Osteoarthritis 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, which disrupts the structure and function of the cartilage. The disease has several names - gonarthrosis, deforming arthrosis. The treatment of osteoarthritis of the knee joint does not have a clear scheme or a single drug that could help everyone who suffers from this problem in the same way. Because osteoarthritis is a progressive disease, it is more commonly seen in obese women, venous disease, 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 affects one or both legs). At the first symptoms, it is necessary to resort to adequate treatment, since ignoring this problem can lead to the definitive destruction of cartilage and bone exposure, and as a result, 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 cartilage rubs against each other during movement, causing severe discomfort to the patient. The cartilage becomes rough, deformed, dries up, in the advanced stage of the disease - even with cracks.
2. Due to the decrease in depreciation, bone deformation begins, which leads to the formation of osteophytes (growths on the bone surface) - this is the second stage of the disease. The synovial membrane of the joint and the capsule are also deformed, the knee joint gradually atrophies due to rigidity of movement. In addition, there is a change in the density of the synovial fluid (it becomes thicker, more viscous), circulatory disorders, deterioration in the supply of nutrients to the knee joint. The thinning of the lining between the cartilaginous joints decreases 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 cartilage tissue, leading to human disability.

Most often, osteoarthritis or gonarthrosis develops after an injury or bruise, while a person constantly feels severe pain in the knee, which significantly impedes its movements.

Reasons for the development of osteoarthritis

Arthrosis 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: sprains, bruises, fractures. When treating an injured knee, the joint is fixed and the person cannot bend and release the leg for a period of time. This leads to a deterioration in blood circulation, which most often provokes the development of post-traumatic osteoarthritis of the knee.
3. removal of the meniscus.
4. Excessive physical activity that does not correspond to a person's age, leading to injuries or microtraumas, as well as hypothermia of the joints. Running on asphalt or squats, for example, is not recommended for older people, since these exercises put significant pressure on the knee joint, which wears out with age and cannot withstand such loads.
5. overweight and obesity. This factor leads to damage to the menisci, violations 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 cartilage 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 foot construction shifts the center of gravity and increases the load on the joints.
10. stress and nervous tension.

Symptoms of osteoarthritis of the knee

The clinical picture of the disease has the following symptoms:

1. pain sensations. Depending on the physical strain on the knee joint, pain occurs suddenly. Pain can be of different nature. At the initial stage, these are weak back pains, which a person usually does 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 occurs in later stages. At first, the knee looks swollen or swollen.
3. Accumulation of synovial 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. In patients with the second and third stages of the development of the disease, sharp crackling sounds accompanied by pain are observed.
5. Inflammatory reactions in the joint synovium, causing the cartilage to swell and increase in volume.
6. Decreased mobility of the joints. 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. Movement of a person becomes difficult or completely impossible (some patients move on bent legs).

Diagnosis of knee osteoarthritis

If there are obvious or minor symptoms of osteoarthritis of the knee joint, it is best to contact an orthopedist or rheumatologist immediately. Diagnosis most often consists of taking a patient's medical history and analyzing their general health. For a more accurate conclusion, they also resort to an X-ray examination or an MRI of the knee. The patient is also given a referral for laboratory tests - a general blood and urine test. Based on the data obtained, the doctor draws 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 drug that alleviates this disorder. One of the most important prerequisites for successful treatment is timely diagnosis. The earlier treatment of knee osteoarthritis is started, the more likely it is that it will prolong the period of remission and prevent the destruction and deformation of cartilage and bone tissue.

During treatment, the doctor and patient face several tasks:

1. eliminate or relieve pain;
2. To establish the nutrient supply to the knee joint, thereby increasing its recovery function;
3. activate blood circulation in the knee joint area;
4. Strengthen the muscles around the joint;
5. Increase joint mobility;
6. Try to increase the distance between the joint bones.

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

Conservative treatment of osteoarthritis of the knee joint

Pain-relieving anti-inflammatory drugs

To relieve or relieve pain, the patient is usually prescribed treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). It can be tablets, ointments and injections. The most common painkillers can be used in two ways - internally or locally.

Usually, patients prefer topical treatment in the form of gels, ointments, heat patches. The effect of these painkillers does not set in immediately, but only after a few days (approx. 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 pain treatment.

Painkillers should be taken strictly according to the doctor's prescription, they should be used only in case of 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 side effects increases, including gastric ulcer, duodenal ulcer, impaired normal functioning of the liver, kidneys, and allergic manifestations in the form of dermatitis.

