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, as a result of which the structure and functions of the cartilage are disturbed. The disease has several names: gonarthrosis, deforming osteoarthritis. The treatment of osteoarthritis of the knee joint does not have a single scheme or a single drug that can help all those who suffer from this problem in the same way. Since osteoarthritis is a disease of a progressive nature, it is most 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 proper treatment, as ignoring this problem can lead to the eventual destruction of cartilage and bone exposure and, consequently, to a person's disability.

There are three stages of the disease:

1. The initial phase of knee osteoarthritis 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. 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 the bones) - this is the second stage of the disease. The synovial membrane of the joint and the capsule also undergo deformation, the knee joint gradually atrophies due to stiffness of movements. There is also a change in the density of the joint fluid (it becomes denser, viscous), circulatory disorders, deterioration of the supply of nutrients to the knee joint. The thinning of the lining between the cartilage joints reduces the distance between the joint bones.
3. The disease progresses rapidly and rapidly 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 the cartilage tissue, leading to a person's disability.

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

Reasons for the development of arthrosis

Arthrosis of the knee joint, the treatment of which takes 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 of blood circulation, which most often provokes the development of post-traumatic gonarthrosis.
3. Removal of the meniscus.
4. Excessive physical activity that does not match a person's age, leading to injury or microtrauma, 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 and is unable to withstand such loads.
5. Overweight and obesity. This factor leads to damage to the menisci, injuries of which provoke the development of osteoarthritis 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 results in the destruction of the cartilage tissue in 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 feet. The wrong 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 has the following symptoms:

1. Pain sensations. Pain occurs suddenly, depending on the physical load on the knee joint. Pain can be of a different nature. In the initial stage, these are weak back pains, which a person usually does not pay much attention to. Mild periodic 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 appears in the 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 posterior wall of the knee joint.
4. Breakdown of the joints. Sharp crackling sounds, which are 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, as a result of which the cartilage swells and increases in volume.
6. Decreased joint mobility. seen in the 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 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 contact an orthopedist or rheumatologist immediately. Diagnosis most often involves taking a patient's history and analyzing her general health. For a more accurate conclusion, they also resort to X-ray examination or 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 medical drug that relieves this ailment. One of the most important conditions for successful treatment is timely diagnosis. The earlier treatment of osteoarthritis of the knee is initiated, 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 faced with several tasks:

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

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

Conservative treatment of osteoarthritis of the knee joint

Pain relieving anti-inflammatory drugs

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

Usually, patients prefer topical treatment in the form of gels, ointments, 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 medicines do not treat the disease as such, but only relieve the pain syndrome, as 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, as 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 adverse reactions increases, including stomach ulcers, duodenal ulcers, changes in the normal functioning of the liver, kidneys and allergic manifestations in the form of dermatitis.

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 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, a course of taking hormonal drugs 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 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

To restore and nourish the cartilage tissue in the initial 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 in rare cases side effects appear.

Glucosamine stimulates the restoration of cartilage, improves metabolism, protects cartilage tissue from further destruction, providing it with normal nutrition. Chondroitin Sulfate neutralizes enzymes that destroy cartilage tissue, stimulates the production of collagen proteins, helps saturate the cartilage with water and also helps keep it inside. The effectiveness of chondroprotectors is absent in the late 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 must be strictly systematic to achieve the desired result. The course of treatment should be repeated 2-3 times a year. Both tools must be used in combination.

In pharmacies, glucosamine comes in the form of injections, powder, 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 supply of nutrients to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. They are used together with chondroprotectors. If osteoarthritis 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 the 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. The course of treatment with hyaluronic acid is prescribed only after the removal of pain and elimination of the exacerbation.

Physiotherapy

A physical therapy course can be very useful and bring good results only if prescribed by a doctor and carried out under supervision, on the advice of a specialist or trainer. Self-medication is dangerous to health. Physical therapy is used as an additional prevention of the destruction of cartilage tissue, slowing the development of stiffness, relaxing the muscle spasm that causes pain. During the exacerbation of physical therapy it 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. Tablets based on dimethyl sulfoxide or bischofite, medical bile are widely used. Physiotherapeutic methods act in different directions: they relieve pain, reduce inflammation, normalize the metabolism within the joint and restore its normal functions. The method and duration of the course of physiotherapeutic treatment are determined by the patient's history and are prescribed only after a thorough diagnosis and study of the condition of the joints.

The patient must strictly control his diet, as excess weight places additional stress 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 physical 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 the field of rheumatology and orthopedics for the treatment of osteoarthritis of the knee.

Physical therapy for pain relief 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. In the tissues, substances are formed that attenuate the sensitivity of nerve fibers, due to which an analgesic effect is achieved. The duration of the course of treatment is prescribed by the doctor based on the symptoms, frequency and strength of pain. On average, the course of treatment is approximately 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 osteoarthritis 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, interference therapy, prescribed to improve blood circulation in the joint.

Equally important is the sanitary-resort treatment. Such treatment is prescribed for deforming and dystrophic osteoarthritis. Such treatment, in addition to those listed above, has its own contraindications, so the attending physician carefully studies the patient's history before recommending a sanitary method to him.

Surgical treatment of osteoarthritis of the knee joint

This is a radical method of treating osteoarthritis of the knee joint, which partially or completely restores the functioning of the joint. The methods and forms of surgery depend on the degree of joint damage, as well as the patient's history.

Late osteoarthritis 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 stages of knee osteoarthritis. A significant drawback of the operation, many consider a long recovery period with the use of physical therapy, mechanotherapy and other means.

There are several types of knee joint osteoarthritis surgery:

1. Joint arthrodesis. The principle of the 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 surgery 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 pain. The efficiency after the operation is maintained for two to three years.
3. Endoprosthesis. The most popular treatment for this disease. The knee joint is removed completely or partially. And in its place is a ceramic, metal or plastic endoprosthesis. 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 lasts about three months. The purpose of rehabilitation is:

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

Drainage is removed on the second or third day after the operation. To eliminate pain, special preparations with a cooling effect are used. It is recommended to start motor activity immediately after the drainage has been removed. A week later, the patient is transferred to a rehabilitation center. The physiotherapist checks the patient's condition.

For some time after the operation (about a year), the patient still feels pain, this is due to the implantation of the prosthesis. The older the patient, the longer the implantation process of the prosthesis. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that ensure a stable effect.

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

After discharge from the clinic, the patient must comply with certain instructions regarding further lifestyle. Physical activities such as dance or yoga are allowed six months after the operation. Loads that can damage the prosthesis (fast running, jumping, power sports) are strictly prohibited. After the operation, it is not recommended to lift weights greater than twenty-five kilograms. In the house where the patient will live, it is necessary to strengthen all the handrails of the stairs, equip the shower with a handrail, carefully check the functionality of all chairs and other furniture. By following these simple tips, the prosthesis will last a long time.

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

Prevention of osteoarthritis of the knee joint

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

1. Proper nutrition and weight loss. It is necessary to exclude harmful foods from the diet: fatty, fried, alcohol, but it is better to consult a nutritionist who will help you individually to 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 diseases of the spine, if any, the development of correct posture.
5. Sports activities (cycling, swimming, walking, special gymnastics for the joints).
6. No self-treatment! At the first symptoms of osteoarthritis of the knee joint, contact the clinic.
7. Avoid stress, sleep well.
8. Systematically increase your immunity (harden 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 prompt treatment are the best means of preventing osteoarthritis of the knee joints.