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 arthrosis. The treatment of osteoarthritis of the knee joint does not have an unequivocal scheme or a single drug that will help everyone who suffers from this problem in the same way. Since arthrosis 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 neglecting this problem can lead to the final destruction of the cartilage and bone exposure and, as a result, to a person's disability.

There are three stages of the disease:

1. The initial stage of knee arthrosis is characterized by a loss of cushioning properties, and as a result, the cartilage rubs against each other during movement, causing severe discomfort to the patient. The cartilage thickens, deforms, dries up, in an advanced stage of the disease - it even becomes covered with cracks.
2. Due to the reduction of depreciation, deformation of the bones 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 are also deformed, the knee joint gradually atrophies due to stiffness of movements. There is also a change in the density of the joint fluid (it becomes thicker, viscous), blood circulation disorders, deterioration of the supply of nutrients to the knee joint. 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, leading to damage to the person.

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

Reasons for the development of arthrosis

Osteoarthritis of the knee joint, the treatment of which takes a long time, can occur 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 unbend the leg for a certain time. This leads to 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 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 are not recommended for elderly people, because during these exercises there is significant pressure on the knee joint, which wears out with age and is not able to withstand such loads.
5. Overweight and obesity. This factor leads to damage to the menisci, the injuries of which provoke the development of arthrosis of the knees.
6. Loose connections or weak connections.
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 cartilage tissue of the knee, which leads to arthrosis of the knee joints.
8. Metabolic disorders in the human body. The insufficient amount of calcium significantly worsens the condition of bone and cartilage tissue in the human body.
9. Flat steps. The incorrect structure of the foot shifts the center of gravity and the load on the joint becomes greater.
10. Stress and nervous tension.

Symptoms of osteoarthritis of the knee

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

1. Painful sensations. The pain appears 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, to which a person usually does not pay much attention. Intermittent mild pain can be experienced for months and sometimes years until the disease progresses to a more aggressive stage.
2. Visible knee deformity. This symptom appears in the later stages. Initially, the knee appears swollen or swollen.
3. Accumulation of synovial fluid in the joint cavity or Baker's cyst. It is a dense formation on the back wall of the knee joint.
4. Crackling joints. In patients in the second and third stages of the development of the disease, sharp popping sounds are observed, which are accompanied by pain.
5. Inflammatory reactions in the joint synovium, due to which the cartilage swells and increases in volume.
6. Reduced joint mobility. seen in the later stages. Bending the knee becomes almost impossible and is accompanied by severe pain. In the final 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 joints

If obvious or minor symptoms of arthrosis of the knee joint appear, it is better to contact an orthopedist or rheumatologist immediately. The diagnosis most often consists of taking the patient's history and analyzing his general state of 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 obtained 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 medical drug that can alleviate this disorder. One of the most important conditions for successful treatment is timely diagnosis. The earlier the treatment of knee arthrosis begins, 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 in the knee joint and thereby increase its restorative function;
3. Activate blood circulation in the area of the knee joint;
4. Strengthening of the muscles around the joint;
5. Increase joint mobility;
6. Aim to increase the distance between the articulated 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

To relieve or reduce the patient's pain, a course of non-steroidal anti-inflammatory drugs (NSAIDs) is usually prescribed. 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 gels, ointments, warming patches. The effect of these painkillers does not come immediately, but after a few days (approximately 3-4 days). The maximum effect is achieved after one week of regular use of the drug. Such drugs do not treat the disease as such, but only relieve the pain syndrome, since it is impossible to start pain treatment.

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

Given the limited scope of use, NSAIDs are prescribed with great care, especially in elderly patients. The average course of taking NSAIDs is approximately 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, a course of taking hormonal drugs is prescribed. They are prescribed if NSAIDs already become 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 in 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 initial stages of the disease, a course of glucosamine and chondroitin sulfate, the so-called chondroprotectors, is prescribed. It is the most effective treatment for osteoarthritis. They have almost no contraindications, and side effects occur in rare cases.

Glucosamine stimulates cartilage regeneration, improves metabolism, protects cartilage tissue from further destruction, providing it with 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 also helps to keep it inside. The effectiveness of chondroprotectors is lacking in the last 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. The intake of these drugs must be strictly systematic in order to achieve the desired result. The course of treatment should be repeated 2-3 times a year. Both tools should be used in combination.

