Arthrosis of the knee joint

Osteoarthritis of the knee joint is a disease of the musculoskeletal system consisting of deformation and destruction of the cartilage tissue of the joint, as a result of which the structure and functions of the cartilages are disturbed. The disease has several names - gonarthrosis, deforming osteoarthritis. There is no unequivocal scheme for the treatment of arthrosis of the knee joint or a single drug that can help everyone suffering from this problem in the same way. Since arthrosis is a progressive disease, it is more common in overweight women, venous diseases 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 develops in one or both legs). At the first symptoms, it is necessary to seek adequate treatment, because ignoring this problem can lead to the final destruction of cartilage and bone exposure and, as a result, a person's disability.

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. 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 joint's synovial membrane and capsule are also deformed, the knee joint gradually atrophies due to the stiffness of the movements. Also, there is a change in the density of the joint fluid (it becomes thicker, more viscous), blood circulation is disturbed, and the supply of nutrients to the knee joint deteriorates. Thinning of the lining between cartilaginous joints reduces the distance between the joint 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, which causes a person's disability.

Often, arthrosis or gonarthrosis develops after injury or decay, 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 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 or twist the leg for a certain period of time. This leads to the deterioration of blood circulation, which most often leads to the development of post-traumatic gonarthrosis.
3. Removal of the meniscus.
4. Excessive physical activity inappropriate for a person's age, which causes injuries or microtrauma, as well as hypothermia of the joints. For example, it is not recommended for elderly people to run or squat on the asphalt, because during these exercises there is a significant pressure on the knee joint, which wears out with age and cannot withstand such loads.
5. Overweight and obesity. This factor causes damage to the meniscus, its damage leads to the development of knee arthrosis.
6. Loose ligaments or weak ligaments.
7. Arthritis or other acquired joint diseases. The inflammatory process can lead to accumulation of synovial fluid or swelling in the joint cavity. This leads to the destruction of the knee cartilage tissue, 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. Straight legs. The incorrect structure of the foot changes the center of gravity and the load on the joint is greater.
10. Stress and nervous tension.

Symptoms of knee osteoarthritis

The clinical picture of the disease is manifested by the following symptoms:

1. Feelings of pain. Pain occurs suddenly depending on the physical load in the knee joint. Pain can have a different nature. At the initial stage, these are weak back pains that a person usually does not pay much attention to. Periodic mild pain can be observed for months, and sometimes years, before the disease progresses to a more aggressive stage.
2. Visible deformity of the knee. This symptom appears in later stages. At first, the knee appears 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. Cracked joints. Patients in the second and third stages of the disease develop sharp creaking sounds accompanied by pain.
5. Inflammatory reactions in the articular synovium, due to which the cartilage swells and increases in volume.
6. Decreased joint mobility. appears in later stages. Bending the knee becomes almost impossible and is accompanied by severe pain. In the final stage, the knee may be completely immobile. A person's movement becomes difficult or completely impossible (some patients move on bent legs).

Diagnosis of knee osteoarthritis

If obvious or minor symptoms of arthrosis of the knee joint appear, it is better to contact an orthopedist or rheumatologist immediately. Diagnosis mostly consists of taking the patient's history and analyzing the general state of health. To get a more accurate result, they also refer to an X-ray or MRI of the knee. The patient also receives a referral for laboratory tests - a general blood and urine test. Based on the received information, the doctor draws 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 can cure this disorder. One of the most important conditions for successful treatment is timely diagnosis. The earlier the treatment of knee arthrosis begins, the higher the probability of prolonging the remission period and preventing the destruction and deformation of cartilage and bone tissues.

During the treatment, the doctor and the patient face a number of tasks:

1. Eliminate or reduce pain;
2. Establishing the supply of nutrients to the knee joint and thereby increasing its regenerative function;
3. Activate blood circulation in the area of the knee joint;
4. strengthen the muscles around the joint;
5. Increase joint mobility;
6. Try to increase the distance between the articular 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

Anti-inflammatory pain relievers

The patient is usually prescribed a course of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve or reduce pain. These can be tablets, ointments and injections. The most common pain medications can be used in two ways - internally or topically.

Usually, patients prefer local treatment in the form of gel, ointment, warming patches. The effect of these painkillers does not come immediately, but after a few days (about 3-4 days). The maximum effect is achieved after a week of regular use of the drug. Such drugs do not cure the disease, but eliminate the pain syndrome, because 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, because their long-term and frequent use can cause side effects and even accelerate the destruction of cartilage tissue of the joint. In addition, long-term use of these drugs increases the risk of adverse reactions, including stomach ulcers, duodenal ulcers, disruption of the normal functioning of the liver, kidneys, and allergic manifestations in the form of dermatitis.

Considering 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 non-steroidal drugs, doctors sometimes offer selective drugs. They are usually prescribed for long-term use, from 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, a course of taking hormonal drugs is prescribed in the treatment of arthrosis of the knee joint. They are prescribed if NSAIDs become ineffective and the disease itself begins to progress. Hormonal drugs are often used in the form of injections to treat this disease.

