Arthrosis of the knee joint

Osteoarthritis of the knee joint is a disease of the musculoskeletal system, which consists of the deformation and destruction of joint cartilage tissue, as a result of which the structure and function of the cartilage is disturbed. This disease has several names - gonarthrosis, deformation of osteoarthritis. The treatment of arthrosis of the knee joint does not have a clear scheme or a single drug that can help all people with this problem in the same way. Since arthrosis is a disease with a progressive nature, it is observed more often in overweight women, venous disease, and the elderly. Treatment is created 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 use 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 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 bone surface) - this is the second stage of the disease. The synovial membrane of the joint and capsule also undergo deformation, the knee joint gradually atrophies due to the stiffness of the movement. There are also changes in the density of the joint fluid (it becomes thicker, viscous), blood circulation disorders, deterioration in the supply of nutrients to the knee joint. Thinning of the layer between the cartilaginous joints reduces the distance between the articulating bones.
3. The disease develops rapidly and quickly passes 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 cartilage tissue, which leads to a person's disability.

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.

Reasons for the development of arthrosis

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

1. genetic predisposition.
2. Injuries: sprains, bruises, broken bones. When treating an injured knee, the joint is fixed and the person cannot bend and bend the leg for a certain time. This leads to a deterioration in blood circulation, which most often provokes the development of gonarthrosis after trauma.
3. Meniscus removal.
4. Excessive physical activity that does not correspond to a person's age, which leads to injuries or microtrauma, as well as hypothermia in the joints. For example, running on asphalt or squatting is not recommended for older people, because during these exercises there is significant pressure on the knee joints, which wear out with age and cannot withstand such a load.
5. Overweight and obesity. This factor leads to damage to the menisci, an injury that triggers the development of knee arthrosis.
6. Loose ligaments or weak ligaments.
7. Arthritis or other acquired joint disease. The inflammatory process can cause the accumulation of synovial fluid in the joint cavity or swelling. This causes the destruction of the cartilage tissue of the knee, which leads to arthrosis of the knee joint.
8. Metabolic disorders in the human body. An insufficient amount of calcium significantly worsens the condition of bones and cartilage tissue in the human body.
9. Flat feet. The wrong structure of the foot shifts the center of gravity, and the load on the joints becomes greater.
10. Stress and nervous tension.

Symptoms of knee osteoarthritis

The clinical picture of this disease has the following symptoms:

1. Sensation of pain. Pain occurs suddenly, depending on the physical load on the knee joint. Pain can be of a different nature. In the early stages, this is a 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 moves to a more aggressive stage.
2. Visible deformity of the knee. These symptoms appear in the final stage. 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. Cracked joints. A sharp crackling sound, which is accompanied by pain, is observed in patients in the second and third stages of the development of the disease.
5. An inflammatory reaction in the articular synovium, which is caused by the cartilage swelling and increasing in volume.
6. Joint mobility is reduced. seen at the next level. Bending the knee becomes almost impossible and is accompanied by severe pain. In the last stage, the knee may not move completely. A person's movement becomes difficult or completely impossible (some patients move with bent legs).

Diagnosis of knee osteoarthritis

If obvious or minor symptoms of arthrosis of the knee joint appear, it is better to immediately contact an orthopedic specialist or a rheumatologist. Diagnosis often consists of taking the patient's history and analyzing their general health. For a more accurate conclusion, they also use an X-ray or MRI examination of the knee. Patients also receive referrals for laboratory tests - general blood and urine tests. Based on the data obtained, the doctor draws conclusions 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 relieves this disorder. One of the most important conditions for successful treatment is timely diagnosis. The earlier treatment of knee arthrosis 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 treatment, doctors and patients face several tasks:

1. Eliminate or reduce pain;
2. To create a supply of nutrients to the knee joint and thereby improve its recovery function;
3. Activate blood circulation in the knee joint area;
4. Strengthens the muscles around the joints;
5. Improve 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 operative.

Conservative treatment of arthrosis of the knee joint

Anti-inflammatory drugs that relieve pain

To relieve or reduce pain, patients are usually prescribed a course of non-steroidal 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, heating patches. The effect of this painkiller 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 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 prolonged and frequent use can cause side effects and also accelerate the destruction of joint cartilage tissue. In addition, with prolonged use of these drugs, the risk of adverse reactions increases, including stomach ulcers, duodenal ulcers, disturbances in the normal functioning of the liver, kidneys, and allergic manifestations in the form of dermatitis are also possible.

Given the limited range of use, NSAIDs are prescribed very carefully, 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 cartilaginous tissue of the knee joint.