In pharmacies, glucosamine is available 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.

Vasodilator drugs

Vasodilators are prescribed to relieve spasm of small vessels, improve blood circulation and delivery of nutrients to the knee joint area, as well as eliminate 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 liquid 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 cartilage from rubbing against each other during movement. The course of treatment with hyaluronic acid is prescribed only after the removal of pain and removal of exacerbation.

Physiotherapy

A course of exercise therapy can be very useful and lead to good results only when it is prescribed by a doctor and is carried out under supervision, on the recommendations of a specialist or trainer. Self-medication is dangerous to health. Exercise 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 an exacerbation, exercise therapy is contraindicated. A course of special individual exercises that take 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 specialist competent in this field.

Physiotherapy

Physiotherapy is used as one of the methods of conservative therapy - electrophoresis, laser therapy, acupuncture, diadynamic currents, UHF. A course of local massage also gives positive results. Compresses based on dimethylsulfoxide or bischofite, medical bile, are widely used. Physiotherapy methods act in several directions - they relieve pain, reduce inflammation, normalize the exchange of substances in the joint and restore its usual functions. The method and duration of the course of physiotherapy treatment are determined by the patient's history and are prescribed only after a thorough diagnosis and examination of the condition of the joints.

The patient must strictly control his diet, because excess weight puts additional stress on the knee joint and accelerates the progression of the disease. Excessive physical activity is dangerous, 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 the field of rheumatology and orthopedics to treat 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 the appearance of slight redness. Substances are formed in the tissues that dull the sensitivity of nerve fibers, due to which an analgesic effect is achieved. The duration of the treatment course is prescribed by the doctor depending on the symptoms, frequency and strength of the pain. On average, the course of treatment is approximately 7-8 sessions.
2. Local magnetotherapy aimed at general recovery of the patient's body. This procedure relieves inflammation, removes 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 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.

Equally important is the sanatorium-resort treatment. Such treatment is prescribed for deforming and dystrophic arthrosis. Such treatment, as well as those listed earlier, has its own contraindications, so the attending physician carefully studies the patient's history before recommending a sanatorium-resort 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 functioning of the joint. The methods and forms of surgical intervention depend on the degree of damage to the joint, as well as on the patient's history.

Late arthrosis of the knee joint is treated only surgically - the knee joint is replaced in whole or in part 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 arthrosis. A significant disadvantage of the operation, many consider the long recovery period with the use of exercise therapy, mechanotherapy and other means.

There are several types of knee osteoarthritis surgery:

1. Arthrodesis of the joint. The principle of the operation is fixing the lower limb in the most functional position for it and immobilizing it in the area of the knee joint. The damaged cartilage is removed completely. 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 disease. During the operation, damaged parts of the cartilage tissue are removed, thereby eliminating pain. Effectiveness after surgery is maintained for two to three years.
3. Endoprosthetics. The most popular treatment for this disease. The knee joint is removed completely or partially. And in its place is an endoprosthesis made of ceramic, metal or plastic. As a result, the patient recovers motor activity, relieves pain. The effectiveness of the operation is maintained for more than fifteen to twenty years.

Recovery period

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

1. Restoration of motor activity.
2. Improving the work of muscles and joints.
3. Provision of protection of the prosthesis.

The drain is removed on the second or third day after surgery. To eliminate pain, special preparations with a cooling effect are used. Motor activity is recommended to begin immediately after drain removal. A week later, the patient is transferred to a rehabilitation center. The physiotherapist monitors the patient's condition.

Some time after the operation (about a year), the patient still experiences pain, this is due to the grafting of the prosthesis. The older the patient, the longer the process of implanting the prosthesis. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable effect.

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

After discharge from the clinic, the patient must follow certain instructions regarding the further way of life. Physical activities such as dancing or yoga are allowed six months after surgery. Loads that can damage the prosthesis are strictly prohibited (fast running, jumping, strength sports). After the operation, it is not recommended to lift weights over twenty-five kilograms. In the house where the patient will live, it is necessary to strengthen all handrails on the stairs, equip the shower cabin with a handrail, carefully check all chairs and other furniture for serviceability. 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

To avoid this disease, people at risk (athletes, elderly people, overweight people, employees of enterprises) must comply with 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 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 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-medication! 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 of the lower extremities.

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