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Osteoarthritis of the knee joint

knee joint arthrosis on X-ray

Osteoarthritis of the knee joint is a specific disease that has a destructive effect on the cartilage of the knee joint.

When such a disease appears, doctors observe serious disturbances in the processes of blood circulation in the bone vessels, which causes deformation and destruction of cartilage tissue, the person feels severe pain that hinders any movement of the legs and knees, and observes swelling and changes in the appearance of the knees.

In order to prevent the development of serious consequences of gonarthrosis (extremity deformation and ankylosis - joint immobilization), when the patient can only be helped by joint replacement surgery, the disease must be identified and treated in time.Moreover, do not treat independently with folk methods and advertised drugs, but under the supervision of qualified doctors.

what are the reasons?

Mechanisms of arthrosis in medicine are usually divided into:

  • Primary- which occurs in old age due to the natural aging of body tissues and against the background of some factors that provoke this disease, such as obesity (10% of cases), heredity and increased stress during life.
  • Secondary- accounts for 30% of all cases of arthrosis of the knee joint;it usually manifests itself after an injury, fracture of the tibia, rupture of ligaments or damage to the meniscus.Moreover, with such arthrosis of the knee joint, the symptoms of the disease appear in most cases after 3-4 years, but after a serious injury it is possible even after 2-3 months.

In 50-60% of cases, the cause of arthrosis of the knee joint is a spasm of the muscles of the front surface of the thigh.

What happens to the knee joint in arthrosis?

With excessive regular loads, genetic predisposition, metabolic disorders in the body, long-term muscle spasms and injuries, the knee cartilage loses its smoothness and begins to thin.The soft gliding of the articular bones is replaced by strong friction and the first stage of gonarthrosis develops, in which the cartilage loses its cushioning properties.

The degradation process continues to progress, and poor shock absorption leads to the flattening of bone surfaces with the formation of osteophytes in the form of bone growths.In this case, the disease already has the second stage and is accompanied by degeneration of the synovial membrane and joint capsule.The lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the cartilage nutrition process is disrupted, which leads to an even greater deterioration of the patient's condition.

The thinning of the cartilage leads to a reduction of the distance between the joint bones by up to 80%.When walking, due to abnormal friction and the absence of shock absorbers, destructive processes in the joint rapidly increase, which quickly leads to the development of the third stage of arthrosis with pronounced symptoms:

  • Pain when moving, especially when going up or down stairs.
  • Pain during exercise and at rest, morning stiffness.
  • The patient begins to limp, trying to spare the painful joint.
  • Severe cases of the disease require the use of crutches or a cane.

The third stage of arthrosis of the knee joint is characterized by an almost complete lack of cartilage tissue, which leads to a reduction in the mobility of the joint to a minimum.Therefore, no magical methods, super drugs or ointments can restore worn cartilage tissue, and given the degree of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.

destruction of the knee joint due to arthrosis

Stages of arthrosis

As arthrosis progresses, the following stages or degrees are distinguished:

  • The initial stage, or stage 1, is often called compensated, because there are still no pronounced clinical signs of the pathology.The patient may feel discomfort in the knees after physical activity, which quickly disappears after rest;the joints are still fully functional.
  • In arthrosis of the 2nd degree, subcompensated, the symptoms of the disease intensify.A pronounced pain syndrome is formed, which, however, is alleviated by anesthetic ointments and gels used locally.Motor activity is impaired and joint instability occurs.In the vast majority of cases, patients turn to doctors at this stage.
  • 3rd degree, decompensated, can also be called deforming.The knee joint is twisted, unstable, immobile and completely non-functional.The pain syndrome is constant and requires serious medical intervention.To relieve the joint and move, a person needs a cane.

Symptoms and first signs

Depending on the severity of the symptoms, the development of the disease is divided into 3 stages.Symptoms of early development of gonarthrosis vary widely and are not specific.

In the first stage of the pathology, the following signs are possible:

  1. knee pain when squatting or walking up stairs;
  2. joint pain after prolonged exercise or cooling;
  3. the knee may hurt at the end of the day or in the morning;
  4. stiffness and pain disappear in the morning after daily work.

After that, the symptoms characteristic of stages 2 and 3 appear (in ascending order):

  • pain becomes acute and long-lasting;
  • swelling in the joint area;
  • fluid may appear in the joint;
  • between the articular surfaces, it is possible to pinch particles of cartilage, meniscus, and synovial villi, which causes sharp immobility (it can also pass suddenly);
  • it is difficult to stand on one's feet;
  • joint immobility develops.