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

In the initial stages of the disease, a course of glucosamine and chondroitin sulfate, called chondroprotectors, is prescribed to restore and nourish the cartilage tissue. It is the most effective treatment for osteoarthritis to date. They have almost no contraindications and side effects are rarely seen.

Glucosamine stimulates cartilage regeneration, improves metabolism, protects cartilage tissue from further destruction, and provides normal nutrition. Chondroitin sulfate neutralizes enzymes that destroy cartilage tissue, stimulates the production of collagen protein, helps to saturate the cartilage with water, and also helps to keep it inside. The effectiveness of chondroprotectors is absent in the last stages of the disease, because the cartilage tissue is practically destroyed and cannot be restored. The daily dose of glucosamine is 1500 milligrams, and chondroitin sulfate is 1000 milligrams. In order to get the desired result, the administration of these drugs must be strictly systematic. The treatment course should be repeated 2-3 times a year. Both tools should be used together.

Glucosamine is available in pharmacies in the form of injection, powder, capsule, gel; chondroitin - in ampoules, tablets, ointments, gels. There are also combined preparations containing both chondroprotectors. There are also third-generation chondroprotectors that combine a chondroprotector and one of NSAIDs.

Vasodilator drugs

Vasodilators are prescribed to eliminate spasm of small vessels, improve blood circulation and improve the delivery of nutrients to the knee joint area, as well as to relieve vascular pain. 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 intra-articular fluid. When the drug is injected into the joint, it forms a film that prevents the cartilage from rubbing against each other during movement. A course of treatment with hyaluronic acid is prescribed only after the pain is relieved and the exacerbation is relieved.

Physiotherapy

A course of exercise therapy can be very useful and can give good results only when it is prescribed by a doctor and carried out under supervision, with the recommendation of a specialist or trainer. Self-medication is dangerous to health. Exercise therapy is used to prevent further destruction of cartilage tissue, slow down the development of stiffness, and relieve muscle spasms that cause pain. Exercise therapy is contraindicated during exacerbation. A special course of individual exercises that takes into account not only the stage of the disease and the condition of the cartilage, but also the age of the patient should be prepared by a competent specialist in this field.

Physiotherapy

Physiotherapy is used as one of the methods of conservative therapy - 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. Physiotherapy methods act in several directions - relieve pain, reduce inflammation, normalize metabolism within the joint and restore its normal functions. The method and duration of the course of physiotherapy treatment is determined by the patient's history and is prescribed only after a comprehensive diagnosis and study of the condition of the joints.

The patient must strictly control his diet, because excess weight causes additional stress on the knee joint and accelerates the progression of the disease. Excessive physical activity is dangerous and 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 rheumatology and orthopedics for the treatment of knee arthrosis.

Pain-relieving physical therapy includes:

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

Spa treatment is equally important. Such treatment is prescribed for deformation and dystrophic osteoarthritis. This type of treatment also has its own contraindications, like the ones listed earlier, so the attending physician carefully studies the patient's history before recommending the spa method.

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 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 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 final 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 extremity in the most functional position for it and 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 pain relief, 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 stage of disease development. During the operation, damaged parts of the cartilage tissue are removed, thereby relieving pain. After the operation, the effectiveness 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 recovers motor activity and relieves pain. The effectiveness of the operation has been maintained for more than fifteen to twenty years.

Recovery time

After such an operation, the rehabilitation period takes about three months. The goal of rehabilitation:

1. Restoration of motor activity.
2. Improving the functioning of muscles and joints.
3. To ensure the 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 activity immediately after removing the drain. A week later, the patient is transferred to the rehabilitation center. Physiotherapist monitors the patient's condition.

Some time after the operation (about a year), the patient still feels pain, which is due to the carving of the prosthesis. The older the patient, the longer the process of carving 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 a course of exercise therapy. Lessons should be prepared individually for each patient and should be strictly followed every day. Physical activity is gradually increased to prevent injuries.

After leaving the clinic, the patient must follow certain instructions regarding the future lifestyle. Physical activities such as dancing or yoga are allowed six months after surgery. Loads that can damage the prosthesis (fast running, jumping, strength sports) are strictly prohibited. It is not recommended to lift more than twenty five kilograms after the operation. In the house where the patient will live, it is necessary to strengthen all the handrails of the stairs, equip the shower room with handrails, carefully check the serviceability of all chairs and other furniture. By following these simple recommendations, the prosthesis will last a long time.

Despite compliance with 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 prevent this disease, people in the risk group (athletes, the elderly, people suffering from excess weight, employees of institutions) 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 help you choose the right diet individually.
2. Monitor the load on the joints while playing sports, reduce it if necessary.
3. Monitor your health and treat infectious diseases in time, prevent them from becoming chronic.
4. Timely and adequate treatment of diseases of the spine, if any, development of correct posture.
5. Sports activities (cycling, swimming, walking, special gymnastic exercises for joints).
6. No self-medication! Contact the clinic at the first symptoms of arthrosis of the knee joint.
7. Avoid stress, sleep well.
8. Systematically increase your immunity (strengthen it or take a vitamin course 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 means to prevent arthrosis of the knee joints.