Hormones

Sometimes, in the treatment of arthrosis of the knee joint, a course of taking hormonal drugs is prescribed. They are prescribed if NSAIDs have already become ineffective, and the disease itself begins to develop. 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 prescribed during periods of severe exacerbation, when inflammatory fluid accumulates in the joints. 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, courses of glucosamine and chondroitin sulfate, called chondroprotectors, are 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 cartilage recovery, improves metabolism, protects cartilage tissue from further destruction, provides it with normal nutrition. Chondroitin sulfate neutralizes enzymes that destroy cartilage tissue, stimulates collagen protein production, helps weave cartilage with water, and also helps keep it inside. The effectiveness of chondroprotectors is not present at the last stage of the disease, because 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 results. The treatment course 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, powders, capsules, gels; 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.

Vasodilator drugs

To relieve spasm of small vessels, improve blood circulation and delivery of nutrients to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. 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 removal of pain and elimination of exacerbations.

Physiotherapy

Exercise therapy courses can be very useful and bring good results only when prescribed by a doctor and carried out under supervision, on the recommendation of a specialist or trainer. Medicines themselves are dangerous to health. Exercise therapy is used as further prevention of the destruction of cartilage tissue, slows down the development of stiffness, relieves muscle spasms that cause pain. During exacerbation exercise therapy is contraindicated. A special individual training course 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 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 current, UHF. Local massage courses also give positive results. Compresses based on dimethyl sulfoxide or bischofite, medical bile are widely used. Physiotherapy methods act in several directions - they relieve pain, reduce inflammation, normalize metabolism in the joints, and restore normal function. 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 needs to strictly control his diet, because excess weight puts additional pressure on the knee joint and accelerates the progression of the disease. Excessive physical activity is dangerous, they should be avoided, but at the same time, exercise therapy is only necessary. Orthopedists recommend wearing comfortable shoes with special insoles, using crutches to facilitate movement. There are many techniques developed by specialists in rheumatology and orthopedics for the treatment of knee osteoarthritis.

Pain-relieving physical therapy includes:

1. Medium wave ultraviolet radiation (SUV radiation). The contact of ultraviolet rays with the skin of the knee continues until a slight redness appears. A substance is formed in the tissue that dulls the sensitivity of nerve fibers, which causes an analgesic effect to be 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 treatment course is about 7-8 sessions.
2. Local magnetotherapy is aimed at general rehabilitation of the patient's body. This procedure relieves inflammation, relieves pain, neutralizes muscle spasms. Effectively used for arthrosis of the knee joint in the early 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, distraction therapy, prescribed to improve blood circulation in the joints.

Equally important is the hygienic resort treatment. Such treatment is prescribed for deforming and dystrophic osteoarthritis. Such treatments, as well as the ones listed before, have their own contraindications, so the attending physician carefully studies the patient's history before recommending a sanitary resort method to him.

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 method and form of surgical intervention depends on the degree of joint damage, as well as on 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 last stage 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 operation is to fix the lower limb 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 the elimination of pain, but the patient becomes 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, part of the damaged cartilage tissue is removed, thereby relieving pain. Postoperative efficiency is maintained for two to three years.
3. Endoprosthetics. 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, relieves pain. Operational effectiveness has been maintained for more than fifteen to twenty years.

Recovery period

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

1. Restoration of motor activity.
2. Improve muscle and joint function.
3. Provides protection to the prosthesis.

Drainage is removed on the second or third day after the operation. Special preparations with a cooling effect are used to eliminate pain. Motor activity is recommended to begin immediately after drain removal. A week later, the patient was transferred to a rehabilitation center. A 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 strengthening of the prosthesis. The older the patient, the longer the process of incorporating the prosthesis. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

Mandatory is a course of exercise therapy. Classes should be designed individually for each patient and strictly implemented every day. Physical activity increases gradually to avoid injury.

After leaving the clinic, the patient must comply with certain instructions regarding the further way of life. Physical activity such as dancing or yoga is allowed six months after surgery. Loads that can damage the prosthesis are strictly prohibited (fast running, jumping, power sports). After the operation, it is not recommended to lift more than twenty five kilograms. In the house where the patient will live, it is necessary to strengthen all handrails, equip the bathroom with handrails, carefully check all chairs and other furniture for usability. 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 intervention (after about 2-3 years).

Prevention of arthrosis of the knee joint

To avoid this disease, people at risk (athletes, the elderly, overweight people, company workers) must comply with several 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 spinal diseases, 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. Increase your immunity systematically (harden or at least take a course of vitamins 2-3 times a year).
9. Avoid hypothermia of the body, especially the lower legs.

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