Damage osteoarthritis of the knee joint (aka gonarthrosis or abbreviated DOA)- degenerative-dystrophic diseases of the knee joint, characterized by persistent chronic processes, damage to all structural elements (hyaline cartilage, periarticular bone structure, synovial membranes, capsules and ligaments of the joints) and leading to articular deformities, reduced range of motion and oftenLost the ability.
The disease begins with changes in the articular cartilage, as the surface of the articular bone slips. Lack of nutrients and loss of elasticity cause dystrophy (thinning) and its absorption, while the bone tissue of the articular surface is exposed, sliding is disrupted, the articular knee slit is narrow, the biomechanics of the joint is altered. The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and plays the role of a physiological lubricant) becomes irritated, causing an increase in its volume in the joint (synovitis). Against the background of narrowing of the joint space, joint volume decreases, synovial fluid protrudes the posterior wall of the joint capsule, and a Becker cyst is formed (which, with a large size, can cause pain in the popliteal fossa). The thin and fine tissue of the joint capsule is replaced by coarse connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growth) are formed. Blood circulation in the periarticular tissues is disrupted, metabolic products under irritating oxidation of chemoreceptors accumulate in them, and pain syndrome continues to develop. Against the background of changes in the anatomy of the joint, violations of the surrounding muscles occur, hypotrophy and spasms appear, and gait is disturbed. There is a constant limitation of movement in the joint (contracture), sometimes so obvious that only rocking movement (stiffness) or absence of movement (ankylosis) is possible.
Regarding arthrosis of the knee joint, we can say that this is a fairly common disease: it affects 10% of the entire population of the planet, and over 60 years, it affects every third person.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
- Violations of mineral metabolism in various endocrinopathy (diabetes mellitus, parathyroid gland disease, hemochromatosis).
- Muscular apparatus disease and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which include:
- overweight (literally putting pressure on the lower limbs);
- age (especially the elderly are prone to this disease);
- female sex (according to statistics, women get sick more often);
- increased sports and professional physical activity.
Symptoms of osteoarthritis of the knee joint
- Pain that increases during walking and decreases during rest.
- Habitual difficulties, physiological movements in the joints.
- A special feature of "crunch" on the joints.
- Joint enlargement and visible deformities.
Stages of gonarthrosis
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There are several stages of arthrosis:
- In the first stage, a person only experiences such symptomslittle discomfortor "heavy" in the knee, interfering when walking for long distances or increased physical activity. X-ray examination will be little information: only a slight narrowing of the joint space can be detected, there will be no other changes. At the beginning of the defeat of arthrosis of the knee joint, a person does not turn to a specialist, regardless of the symptoms that appear.
- For second stage arthrosis of the knee joint,significant pain, its severity decreases during rest. Difficulty of movement in the joints appears, when walking, the characteristic "creaking" is heard (from the patient you can hear a common expression in everyday life - "creaking knee"). During radiography, there was a clear narrowing of the joint space and a single osteophyte.
- With the transition of gonarthrosis to the third, next stage,pain symptoms will bother the patient continuously, including at rest, there is a violation of the configuration of the joint, i. e. deformity, exacerbated by edema at the time of joining the inflammation. On radiography, moderate narrowing of the joint space and various osteophytes were determined. In the third stage, many are already seeking medical help, because their quality of life is affected by pain and difficulty walking normally.
- The fourth stage of arthrosis of the knee joint is accompanied byunquenchable, exhausting pain. . . Minimal attempts to move become a difficult test for a person, joint deformities can be seen visually, walking is very difficult. Radiographs revealed significant changes: the joint space was practically undetectable in the picture, there were many coarse osteophytes, "articular rats" (collapsed bone fragments falling into the joint cavity). This stage of gonarthrosis almost always leads to deformity: often the result of the disease is the complete consolidation of the joint, its instability, and the formation of "false joints".
Who treats knee joint arthrosis?
Qualified medical treatment for gonarthrosis can be given to patients by therapists, rheumatologists and general practitioners (family physicians), but these specialists deal with the treatment of the knee joint for uncomplicated arthrosis.
