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Osteoarthritis of the knee joint

Osteoarthritis of the knee joint (gonarthrosis, osteoarthritis deformans)

Osteoarthritis of the knee joint is a disease of the musculoskeletal system, which consists of the deformation and destruction of the cartilage tissue of the joint, as a result of which the structure and functions of cartilage are disturbed. The disease has several names - gonarthrosis, osteoarthritis deformans. The treatment of osteoarthritis of the knee joint does not have an unambiguous scheme or a single drug that can help all who suffer from this problem in the same way. As arthrosis is a disease of a progressive nature, it is more frequently observed in overweight women, venous diseases and the elderly. The treatment is produced and prescribed individually for each patient.

Osteoarthritis of the knee joint can be unilateral or bilateral (depending on whether the disease develops in one or both legs). At the first symptoms, it is necessary to resort to the appropriate treatment, since ignoring this problem can lead to the final destruction of cartilage and bone exposure and, consequently, to the 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 cartilages rub against each other during movement, causing great discomfort to the patient. Cartilage becomes rough, deformed, dry, 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 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 rigidity of movements. There is also a change in joint fluid density (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 virtually unable to move due to constant knee pain. Global and irreversible changes occur in the cartilage tissue, leading to a person's disability.

Most often, osteoarthritis or gonarthrosis develops after an injury or hematoma, while a person experiences constant pain in the knee, which significantly hinders their movements.

Reasons for the development of osteoarthritis

Osteoarthritis of the knee joint, the treatment of which takes a long time, can manifest itself due to these factors:

  1. genetic predisposition.
  2. Injuries: dislocations, bruises, fractures. When treating an injured knee, the joint is fixed and the person cannot bend and release the leg for a certain amount of time. This leads to a deterioration of blood circulation, which most often causes the development of post-traumatic gonarthrosis.
  3. Meniscus removal.
  4. Excessive physical activity that does not match a person's age, leading to injuries or microtraumas, as well as hypothermia of the joints. For example, running on asphalt or squatting is not recommended for the elderly, as during these exercises there is significant pressure on the knee joint, which wears out with age and is not able to withstand these loads.
  5. Overweight and obesity. This factor leads to damage to the menisci, injuries that cause the development of osteoarthritis 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 causes 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 foot. The wrong foot structure 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. The pain can be of another nature. In the initial stage, it is weak back pain, to which a person usually does not pay much attention. Periodic mild pain may be observed for months and sometimes for years, until the disease moves to a more aggressive stage.
  2. Visible knee deformity. This symptom appears in later stages. At first, the knee feels swollen or swollen.
  3. Accumulation of joint fluid in the joint cavity or Baker's cyst. This is a dense formation on the posterior wall of the knee joint.
  4. Cracks in the joints. Acute crackling sounds, accompanied by pain, are seen in patients in the second and third stages of disease development.
  5. Inflammatory reactions in the joint 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 intense pain. In the last step, the knee can be completely immobilized. A person's movement becomes difficult or completely impossible (some patients move with their legs bent).

Diagnosis of knee osteoarthritis

If obvious or minor symptoms of osteoarthritis of the knee joint appear, it is best to immediately contact an orthopedist or rheumatologist. Diagnosis usually consists of taking a patient's history and analyzing their general health. For a more accurate conclusion, they also resort to X-ray or MRI scan of the knee. The patient is also referred for laboratory tests - general blood and urine tests. Based on the data obtained, the doctor makes a conclusion and prescribes the necessary treatment.

Treatment of osteoarthritis of the knee joint

The treatment of osteoarthritis of the knee joint must be comprehensive. To date, there is no medication that alleviates this disorder. One of the most important conditions for successful treatment is timely diagnosis. The earlier the treatment of osteoarthritis of the knee 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 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. Make an effort to increase the distance between the jointed bones.

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

Conservative treatment of osteoarthritis of the knee joint

Anti-inflammatory drugs that relieve pain

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

Typically, patients prefer topical treatment in the form of gels, ointments, heating patches. The effect of these pain relievers does not occur immediately, but after a few days (approximately 3-4 days). The maximum effect is achieved after a week of regular use of the drug. These drugs do not treat the disease as such, but only relieve the pain syndrome, as it is impossible to start treating the pain.

Analgesics should be taken strictly according to the doctor's prescription, they should only be used for severe pain, as 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, impairment of the normal functioning of the liver, kidneys 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 approximately fourteen days. As an alternative to non-steroids, doctors sometimes offer 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 cartilaginous tissue of the knee joint.

hormones

Sometimes, in the treatment of arthrosis of the knee joint, a course of 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 early stages of the disease, a course of glucosamine and chondroitin sulfate, 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 cartilage restoration, improves metabolism, protecting cartilage tissue from further destruction, providing you with normal nutrition. Chondroitin sulfate neutralizes the enzymes that destroy cartilage tissue, stimulates collagen protein production, helps saturate cartilage with water, and also helps keep it inside. The effectiveness of chondroprotectors is absent in the later stages of the disease, as 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 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 small vessel spasm, improve blood circulation and the supply of nutrients to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. They are used in conjunction with chondroprotectors. If knee arthrosis is not accompanied by fluid accumulation, then it is also recommended to use warming ointments, gels, liquids.