Given the limited scope, NSAIDs are prescribed with great caution, especially in elderly patients. The average length of time NSAIDs are taken is about 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 cartilage tissue of the knee joint.

hormones

Sometimes in the treatment of arthrosis of the knee joint, taking hormonal drugs is prescribed. They are prescribed when NSAIDs are already becoming ineffective, and the disease itself is progressing. Most often, hormonal drugs are used to treat this disease 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 every ten days.

chondroprotectors

To restore and nourish the cartilage tissue at the initial stage of the disease, a regimen 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 occur 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 the cartilage with water and also helps 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 and 1000 milligrams of chondroitin sulfate. Taking these drugs must be strictly systematic in order to achieve the desired result. The 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 combination preparations that contain both chondroprotectors. There are also so-called third-generation chondroprotectors that combine a chondroprotector and one of the NSAIDs.

vasodilator drugs

To relieve spasms 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 warming ointments, gels and liquids.

hyaluronic acid

The second name of this drug is an intra-articular liquid 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 cartilage from rubbing against each other when you move. The course of treatment with hyaluronic acid is prescribed only after eliminating the pain and eliminating the exacerbation.

physical therapy

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

physical therapy

As one of the methods of conservative therapy, physiotherapy is used - electrophoresis, laser therapy, acupuncture, diadynamic currents, UHF. Local massage also gives positive results. Compresses based on dimethyl sulfoxide or bischophite, medicinal bile, are widely used. Physiotherapeutic methods work in several directions - they relieve pain, reduce inflammation, normalize metabolism in the joint and restore its normal functions. The method and duration of physiotherapeutic treatment is determined by the patient's medical history and is prescribed only after a thorough diagnosis and examination of the condition of the joints.

The patient must strictly control his diet, since being overweight puts an additional load on the knee joint and accelerates the course 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 and using a cane to facilitate movement. There are many techniques developed by specialists in the field of rheumatology and orthopedics to treat osteoarthritis of the knee.

Physiotherapy for pain relief includes:

1. Medium wave UV exposure (SUV exposure). Contact of the ultraviolet radiation with the skin of the knee continues until slight reddening appears. Substances are formed in the tissues that dampen the sensitivity of nerve fibers, thereby providing an analgesic effect. The duration of treatment is prescribed by the doctor depending on the symptoms, frequency and severity of pain. On average, the treatment lasts about 7-8 sessions.
2. Local magnetic therapy aimed at the general recovery of the patient's body. This procedure reduces inflammation, eliminates pain and neutralizes muscle spasms. Effectively used in the early stages of arthrosis of the knee joint. The course of treatment is usually limited to 20-25 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 in the sanitary area. Such treatment is prescribed for deforming and dystrophic arthrosis. Such treatment, as well as the previously listed ones, have their own contraindications, so the attending physician carefully studies the patient's medical history before recommending a sanitation treatment method to him.

Surgical treatment of osteoarthritis of the knee joint

This is a radical method of treating arthrosis of the knee joint, partially or completely restoring 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 only treated surgically - the knee joint is completely or partially replaced by 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 is considered by many to be a long recovery period using 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 extremity in the most functional position for it and to 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 is disabled for life.
2. Arthroscopic debridement. This method of surgical intervention has a temporary, but permanent effect. It is mainly used in the second phase of the development of the disease. During the operation, damaged parts of the cartilage tissue are removed, eliminating pain. Performance after the operation is maintained for two to three years.
3. endoprosthetics. The most popular treatment for this disease. The knee joint is removed in whole or in part. And they are replaced by an endoprosthesis made of ceramic, metal or plastic. As a result, the patient restores motor activity and 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. Restoration of motor activity.
2. Improving the function of muscles and joints.
3. protection of the prosthesis.

The drain is removed on the second or third day after the operation. Special preparations with a cooling effect are used to relieve pain. It is recommended to start motor skills 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 has pain, which is due to the transplantation of the prosthesis. The older the patient, the longer it takes to transplant the prosthesis. NSAIDs are prescribed to reduce inflammation and relieve 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 carried out strictly every day. Physical activity increases gradually to avoid injury.

After discharge from the clinic, the patient must follow certain instructions on how to continue his life. Physical activities such as dancing or yoga are allowed six months after the operation. Loads that can damage the prosthesis are strictly prohibited (fast running, jumping, weight training). After the operation, it is not recommended to lift weights over 25 kg. In the house where the patient will live, all the handrails of the stairs must be strengthened, the shower room must be equipped with a handrail, and all chairs and other furniture must be carefully checked for serviceability. If you follow these simple recommendations, the prosthesis will last a long time.

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

Prevention of arthrosis of the knee joint

To avoid this disease, people at risk (athletes, elderly, overweight, employees of companies) must meet some requirements:

1. Proper nutrition and weight loss. It is necessary to exclude harmful foods from your diet - fat, fried, alcohol. However, it is better to consult a nutritionist who will help you choose the right diet individually.
2. During sports, monitor the load on the joints, reduce them if necessary.
3. Monitor your health and treat infectious diseases in time so that they do not become chronic.
4. Timely and adequate treatment of diseases of the spine, if any, development of correct posture.
5. Sports activities (cycling, swimming, hiking, special gymnastic exercises for the joints).
6. No self treatment! Contact the clinic at the first symptoms of arthrosis of the knee joint.
7. Avoid stress, sleep well.
8. Systematically increase your immunity (harden up or take a vitamin regimen at least 2-3 times a year).
9. Avoid hypothermia of the body, especially the lower extremities.

A healthy lifestyle and timely treatment are the best ways to prevent arthrosis of the knee joints.