Consequences

If left untreated, the following complications of knee arthrosis may develop:

  • Joint deformity.In fact, joint deformation is more likely not a complication, but the last stage of the disease.
  • Infection in the joint.Infection usually occurs due to microtrauma.They can be considered small cracks in the cartilage tissue.Pathogenic microorganisms are introduced into the joint through the flow of blood or lymph from other areas.This often occurs after infectious diseases.
  • Dislocations and fractures.These complications are explained by knee joint dysfunction.In arthrosis, there is not an even distribution of the load from the femur to the lower leg bones.The ligaments that normally strengthen the joint also weaken.Therefore, at a certain moment (even during normal walking), the bones of the lower leg can be exposed to excessive stress, which will lead to a fracture or dislocation.To avoid this, people with severe structural and functional damage in the knee joint should move with the help of crutches or a cane.
  • Ankylosis.Ankylosis is the joining of two bones where a joint used to be.This complication is perhaps the most difficult, because the joint simply disappears.The tibia and femur are gradually joined, and the tibia is fixed in one position.Movement is, of course, impossible.

Diagnostics

To diagnose gonarthrosis, use:

  • blood tests (general and biochemical);
  • radiography;
  • arthroscopy;
  • Ultrasound;
  • MRI.

The most important diagnostic method for confirming the diagnosis of gonarthrosis is radiography.Although it is not possible to examine the initial stage of the disease and the condition of the cartilage tissue on X-rays, bone changes of the 2nd and 3rd stages are still clearly visible.this:

  1. narrow joint space;
  2. edge spines located along the bone contour, edges of the patella - osteophytes;
  3. changes in the periosteum;
  4. change in height of one of the condyles and others.

However, the changes can be examined in more detail using arthroscopy.

Ultrasound and MRI help detect changes in the soft tissues of the knee joint during early arthrosis.These methods also give a good indication of the condition of cartilage tissue, synovium and fluid.

How to treat arthrosis?

Treatment of arthrosis of the knee joint is long and sometimes painful.The duration is due to the fact that once the disease is manifested, it will be constantly reminded as long as the person is alive.

Therefore, proper treatment of gonarthrosis requires a fairly strong financial basis and discipline.An important role is played by how seriously the patient takes the treatment, because often, in order to reduce the frequency of exacerbations of the disease, the patient is forced to change his daily activity, his favorite profession, engage in joint development, stop smoking and drinking alcoholic beverages.

There are three main stages in the treatment of deforming arthrosis of the knee joint.

The first phase of treatment includes:

  • communicating to patients the essence of their disease, risk factors and secondary prevention measures;
  • daily gymnastics with elements of stretching;
  • contrast shower;
  • swimming in the pool 2-3 times a week;
  • weight loss.

The second phase of treatment includes:

  • external fixation of the joint using jaws, bandages, elastic bandages and orthoses;
  • use of ointments and creams based on non-steroidal anti-inflammatory drugs to relieve inflammation and pain;
  • the use of drugs from the group of chondroprotectors to reduce the rate of cartilage destruction.

The third stage of treatment includes:

  • course of oral use of NSAIDs;
  • intra-articular injections with hormonal anti-inflammatory drugs;
  • additional use of drugs with pronounced analgesic effect;
  • surgical replacement of the diseased joint with an implant.

In addition to drug treatment, modern medicine uses methods such as:

  1. Kinesitherapy.In this case, the treatment of arthrosis of the knee joint is carried out using special exercises.The load is chosen in accordance with the degree of development of the disease and the physical fitness of the individual patient.
  2. Ozone therapy.This is the effect of ozone on a painful knee joint.With this method of physiotherapeutic treatment, the substance can be given by injection or used externally.
  3. dietary supplement.Biologically active supplements are a worthy alternative to other drugs.
  4. Homeopathy.It involves taking medication in small doses.The course of treatment lasts only a few weeks, but during this time, provided that the drugs are chosen correctly, blood circulation and normal nutrition of cartilage tissue cells are completely restored.
  5. Exercisesthey allow you to improve blood circulation in the knee joint, restore the elasticity of the ligaments, improve the nutrition of cartilage tissue cells and stimulate its renewal.

Drug treatment

All drugs used in the treatment of gonarthrosis can be divided into those that help eliminate the main symptoms of the disease and those that restore the function of the knee joint and prevent the progression of the pathology.The first type of medication includes non-steroidal anti-inflammatory drugs and hormonal drugs.The second group includes chondroprotectors and hyaluronic acid.

Nonsteroidal anti-inflammatory drugs

Treatment of arthrosis with drugs begins with the removal of pain.They are the ones who cause the patients the greatest moral and physical suffering and lead to the loss of working ability.Nonsteroidal anti-inflammatory drugs (NSAIDs) have worked well among pain relievers.