Hyaluronic acid

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

Physiotherapy

A course of exercise therapy can be very helpful and bring good results only when prescribed by a physician and carried out under supervision, under the recommendations of a specialist or trainer. Self-medication is dangerous to health. Exercise therapy is used as an additional prevention of cartilage tissue destruction, delaying the development of stiffness, relaxing muscle spasm that causes pain. During 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 competent specialist in this field.

Physiotherapy

As one of the methods of conservative therapy, physiotherapy is used - electrophoresis, laser therapy, acupuncture, diadynamic currents, UHF. A local massage course also gives positive results. Dimethylsulfoxide or bischofite-based medical bile compresses are widely used. Physiotherapeutic methods work in several directions - they relieve pain, reduce inflammation, normalize metabolism within the joint and restore its usual functions. The method and duration of physical therapy treatment are determined by the patient's history and are 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 a strain on the knee joint and accelerates the progression of the disease. Excessive physical activity is dangerous, it should be avoided, but at the same time, exercise therapy is simply necessary. Orthopedists recommend the use of 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 knee osteoarthritis.

Physical therapy for pain relief includes:

  1. Medium-wave ultraviolet irradiation (SUV irradiation). The contact of ultraviolet radiation with the skin of the knee continues until a slight redness 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 intensity of pain. On average, the course of treatment is approximately 7-8 sessions.
  2. Local magnetotherapy aiming at the general recovery of the patient's body. This procedure relieves inflammation, eliminates pain, counteracts muscle spasms. Effectively used for osteoarthritis of the knee joint in the early stages. The course of treatment is usually limited to 20 to 25 procedures, each lasting 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 the treatment of health resorts. Such treatment is prescribed for deforming and dystrophic osteoarthritis. Such treatment, as well as those listed above, has its own contraindications, so the attending physician carefully studies the patient's history before recommending a method of sanitary recourse.

Surgical treatment of osteoarthritis of the knee joint

This is a radical method of treating osteoarthritis of the knee joint, which partially or completely restores joint function. The 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 replaced in whole or in part with an endoprosthesis. Surgical treatment allows not only to improve well-being, but also to restore the patient's ability to work in the later 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 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 elimination of pain, but the patient is disabled for life.
  2. Arthroscopic debridement. This method of surgical intervention has a temporary but lasting effect. It is mainly used in the second stage of disease development. During the operation, damaged parts of cartilaginous tissue are removed, thus eliminating pain. Efficiency after operation is maintained for two to three years.
  3. Endoprostheses. 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 restores motor activity, eliminates pain. The effectiveness of the operation was 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. Improve the functioning of muscles and joints.
  3. Providing protection to the prosthesis.

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 drainage is removed. A week later, the patient is transferred to a rehabilitation center. The physical therapist monitors the patient's condition.

For some time after the operation (about a year), the patient still feels pain, this is due to the grafting of the prosthesis. The older the patient, the longer the prosthesis grafting process. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

A mandatory item is the exercise therapy course. Classes must be individually planned for each patient and held strictly every day. Physical activity gradually increases to avoid injury.

After discharge from the clinic, the patient must comply with certain instructions on the later way of life. Physical activities such as dancing or yoga are allowed six months after the operation. Loads that could damage the prosthesis are strictly prohibited (fast running, jumping, strength sports). After the operation, it is not recommended to lift weights greater than twenty-five kilos. In the house where the patient will live, it is necessary to strengthen all the handrails on the stairs, equip the bathroom with a handrail, carefully check all the chairs and other furniture for maintenance. By following these simple recommendations, your denture will last a long time.

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

Prevention of osteoarthritis of the knee joint

To avoid this disease, people at risk (athletes, elderly people, overweight people, company employees) must meet certain 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 proper treatment of spinal disorders, if any, the development of correct posture.
  5. Sports activities (cycling, swimming, walking, special gymnastics for the joints).
  6. No self-treatment! At the first symptoms of osteoarthritis of the knee joint, contact the clinic.
  7. Avoid stress, sleep well.
  8. Systematically boost your immunity (harden up or at least take a course of vitamins 2-3 times a year).
  9. Avoid hypothermia of the body, especially of the lower extremities.

A healthy lifestyle and timely treatment are the best means of preventing osteoarthritis of the knee joints.