Osteoarthritis of the knee joint

Arthrosis 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 functions of the cartilage. The disease has many names - gonarthrosis, deforming arthrosis. The treatment of osteoarthritis of the knee joint does not have an unambiguous scheme or a single drug that could equally help all people suffering from this problem. Since osteoarthritis is a disease of a progressive nature, it is more often observed in overweight women, venous diseases and the elderly. The 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 on one or both legs). At the first symptoms, it is necessary to resort to adequate treatment, since ignoring this problem can lead to the final destruction of the exposed cartilage and bones and, as a result, to the disability of a person.

There are three stages of the disease:

1. The initial stage of osteoarthritis of the knee is characterized by the loss of cushioning properties, and as a result the cartilage rubs against each other during movement, causing significant discomfort for the patient. The cartilage becomes rough, deformed, dries out, in advanced stages of the disease - even covered with cracks.
2. Due to the decrease in impairment, 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 deformations, the knee joint gradually atrophies due to the stiffness of the movements. There is also a change in the density of joint fluid (it becomes thicker, viscous), circulatory disorders, a deterioration in the supply of nutrients to the knee joint. The thinning of the mucosa between the cartilaginous joints reduces 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 the cartilage tissue, leading to disability of a person.

Most often, osteoarthritis or gonarthrosis develops after an injury or bruise, while a person experiences constant severe pain in the knee, which significantly impedes movement.

Reasons for the development of arthrosis

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: dislocations, bruises, fractures. When treating an injured knee, the joint is fixed and the person cannot bend and straighten the leg for some time. This leads to a deterioration in blood circulation, which most often provokes the development of post-traumatic gonarthrosis.
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. For example, running on asphalt or squats is not recommended for older people, since during these exercises there is significant pressure on the knee joint, which wears out with age andis 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 cartilage 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. Flat foot. The poor structure of the foot shifts the center of gravity and the load on the joint becomes greater.
10. Stress and nervous tension.

Symptoms of knee osteoarthritis

The clinical picture of the disease has the following symptoms:

1. Feeling of pain. The pain occurs 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 back pain, 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 later stages. At first, the knee looks 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. Cracking joints. Sharp crackles, 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 final stage, the knee can be completely immobilized. 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 best to immediately contact an orthopedist or rheumatologist. Diagnosis most often involves taking a patient's 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 also receives 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 relieves this disorder. One of the most important conditions for successful treatment is timely diagnosis. The earlier treatment for osteoarthritis of the knee is started, the more likely it is to prolong the period of remission and prevent the destruction and deformation of cartilage and bone tissue.

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

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

Analgesic anti-inflammatories

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 painkillers 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 (about 3-4 days). The maximum effect is achieved after a week of regular use of the drug. These drugs do not treat the disease as such, but only relieve the pain syndrome, since it is impossible to start treatment for pain.

Painkillers should be taken strictly as prescribed by the doctor, they should be used only for severe pain, since prolonged and frequent use can lead to side effects and even accelerate the destruction of cartilage tissue in 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 dermatitisare also possible.

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 non-steroids, doctors sometimes offer selective drugs. They are usually prescribed for long-term use for 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, hormone therapy 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 duration 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 early 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 proteins, helps saturate cartilage with water, and also helps keep it inside. 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. Taking these drugs should be strictly systematic in order to achieve the desired result. The treatment should be repeated 2-3 times a year. Both tools should be used in combination.

In pharmacies, glucosamine comes 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 so-called third-generation chondroprotectors, which combine a chondroprotector and one of the NSAIDs.

Vasodilating drugs

To relieve spasms of small vessels, improve blood circulation and the supply of nutrients to the knee joint area, as well as to eliminate vascular pain, vasodilators are prescribed. They are used together with chondroprotectors. If arthrosis of the knee 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 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 cartilages from rubbing against each other during movement. 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 bring good results only if it is prescribed by a doctor and carried out under the supervision, on the recommendation of a specialist or trainer. Self-medication is dangerous for health. Exercise therapy is used as an additional prevention of the destruction of cartilage tissue, slowing the development of stiffness, relaxing muscle spasms that cause pain. During the exacerbation 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 age of the patient, should be developed by a competent specialist in this field.

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 dimethylsulfoxide or bischofite, medical bile are widely used. Physiotherapeutic methods act in several directions - they relieve pain, reduce inflammation, normalize the metabolism inside the joint and restore its usual 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, 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 soles, using a cane to facilitate movement. There are many techniques developed by specialists in the field of rheumatology and orthopedics for the treatment of osteoarthritis of the knee.

Physiotherapy 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 dull the sensitivity of nerve fibers, due to which an analgesic effect is achieved. The duration of treatment is prescribed by the doctor depending on the symptoms, frequency and intensity of pain. On average, the duration 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 duration 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.

Sanitary treatment is equally important. Such treatment is prescribed for deforming and dystrophic arthrosis. Such treatment, as well as those listed earlier, have their own contraindications, so the attending physician carefully studies the patient's history before recommending a method of sanitary remedy.

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 functioning 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 later stages of knee arthrosis. A significant drawback 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 it and to immobilize it at the knee joint. The damaged cartilage is completely removed. It is a radical method, used in extreme cases. The result is the elimination of pain, but the patient becomes disabled for life.
2. Arthroscopic debridement. This method of surgical intervention has a temporary, but long-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. The effectiveness after the operation is maintained for two to three years.
3. Stents. The most popular treatment for this disease. The knee joint is completely or partially removed. And in its place is a ceramic, metal or plastic stent. As a result, the patient restores motor activity, eliminates pain. The effectiveness of the operation was maintained for more than fifteen to twenty years.

Recovery period

The rehabilitation period after such an operation takes about three months. The purpose of rehabilitation is:

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

The drainage 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 begin motor activity immediately after removal of the drainage. 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 feels pain, this is due to the engraftment of the prosthesis. The older the patient, the longer the prosthesis engraftment process. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

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

After discharge from the clinic, the patient must comply with certain instructions regarding further lifestyle. Physical activities such as dancing or yoga are allowed six months after the operation. Loads that could damage the prosthesis are strictly prohibited (fast running, jumping, strength sports). 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, to equip the shower room with a handrail, to 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 osteoarthritis of the knee joint

In order to avoid this disease, people at risk (athletes, elderly people, overweight people, company employees) must meet certain 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. 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, 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 (strengthen or at least take a course of vitamins 2-3 times a year).
9. Avoid hypothermia of the body, especially the lower limbs.

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