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. There is no clear scheme for the treatment of knee arthrosis or a single drug that can equally help everyone who suffers from this problem. Since arthrosis is a progressive disease, it is more often observed in overweight women, venous diseases and the elderly. The 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 on one or both legs). At the first symptoms, appropriate treatment should be applied, as neglecting this can lead to the final destruction of cartilage and bone exposure and, as a result, to the person's disability.

The disease has three stages:

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 severe discomfort to the patient. The cartilage becomes rough, deformed, dry, in the advanced stage of the disease - even covered with cracks.
2. Deformation of the bone begins due to the decrease in amortization, 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 are also deformed, the knee joint gradually atrophies due to the stiffness of the movements. In addition, there is a change in the density of the synovial fluid (it thickens and becomes viscous), circulatory disorders, and deterioration of the nutrient supply to the knee joint. The thinning of the lining between the cartilaginous joints reduces the distance between the articular bones.
3. The disease develops 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 leads to a person's disability.

Most often, arthrosis or gonarthrosis develops after an injury or bruise, while a person feels constant severe pain in the knee, which significantly hinders his movement.

Causes of arthrosis

Osteoarthritis of the knee joint, the treatment of which takes quite a long time, can be manifested due to the following factors:

1. genetic predisposition.
2. Injuries: dislocations, bruises, fractures. When treating an injured knee, the joint is immobilized and the person cannot bend and extend the leg for a certain period of time. This leads to the deterioration of blood circulation, which most often causes the development of post-traumatic gonarthrosis.
3. Removal of the meniscus.
4. Excessive physical activity that does not correspond to a person's age, which leads to injuries or microtrauma, as well as hypothermia of the joints. For example, running on asphalt or squatting are not recommended for older people, as 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 meniscus, the damage of which causes the development of arthrosis of the knee.
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 cartilaginous 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. Crow's feet. Poor foot structure shifts 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 is characterized by the following symptoms:

1. Feelings of pain. The pain appears suddenly, depending on the physical load on the knee joint. Pain can be of a different nature. At the initial stage, these are weak back pains that people usually do not pay much attention to. Intermittent mild pain can be observed for months, sometimes years, until the disease progresses to a more aggressive stage.
2. Visible deformity of the knee. This symptom appears in later stages. At first, the knee will feel 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. Sharp crackling sounds accompanied by pain are observed in patients in the second and third stages of the disease.
5. Inflammatory reactions in the joint synovium, causing the cartilage to swell and increase in volume.
6. Reduced joint mobility. shown in later sections. Bending the knee becomes almost impossible and is accompanied by severe pain. In the last stage, the knee can be completely immobilized. A person's movement becomes difficult or completely impossible (some patients move on bent legs).

Diagnosis of osteoarthritis of the knee

If there are obvious or minor symptoms of arthrosis of the knee joint, it is better to consult an orthopedist or rheumatologist immediately. The diagnosis most often consists of taking the patient's anamnesis and analyzing his general state of health. For a more accurate conclusion, an X-ray or knee MRI is also used. The patient also receives a referral for laboratory tests - general blood and urine tests. Based on the received data, the doctor draws a conclusion and prescribes the necessary treatment.

Treatment of arthrosis of the knee joint

Treatment of arthrosis of the knee joint must be comprehensive. To date, there is no drug that alleviates this disorder. One of the most important conditions for successful treatment is timely diagnosis. The earlier the treatment of knee arthrosis is started, the more likely it is to prolong the remission period and prevent the destruction and deformation of cartilage and bone tissue.

During the treatment, the doctor and the patient have to face several tasks:

1. Eliminate or reduce pain;
2. Creating the nutrient supply of the knee joint and thereby increasing its restorative function;
3. Activates blood circulation in the area of the knee joint;
4. Strengthen the muscles around the joint;
5. Increase joint mobility;
6. Aim to increase the distance between the joint bones.

Depending on the stage of development, treatment of the disease can be conservative or operative.

Conservative treatment of arthrosis of the knee joint

Pain-relieving anti-inflammatory drugs

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

In general, patients prefer local treatment in the form of gels, ointments, and heating patches. The effect of these painkillers does not appear immediately, but 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, but only relieve the pain syndrome, since it is impossible to start treating the pain.

Painkillers must be taken strictly according to the doctor's prescription, and should only be used in case of severe pain, as their long-term and frequent use can lead to side effects and even accelerate the destruction of joint cartilage tissue. In addition, long-term use of these drugs increases the risk of side effects, including stomach ulcers, duodenal ulcers, damage to the normal functioning of the liver and kidneys, and allergic manifestations in the form of dermatitis.

Given their limited range of use, NSAIDs are prescribed with great care, especially in elderly patients. The average duration of taking NSAIDs is about fourteen days. As an alternative to non-steroids, doctors sometimes offer selective drugs. It is usually prescribed for long-term use, from a few 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 become ineffective and the disease itself progresses. Most often, hormonal drugs for the treatment of the disease are used in the form of injections.

Treatment with hormonal drugs is usually short and prescribed during a 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, glucosamine and chondroitin sulfate, a so-called chondroprotector course, are prescribed to restore and nourish the cartilage tissue. It is by far the most effective treatment for osteoarthritis. They have almost no contraindications, and side effects occur in rare cases.