Medicines can be used in two ways - locally or orally (in tablets).Topical treatments (preferred) often include patches, ointments or gels.As a rule, the analgesic effect occurs in 3-4 days, and its maximum develops up to 7-10 days.

The course of treatment with non-steroidal drugs should be limited to 10-14 days.Nonsteroidal anti-inflammatory drugs have a limited range of application and are used with great caution in the treatment of elderly patients.

Hormonal drugs

In cases where NSAID treatment is not enough and the disease continues to progress, the doctor may prescribe hormonal injections.They belong to the "heavy artillery" and help to quickly relieve pain, relieve inflammation and swelling of the surrounding tissues.

Due to the large number of side effects, hormonal drugs are prescribed in short courses, only in the acute period of the disease, when inflammatory fluid accumulates in the joint cavity.The drug is applied to the joint space no more than once every 10 days.

Chondroprotectors

In order to prevent further destruction of the cartilage surfaces of the joint, chondroprotectors are prescribed.

These medications also help reduce pain and reduce signs of inflammation in the surrounding soft tissue.In addition, chondroprotectors slow down the destruction of joint tissues and stabilize the disease due to their function of cushioning and lubrication.Chondroprotectors improve cartilage nutrition, normalize the composition and properties of intra-articular fluid, protect pain receptors from excessive irritation.

Hyaluronic acid

Hyaluronic acid is called a liquid intra-articular fluid prosthesis.Its properties are similar to natural synovial (intra-articular) fluid, which nourishes cartilage tissue and softens the knee joint during movement.

Hyaluronic acid preparations are injected into the joint, creating a thin protective film that prevents the cartilage surfaces from rubbing against each other.Injections are carried out only after the acute phase of the disease has passed.

Exercise therapy and exercises for arthrosis

Physical exercises help restore joint function and strengthen it.They should be performed slowly and carefully so as not to cause sprains and not to exceed the permissible load.

The following exercises are considered the most effective:

  1. Slowly raise your straight legs one at a time while lying on your stomach.This exercise uses the muscles of the thighs and calves.The burden should not be allowed to be transferred to the back.The legs should not be raised too high either.The main thing is to tense the muscles in the upper point;
  2. This exercise is similar to the first one, only now you need to raise the leg with the knee bent.In the upper point, the thigh muscles should be additionally tightened.The exercise must be performed the same number of times on each leg;
  3. Lying on the floor (on your stomach), lift your straight legs up, then spread them apart and bring them together.This exercise requires strong, trained abdominal muscles, so it is not suitable for all patients.In addition, its performance can increase blood pressure.For patients suffering from hypertension or other diseases of the cardiovascular system, it is better to avoid it;
  4. To perform the following exercise, you need to lie on your side, bend the leg lying on the floor at the knee, and slowly raise the other leg and hold it at the top point.It is important that the angle of execution on each leg is the same;
  5. You will need a chair for this exercise.Sitting on it, the legs are straightened one by one, raised and held for the maximum possible time in the straightened position;
  6. It is useful to stand on your toes holding the back of a chair or bed.As with other exercises, you need to stay at the top point for a few seconds and additionally strain the leg muscles;
  7. Smooth movement from toe to heel allows you to activate blood circulation in the lower extremities.Such movements should be performed alternately: while one foot rests on the toe, the other on the heel and vice versa.All movements must be smooth;
  8. Leaning on the back of a chair or bed, stand on your heels for a minute, lifting your toes up.If you cannot stand in this position for a certain time, you should start with less, gradually increasing it;
  9. Massage performed in a standing position.The legs should be rubbed with strong movements directed from the knees to the thighs.The massage should be finished by caressing the skin.

The doctor will conduct several sessions in the office and demonstrate basic techniques so that the patient can massage the problematic knee by himself.Competent procedures improve the condition of the damaged area.

Massage and self-massage

Perform self-massage with the palm, edge of the palm, fingertips or fist.Gently act on the painful knee, maintain strong pressure on the affected area: strong patting, blows, active kneading of the tissue often worsen the condition.

Basic techniques:

  • the first phase is a gentle movement in the clockwise direction, the second phase is circular movements in the counterclockwise direction;
  • Press one palm on the painful knee, gently tap it with the fingertips of the other hand;
  • keep the initial position of the palm, tapping not with the fingers, but with the edge of the palm;
  • gently stroke the knee in a circle, gradually increasing the pressure (but moderately);
  • During the therapy, massage the affected area twice a day for 10-15 minutes.For preventive purposes, it is enough to do a light massage once every 7 days.

Before the procedure, apply an anti-inflammatory ointment or gel to the painful knee.

Physiotherapy treatment

All physiotherapy methods can be divided into several groups:

  1. Pain reduction;
  2. Reducing inflammation;
  3. Restoring nutrition to the joint and accelerating the restoration of joint function.