When synovitis occurs or the treatment prescribed by a therapist does not give the desired effect, then one cannot do it without the help of an orthopedist. In cases where surgical treatment is required, patients with arthrosis of the knee joint are referred to specialized orthopedic and trauma departments.
How and how to treat knee joint arthrosis?
The currently known methods for treating patients with knee joint arthrosis are divided into non -medical, medical and surgical conservative.
Non -drug methods
Many patients ask themselves: "How to deal with arthrosis of the knee joint without pills? " Answering it, we must state with regret that gonarthrosis is a chronic disease, impossible to eradicate it forever. However, many non -pharmacological methods currently available (i. e. , without the use of drugs) to treat the disease can slow its progression and improve patients ’quality of life, especially when used in the early stages of the disease.
With timely visits to the doctor, and enough motivation of the patient to recover, it is sometimes enough to eliminate negative factors. For example, it has been shown that losing excess weight reduces the manifestation of the main symptoms of the disease.
Elimination of pathological physical activity and, conversely,therapeutic gymnasticswith the use of rational physical programs, they can reduce the intensity of pain. Exercises to strengthen the quadriceps femoris have been shown to be comparable to anti-inflammatory drugs.
If we are treating arthrosis of the knee joint, then it needs to be doneproper nutrition: to improve the elastic properties of articular cartilage will help products containing large amounts of animal collagen (meat and fish diet types) and cartilage components (shrimp, crab, krill), fresh vegetables and fruits saturated with vegetable collagen andantioxidants, and interest in smoked meats, marinades, preservatives, sweet and salty dishes, in turn, amplify the disruption of metabolic processes in the body and the accumulation of excess weight to obesity.
Contemplating the most effective treatment for knee arthrosis, keep in mind such effective treatment and prophylaxis methodsorthotic: installing knee bandages, orthoses, elastic bandages and orthopedic soles reduces and distributes the load on the joints properly, thus reducing the intensity of pain in them. The use of crutches is also recommended for effective knee joint relief. It should be in the hand opposite the affected limb.
Comprehensive treatment of arthrosis of the knee joint also shows very effective indications, even with more advanced forms of the diseasephysiotherapy. . . With its widespread use in various categories of patients suffering from arthrosis in any degree, it has proven its effectivenessmagnetotherapy: after several procedures, the intensity of pain decreases, as a result of increased blood circulation, reduction of edema and elimination of muscle spasms, joint mobility increases. The effect of magnetotherapy is very pronounced with the development of active inflammation in the joints: the severity of edema is significantly reduced, the symptoms of synovitis decrease. Not so popular, but no less effective in treating the knee joint for arthrosis, is such a method of physiotherapylaser therapyandcryotherapy(exposed to cold), which has a significant analgesic effect.
Drug treatment
In the effective treatment scheme of arthrosis of the knee joint, the following drugs are used.
Nonsteroidal anti-inflammatory drugs (NSAIDs), produced in the form for external (various gels, ointments) and systemic use (tablets, suppositories, solutions), has long proven its effectiveness in the treatment of osteoarthritis and is widely prescribed by doctors. By suppressing inflammation at an enzymatic level, they relieve joint pain and swelling, and slow the progression of the disease. With the early manifestations of the disease, local application of this drug in combination with non -drug methods (therapeutic training, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joint, pills, and sometimes NSAID injections, are essential. It should be borne in mind that prolonged intake of systemic NSAIDs can lead to the development and enlargement of ulcerative processes in the gastrointestinal tract, and, in addition, have a negative impact on kidney and liver function. Therefore, patients who have long taken NSAIDs should also be given drugs that protect the gastric mucosa, and periodically monitor the performance of laboratory internal organs.
