflammation, eliminates pain, and neutralizes muscle spasms. Effectively used for arthrosis of the knee joint in the initial stages. 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, which is prescribed to improve blood circulation in the joint.

Equally important is sanitary-resort treatment. Such treatment is prescribed for deforming and dystrophic osteoarthritis. Such treatment, as well as those listed earlier, has its own contraindications, so the attending physician carefully studies the patient's history before recommending a sanitary-resort method to him.

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 functioning of the joint. Methods and forms of surgical intervention depend on the degree of joint damage, as well as on 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 with the use of exercise therapy, mechanotherapy and other means.

There are several types of surgery for osteoarthritis of the knee joint:

  1. Arthrodesis of the joint. The principle of the operation is to fix the lower limb in the most functional position for it and immobilize it in the area of the knee joint. 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 disabled for life.
  2. Arthroscopic debridement. This method of surgical intervention has a temporary but lasting effect. It is used mainly in the second stage of the development of the disease. During the operation, damaged parts of the cartilage tissue are removed, thereby eliminating pain. Efficiency after the operation is maintained for two to three years.
  3. Endoprosthetics. The most popular treatment for this disease. The knee joint is removed completely or partially. And in its place is an endoprosthesis made of ceramic, metal or plastic. As a result, the patient restores motor activity, eliminates pain. The effectiveness of the operation has been maintained for more than fifteen to twenty years.

Recovery period

The rehabilitation period after such an operation takes about three months. The purpose of rehabilitation is:

  1. Recovery of motor activity.
  2. Improving the functioning of muscles and joints.
  3. Providing protection to the prosthesis.

The drainage is removed on the second or third day after the operation. Special preparations with a cooling effect are used to eliminate pain. Motor activity is recommended to begin immediately after removal of the drainage. A week later, the patient is 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 due to the engraftment of the prosthesis. The older the patient, the longer the process of engraftment of the prosthesis. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

A mandatory item is the course of exercise therapy. Classes should be designed individually for each patient and performed strictly every day. Physical activity increases gradually to avoid injury.

After discharge from the clinic, the patient must comply with certain instructions regarding the further way of life. Physical activities like dancing or yoga are allowed six months after the operation. Loads that can damage the prosthesis are strictly prohibited (fast running, jumping, power sports). After the operation, it is not recommended to lift weights of more than twenty-five kilograms. In the house where the patient will live, it is necessary to strengthen all the handrails of the stairs, equip the shower room with a handrail, carefully check all chairs and other furniture for serviceability. By following these simple recommendations, the prosthesis will last a long time.

Despite compliance with the recommendations and prescriptions, 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

In order to avoid this disease, people at risk (athletes, the elderly, people who are overweight, employees of enterprises) must comply with some requirements:

  1. Proper nutrition and weight loss. It is necessary to exclude harmful foods from your 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, if necessary, reduce it.
  3. Monitor your health and treat infectious diseases in time, preventing them from becoming chronic.
  4. Timely and adequate treatment of diseases of the spine, if any, the development of correct posture.
  5. Sports activities (cycling, swimming, walking, special gymnastic exercises for the joints).
  6. No self-treatment! At the first symptoms of arthrosis of the knee joint, contact the clinic.
  7. Avoid stress, have a good sleep.
  8. Systematically increase your immunity (harden or at least 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 are the best means of preventing arthrosis of the knee joints.