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. The treatment of arthrosis of the knee joint does not have a single scheme or a single drug that could 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 women with excess weight, vein disease and the elderly. 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, because ignoring this problem can lead to the final destruction of cartilage and bone exposure and, as a result, the 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 cartilages rub against each other during movement, causing serious discomfort to the patient. Cartilage becomes rough, deformed, dries up, in the advanced stage of the disease - even covered with cracks.
2. Due to the decrease in cushioning, 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 the capsule are also subjected to deformation, the knee joint gradually atrophies due to stiffness of movement. There is also a change in the density of the joint fluid (it becomes thicker, viscous), circulation disorders, deterioration of the supply of nutrients to the knee joint. Thinning of the lining between the cartilaginous joints reduces the distance between the joint bones.
3. The disease progresses rapidly and quickly moves 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 lead to a person's disability.

Most often, arthrosis or gonarthrosis develops after an injury or bruise, while a person constantly feels 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 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 fixed and the person cannot bend and bend the leg for a certain period of time. This leads to 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 the person's age, which leads to injuries or microtrauma, as well as hypothermia of the joints. For example, elderly people are not recommended to run on asphalt or do squats, because during these exercises there is a 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 meniscus, whose injuries cause the development of knee arthrosis.
6. Loose 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 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 tissue in the human body.
9. Flat feet. The wrong 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. Feelings of pain. The pain appears suddenly, depending on the physical load on the knee joint. Pain can be of different nature. In the initial stage, these are weak back pains, which a person usually does not pay much attention to. Periodic mild pain can be observed 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. 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. Cracking 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, 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 last stage, the knee can be completely immobilized. Movement of the person becomes difficult or completely impossible (some patients move on bent legs).

Diagnosis of knee osteoarthritis

If obvious or minor symptoms of arthrosis of the knee joint appear, it is better to contact an orthopedist or rheumatologist immediately. The diagnosis usually consists of taking the patient's history and analyzing his general health condition. For a more precise conclusion, they resort to an 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 should be comprehensive. To date, there is no medical 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 period of remission and prevent the destruction and deformation of cartilage and bone tissue.

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

1. Eliminate or reduce pain;
2. 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. Strengthen the muscles around the joint;
5. Increase joint mobility;
6. Try to increase the distance between the joint bones.

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

Conservative treatment of arthrosis of the knee joint

Anti-inflammatory drugs for pain relief

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

Usually patients prefer local treatment in the form of gels, ointments, heating 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 a week of regular use of the drug. Such drugs do not cure the disease as such, but only alleviate the pain syndrome, because it is impossible to start the treatment of pain.

Painkillers should be taken strictly according to the doctor's prescription, they should be used only for severe pain, because their long-term and frequent use can lead to side effects and even accelerate the destruction of cartilage tissue of the joint. In addition, the long-term use of these drugs increases the risk of adverse reactions, including ulcers on the stomach and duodenum, disruption of the normal functioning of the liver and kidneys, and allergic manifestations in the form of dermatitis are also possible.

Due to the limited scope of application, NSAIDs are prescribed with great caution, 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 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 have 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, so-called chondroprotectors, is prescribed. 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 renewal, improves metabolism, protects cartilage tissue from further destruction, ensuring its normal nutrition. Chondroitin sulfate neutralizes 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 absent in the last stages of the disease, because the cartilage tissue is practically destroyed and cannot be renewed. 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 must be used in combination.

In pharmacies, glucosamine is presented 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 alleviate spasm of small vessels, improve blood circulation and delivery of nutrients to the knee joint area, as well as to eliminate vascular pain. They are used together with chondroprotectors. If knee arthrosis is not accompanied by fluid accumulation, it is also recommended to use ointments, gels, and heating fluids.

Hyaluronic acid

Another name for 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, a film is formed 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 exacerbation.

Physiotherapy

A course of exercise therapy can be very useful and bring good results only when it is prescribed by a doctor and carried out under the supervision of a specialist or trainer. Self-medication is dangerous to health. Exercise therapy is used to further prevent the destruction of cartilage tissue, slow down the development of stiffness, and relax muscle spasms that cause 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

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

The patient should 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 and should be avoided, but at the same time exercise therapy is simply necessary. Orthopedists recommend wearing comfortable shoes with special insoles, using a cane for easier movement. There are many techniques developed by specialists in 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 a slight redness appears. Substances are created in the tissues that dull the sensitivity of nerve fibers, which is why an analgesic effect is achieved. The duration of the therapy is prescribed by the doctor depending on the symptoms, frequency and intensity of the 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, 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 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.

Sanitary treatment is equally important. Such treatment is prescribed for deforming and dystrophic osteoarthritis. Such treatment, like those mentioned earlier, has its own contraindications, so the doctor carefully studies the patient's medical history before recommending a sanitary treatment method.

Surgical treatment of arthrosis of the knee joint

It is a radical method of treating arthrosis of the knee joint, which partially or completely restores the function of the joint. Methods and forms of surgical intervention depend 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 stages of knee arthrosis. Many consider the long recovery period with the use of exercise therapy, mechanotherapy and other means to be a significant disadvantage of surgery.

There are several types of surgery for knee osteoarthritis:

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 was 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 permanent effect. It is used mainly in the second stage of the disease. During the operation, the damaged parts of the cartilage tissue are removed, which eliminates the 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 restores motor activity, eliminates pain. The effectiveness of the operation is 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. Improving the work of muscles and joints.
3. Providing protection to the prosthesis.

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

A mandatory item is the course of exercise therapy. Teaching should be designed individually for each patient and carried out strictly every day. Physical activity is gradually increased to avoid injuries.

After discharge from the outpatient clinic, the patient must follow certain instructions about the further way of life. Physical activities such as dancing or yoga are allowed six months after surgery. 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 handrails of the stairs, equip the shower cabin with a handrail, and carefully check all chairs and other furniture for correctness. 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 approximately 2-3 years).

Prevention of arthrosis of the knee joint

In order to avoid this disease, people at risk (athletes, elderly people, overweight people, employees of companies) must comply with some 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, development of proper posture.
5. Sports activities (cycling, swimming, walking, special gymnastic exercises for 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 (fortify or at least take vitamins 2-3 times a year).
9. Avoid hypothermia of the body, especially the lower extremities.

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