Arthrosis of the knee joint

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 osteoarthritis of the knee joint does not have an unambiguous scheme or a single drug that can help everyone who suffers from this problem in the same way. Since osteoarthritis is a disease of a progressive nature, it is most often seen in overweight women, venous disease and the elderly. 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 adequate treatment, since ignoring this problem can lead to the permanent destruction of cartilage and bone exposure and, as a consequence, to the disability of a person.

There are three stages of the disease:

1. The initial stage of knee osteoarthritis is characterized by the loss of shock-absorbing properties, and as a result, the cartilages rub against each other during movement, which causes severe discomfort to the patient. The cartilage becomes rough, deformed, dry, in the advanced stages of the disease, even covered with cracks.
2. Due to decreased 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 stiff movements. There is also a change in the density of the joint fluid (it becomes thicker, more viscous), circulatory disorders, impaired nutrient supply 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 goes to 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 lead to the disability of a person.

In most cases, arthrosis or gonarthrosis develops after an injury or bruise, while a person feels constant severe pain in the knee, which significantly hampers 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, contusions, fractures. When an injured knee is treated, the joint becomes fixed and the person cannot bend and unbend the leg for a period of time. This leads to impaired blood circulation, which in most cases provokes the development of post-traumatic gonarthrosis.
3. Removal of the meniscus.
4. Excess physical activity that does not correspond to a person's age, leading to injuries or microtrauma, as well as hypothermia of the joints. For example, running on asphalt or doing squats is not recommended for older people, since during these exercises there is 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 to 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 causes the destruction of the cartilaginous 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. Flatfoot. The wrong structure of the foot changes the center of gravity and the load on the joint increases.
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. The pain 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 progresses to a more aggressive stage.
2. Visible knee deformity. This symptom appears in the later stages. At first, the knee appears 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. Cracks in the joints. Sharp crunches, which are accompanied by pain, are observed in patients in the second and third stages of the development of the disease.
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 severe pain. In the last stage, the knee can be completely immobilized. The movement of a person becomes difficult or completely impossible (some patients move with bent legs).

Diagnosis of osteoarthritis of the knees

If obvious or minor symptoms of osteoarthritis of the knee joint appear, it is better to immediately contact an orthopedist or rheumatologist. Diagnosis usually consists of taking the patient's history and analyzing her general health. For a more accurate conclusion, they also resort to X-ray or MRI examination 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 osteoarthritis of the knee joint.

Treatment of osteoarthritis 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 timely diagnosis. The sooner treatment for knee osteoarthritis is started, the more likely it is to prolong the remission period and prevent destruction and deformation of cartilage and bone tissues.

During treatment, the doctor and the patient are faced with several tasks:

1. Eliminate or reduce pain;
2. To establish the supply of nutrients to the knee joint and thus increase its reparative function;
3. Activates blood circulation in the area of the knee joint;
4. Strengthen the muscles around the joint;
5. Increase joint mobility;
6. Strive to increase the distance between the articulating bones.

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

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 nonsteroidal 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, heating 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 drugs do not treat the disease as such, but only relieve pain syndrome, since it is impossible to start pain treatment.

Analgesics 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. Also, 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.

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 nonsteroidals, 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 cartilage 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 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, protects cartilage tissue from further destruction and provides 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 keep it in. The effectiveness of chondroprotectors is absent in the later 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 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 the 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 nutrient supply to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. They are used together with chondroprotectors. If knee osteoarthritis is not accompanied by fluid accumulation, it is also recommended to use warm ointments, gels and 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 cartilage from rubbing against each other during movement. The course of treatment with hyaluronic acid is prescribed only after the elimination of pain and the elimination of exacerbation.

Physiotherapy

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

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. Compresses based on dimethyl sulfoxide or bischofite, medical bile are widely used. Physiotherapeutic methods act in several directions: they relieve pain, reduce inflammation, normalize the metabolism inside the joint, restore its usual functions. The method and duration of the course of physiotherapy treatment are determined by the patient's history and are prescribed only after a thorough diagnosis and study of the state of the joints.

The patient must strictly monitor his diet, since excess weight puts additional pressure 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 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 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 numb 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 about 7-8 sessions.
2. Local magnetotherapy aimed at the general recovery of the patient's body. This procedure relieves inflammation, eliminates pain, 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 the sanitary-resort treatment. 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 arthrosis of the knee joint, which partially or completely restores the function of the joint. The methods and forms of surgical intervention depend on the degree of joint damage, as well as the patient's history.

Late osteoarthritis 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 working capacity 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 him and to 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 is 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, the damaged parts of the cartilage tissue are removed, thereby eliminating pain. Efficiency after operation is maintained for two to three years.
3. endoprosthesisThe most popular treatment for this disease. The knee joint is completely or partially removed. And instead there is a stent 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 lasts about three months. The goal of rehabilitation is:

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

The drain is removed on the second or third day after the operation. Special preparations with a cooling effect are used to eliminate pain. It is recommended to start motor activity immediately after removing the drain. 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 grafting of the prosthesis. The older the patient, the longer the grafting process of the prosthesis. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

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

After discharge from the clinic, the patient must comply with certain instructions regarding the subsequent way of life. Physical activities such as dancing or yoga are allowed six months after the operation. Loads that could damage the prosthesis (fast running, jumping, strength sports) are strictly prohibited. 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 on the stairs, equip the bathroom with a handrail, carefully check all the chairs and other furniture for good repair. 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 osteoarthritis of the knee joint.

To avoid this disease, people at risk (athletes, the elderly, overweight people, company employees) must meet 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, sleep well.
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 of the lower extremities.

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