A doctor can determine what type of treatment a patient needs based on existing symptoms and co-morbidities.

Arthrosis surgery

Surgical treatment refers to radical methods that partially or completely restore the functioning of the knee joint.Surgical treatment methods differ from each other in the degree of intervention in the affected joint.

  1. Arthroscopyrefers to the gentlest methods of surgical treatment.This technique is less traumatic and can be used as a therapeutic measure even in the early stages of arthrosis.Its main goal is to prolong the life of the damaged joint.Arthroscopy is performed with an endoscope - a flexible probe with a camera at the end.Small punctures are made in the knee joint through which the endoscope and auxiliary instruments are inserted.During the operation, damaged areas of tissue that cause pain are removed.The operation is most suitable for young people and can be repeated several times if necessary.
  2. Endoprostheticsrefers to the most radical surgical techniques.In this case, the function of the joint is completely restored by replacing the entire knee joint or part of it with an implant.This method is the best alternative to the current technique - arthrodesis (complete immobilization of the damaged joint).Currently, endoprosthesis replacement gives up to 90% positive results and significantly improves the quality of life of patients.
  3. OsteotomyIt is applied when significant deformations have developed in the joint and when the function of the joint is noticeably impaired.An osteotomy involves creating an artificial bone fracture at a pre-planned location.After that, the pieces of bone are aligned in the correct, physiological position and allowed to grow together.Sometimes during the operation, artificial fixators of bone fragments can be used, which contribute to a more stable position of the bone.

Folk remedies

Traditional medicine will also help you in this.The use of various lotions to relieve swelling and pain has been practiced by many patients for a long time.Here are some useful recipes:

  1. Thistle leaves.Take 5 burdock leaves and hold them over boiling water to steam.Lubricate the painful knee with vegetable oil and apply the burnt leaves.Wrap the leg in cling film and a warm scarf.Leave the lotion on for a few hours.
  2. Cabbage leaf lotion.It is made from fresh cabbage leaves soaked in May honey and applied to the leg.The therapeutic effect is enhanced by insulation from wool fabric or plastic film.This product is suitable for people of all age groups.
  3. Egg shells, kefir.Grind the shells of 2 eggs and mix with 1 spoon of kefir.Apply the mixture to the knee, wrap it with a cloth and transparent film and lie under a blanket.Leave it like that for several hours, and then wash off the composition with water.This treatment can be used daily.
  4. Horseradish compress.According to this folk recipe, in order to improve the medicinal properties of horseradish, it is recommended to first crush it and boil it.It must then be applied to the affected area.
  5. Turpentine– an excellent tool for warming up painful joints.The knee is rubbed with turpentine before going to bed and tied with a woolen scarf.Already after the first procedure, the patient experiences significant relief.The course of treatment is chosen individually for each person.

Diet

Therapeutic diet implies avoiding or minimal consumption of canned, smoked and fried food (to suppress appetite).In order to restore damaged cartilage, it is necessary to provide the body with complex carbohydrates (porridges, wholemeal flour products).Juices (carrot, beetroot, apple) should also be included in the diet.They will remove toxins from the body and reduce the impact of inflammatory processes.

The diet should include fish and aspic, which act as a kind of chondroprotector and help create new cartilage.It is worth remembering that you cannot prescribe a diet for yourself - only a nutritionist (nutrition specialist) can choose the best option.

Sample menu:

  • Breakfast: oatmeal with water without butter or sugar, fruit juice, boiled egg;
  • Second breakfast: a glass of low-fat natural yogurt;
  • Lunch: steamed meat or fish, stewed vegetables, tea without sugar;
  • Afternoon snack: cottage cheese casserole with walnuts, a glass of fruit juice;
  • Dinner: vegetable salad, apple, tea without sugar;
  • Second dinner: a glass of low-fat kefir.

Prevention

Prevention of joint diseases:

  • dose the load on the legs during active sports;
  • create a diet that includes foods and dishes that contain calcium, magnesium, gelatin;
  • if the work involves lifting or moving heavy objects, follow safety rules and do not carry loads that exceed a certain limit;
  • Do regular self-massage to prevent arthrosis, especially with constant stress on the legs;
  • eat right, limit "harmful" food;
  • body weight control (excess weight means additional stress on the joints);
  • Go for regular check-ups and treat acute and chronic diseases.

Forecast

Provided that arthrosis of the knee joint is diagnosed in the early stages, the cause of the pathological process is eliminated and adequate treatment is provided, the prognosis is favorable.The proposed therapy makes it possible to achieve long-term remission, but the treatment is usually lifelong.

In the absence of the necessary treatment, as well as when the patient does not follow the doctor's instructions, arthrosis of the knee joint becomes a cause of disability.