Glucocorticosteroids (GCS)- hormone drugs with significant anti-inflammatory effect. They are recommended when NSAIDs previously prescribed to patients do not overcome the elimination of inflammatory manifestations. As a potent anti-inflammatory agent, GCS in the treatment of arthrosis has certain contraindications, as it can cause a number of significant side effects. In the systemic form with gonarthrosis, it is practically not prescribed. As a rule, for the effective treatment of arthrosis, injection of GCS into the periarticular pain point is intended, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted drug side effects. This manipulation can be performed by a rheumatologist or trauma specialist. In the presence of synovitis or rheumatoid arthritis, this drug is injected directly into the joint. With a single administration of GCS, the effect of the treatment lasts up to 1 month. In line with national guidelines for the treatment of osteoarthritis, do not do more than three injections of the drug per year on the same joint.
With advanced and "neglected" osteoarthritis, when a person experiences unbearable pain that does not subside even at rest, interferes with normal sleep, and is not removed by NSAID, GCS and non -drug methods, it is possible to be prescribedopioid painkillers. . . The drug is used only with a doctor's prescription, who considers the appropriateness of their appointment in each case.
Chondroprotectors(literally translated as "protecting cartilage"). The name is understood as a variety of drugs, which are united by one property - the action of changing the structure, namely the ability to slow down degenerative changes in cartilage and narrowing of the joint space. They are produced in good shape for oral administration and for insertion into the joint cavity. Of course, these drugs do not work wonders and do not "grow" new cartilage, but can stop its destruction. To achieve a lasting effect, they must be used for a long period of time, with a regular course several times a year.
Surgical treatment of knee joint arthrosis
There are often cases where, despite sufficient complex treatment, the disease persists, further lowering the quality of human life. In such a situation, the patient begins to ask the question: "what to do if the prescribed medication does not help with knee joint arthrosis? " "Is surgical treatment indicated for knee arthrosis? " Answering these questions, it should be clarified that the indication for surgical treatmentosteoarthritis of the knee joint is a syndrome of intractable pain and significant joint dysfunction, which cannot be eliminated with the use of complex conservative therapy, which may be done with the latter, the fourth stage of the disease.
The most popular type of surgical treatment for third and fourth degree arthrosis isendoprosthetics, i. e. release your own joints with the simultaneous installation of replacement metal, the design of which is similar to the anatomy of the human knee joint. In this case, the prerequisites for surgical treatment of this type are: the absence of gross defects in the joints, "false joints" formed, muscle contraction and severe muscle atrophy. If there is severe osteoporosis (significant decrease in bone mineral density), endoprosthetics are also not indicated: bone "sugar" will not withstand the introduction of metal pins, and rapid resorption (reabsorption) of bone tissue will begin at its installation, pathological fractures may occur. Therefore, a timely decision on the need to install an endoprosthesis seems to be very important - it should be taken when the age and general condition of the human body still allows the operation to be performed. According to the results of long -term studies, the duration of the effect of endoprosthetics in patients with advanced arthrosis, ie. the temporary duration of the absence of significant motor limits and maintaining a good quality of life is around ten years. The best results of surgical treatment are observed in people aged 45-75 years with low body weight (less than 70 kg) and a relatively high standard of living.
Although there is widespread use of knee arthroplasty, the results of such operations are often unsatisfactory, and the percentage of complications is high. This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (hip joint replacement is much easier technically). This determines the need to perform organ preservation surgery (preserving joints). These include arthromedullary bypass surgery and osteotomy correction.
Arthromedullary cracks- connection of the femoral medullary canal with the cavity of the knee joint using a shunt - a hollow metal tube. This allows the fatty bone marrow from the lower third of the femur to enter the knee joint, nourishing and lubricating the cartilage, thus significantly reducing pain.
When changing the axis of the lower limb (but with little restriction of range of motion), it is effectivecorrective osteotomy- transition of the tibia with correction of its axis, followed by mounting with plates and screws at the desired position. At the same time, two goals are achieved - biomechanical normalization due to the restoration of the limb axis, as well as the activation of blood circulation and metabolism during bone fusion.
Summarizing the above, I would like to state that the treatment of gonarthrosis is a complex social task. And even if today medicine can’t offer a cure that will get rid of it forever, or any other way to cure the disease completely, a healthy lifestyle, getting timely medical help and following a doctor’s recommendations can stop its progression.