Glucosamine stimulates cartilage restoration, improves metabolism, protects cartilage tissue from further destruction, and ensures normal nutrition. Chondroitin sulfate neutralizes the enzymes that destroy cartilage tissue, stimulates the production of collagen protein, helps to saturate the cartilage with water, and helps to keep it inside. The effectiveness of chondroprotectors is lacking in the final stages of the disease, as the cartilage tissue is practically destroyed and cannot be restored. The daily dose of glucosamine is 1, 500 milligrams, and that of chondroitin sulfate is 1, 000 milligrams. The intake of these drugs must be strictly systematic in order to achieve the desired result. The treatment must be repeated 2-3 times a year. Both tools must be used together.

In pharmacies, glucosamine is produced in the form of injections, powders, capsules, gels; chondroitin - in ampoules, tablets, ointments, gels. There are also combined preparations that contain both chondroprotectors. There are also so-called third-generation chondroprotectors, which combine a chondroprotector and an NSAID.

Vasodilator drugs

Vasodilators are prescribed to relieve spasm of small blood vessels, improve blood circulation and delivery of nutrients to the knee joint area, and eliminate vascular pain. It is used together with chondroprotectors. If the knee joint is not accompanied by fluid accumulation, the use of warming ointments, gels, and fluids is also recommended.

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 cartilage from rubbing against each other during movement. Hyaluronic acid treatment is prescribed only after the pain has stopped and the aggravation has stopped.

Physiotherapy

Exercise therapy can be very useful and only bring good results if it is prescribed by a doctor and is carried out under supervision and at the suggestion of a specialist or trainer. Self-medication is dangerous to health. Exercise therapy serves to further prevent the destruction of cartilaginous tissue, slows down the development of stiffness, and relaxes muscle spasms that cause pain. Exercise therapy is contraindicated during exacerbations. A course consisting of special individual exercises, which 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 developed by a competent specialist in this field.

Physiotherapy

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

The patient must strictly control his diet, as 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 exercise therapy is simply necessary. Orthopedists recommend wearing comfortable shoes with special insoles, using a cane to facilitate movement. Several techniques have been developed by rheumatology and orthopedic specialists to treat knee arthritis.

Physiotherapy for pain relief includes:

1. Mid-wave ultraviolet irradiation (SUV irradiation). The contact of ultraviolet radiation with the skin of the knee lasts until a slight redness appears. Substances are formed in the tissues that dampen the sensitivity of nerve fibers, thanks to which a pain-relieving effect can be achieved. The duration of the treatment is prescribed by the doctor, depending on the symptoms, frequency and strength of the pain. On average, the duration of the treatment is about 7-8 sessions.
2. Local magnetotherapy aimed at general restoration of the patient's body. This procedure relieves inflammation, eliminates pain, and neutralizes muscle spasms. It is effectively used for arthrosis of the knee joint in the initial stage. The treatment process is usually limited to 20-25 procedures, each of which takes about half an hour.
3. Infrared laser therapy, low intensity UHF therapy, centimeter wave therapy (CMW therapy).
4. Ultrasound, darsonvalization, therapeutic baths, interference therapy, prescribed to improve blood circulation in the joint.

Equally important is the health resort treatment. Such treatment is prescribed for deforming and dystrophic osteoarthritis. Such treatment, as well as those listed earlier, has its own contraindications, so the attending physician carefully studies the patient's medical history before recommending a health resort.

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. The methods and forms of surgical intervention depend on the degree of joint damage and the patient's medical 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 is that many people have a long recovery period using gymnastics therapy, mechanotherapy and other means.

There are several types of surgery for arthrosis 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 it and fix 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 pain relief, but the patient becomes 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 the development of the disease. During the operation, the damaged parts of the cartilage tissue are removed, thereby eliminating the pain. The effectiveness remains for two to three years after the operation.
3. Endoprosthesis. 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 eliminates pain. The effectiveness of the operation has been maintained for more than fifteen to twenty years.

Healing period

The rehabilitation period after such surgery lasts about three months. The aim of the rehabilitation:

1. Restoration of motor activity.
2. Improving the functioning of muscles and joints.
3. Providing protection for the prosthesis.

The drain is removed on the second or third day after surgery. Special preparations with a cooling effect are used to eliminate pain. It is recommended to start motoring 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 (about a year) after the operation, the patient still feels pain, this is due to the implantation of the prosthesis. The older the patient, the longer the prosthesis implantation process. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

Completion of gymnastics therapy is mandatory. Classes must be planned individually for each patient and must be carried out strictly every day. Physical activity is gradually increased to avoid injuries.

After being discharged from the clinic, the patient must follow certain instructions for further living. Six months after surgery, physical activities such as dancing or yoga are allowed. Loads that damage the prosthesis (running, jumping, strength sports) are strictly prohibited. After surgery, it is not recommended to lift more than twenty-five kilograms. In the house where the patient lives, all handrails on the stairs must be strengthened, the shower must be equipped with handrails, and all chairs and other furniture must be carefully checked for usability. By following these simple recommendations, the prosthesis will last a long time.

Despite compliance with recommendations and regulations, 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 avoid the disease, persons at risk (athletes, elderly, overweight, employees of enterprises) must comply with some requirements:

1. Proper nutrition and weight loss. Harmful foods should be excluded from the diet - fatty, fried, alcohol, but 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, 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 diseases, if any, and development of correct posture.
5. Sports activities (cycling, swimming, walking, 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 it or at least take a vitamin course 2-3 times a year).
9. Avoid hypothermia of the body, especially of the lower limbs.

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