The disease begins with changes in the articular cartilage, due to which the joint surfaces of the bones slide.Malnutrition and loss of elasticity lead to its degeneration and resorption, while the bone tissue in the joint surfaces is exposed, gliding deteriorates, the joint space narrows, and the biomechanics of the joint changes.The synovium lining the joint and producing synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) is irritated, leading to an increase in its amount in the joint (synovitis).Against the background of narrowing of the joint space, the volume of the joint decreases, the synovial fluid protrudes from the back wall of the joint capsule, and a Becker cyst is formed (which, when it reaches a large size, can cause pain in the popliteal fossa).
The thin and delicate tissue of the joint capsule is replaced by rough connective tissue, and the shape of the joint changes.The periarticular bone tissue grows, osteophytes (pathological bone growth) are formed.Blood circulation in the periarticular tissues is disturbed, underoxidized metabolic products accumulate in them, irritating chemoreceptors and persistent pain syndrome develop.Against the background of changes in the anatomy of the joint, disturbance of the function of the surrounding muscles occurs, hypotrophy and spasms appear, and gait is disturbed.A persistent restriction of movement in the joint (contracture), sometimes so pronounced that only rocking movements (stiffness) or complete lack of movement (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the entire world's population, and over the age of 60 it affects every third person.
Causes of gonarthrosis
- Damage to bones and joints.
- Inflammatory joint diseases (rheumatoid, arthritis).
- Disturbances in mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular system and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower limbs);
- age (mostly older people are affected by the disease);
- female gender (statistically, women get sick more often);
- increased sports and professional physical activity.
Symptoms of osteoarthritis in the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulties with habitual, physiological movements in the joints.
- A characteristic "crunch" in the joints.
- Increase in the size of the joints and their visible deformation.
Stages of gonarthrosis
Clinical stages of osteoarthritis of the knee joint.The disease goes through several stages.
- In the first stage, a person feels only a slight feeling of discomfort or "heaviness" in the knee, which is disturbing when walking long distances or increased physical activity.An X-ray examination will be uninformative: only a slight narrowing of the joint space can be detected, there will be no other changes.At the onset of the disease, a person does not turn to specialists and does not pay much attention to the symptoms that appear.
- The second phase is characterized by noticeable pain, the severity of which decreases with rest.Difficulty moving the joints appears, and a characteristic "creaking" is heard when walking (from the patient you can hear a common phrase in everyday life: "knees creak").Radiographs reveal a clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis moves to the next, third stage, pain will constantly bother the patient, including at rest, and a disturbance in the configuration of the joints occurs, that is, deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate narrowing of the joint space and multiple osteophytes.At the third stage, many people already seek medical help because... the quality of life suffers significantly due to pain and difficulty walking normally.
- The fourth stage is accompanied by unabated, debilitating pain.Minimal attempts to move become a difficult trial for a person, deformation of the joints is visually noticeable, and walking is extremely difficult.X-ray reveals significant changes: the joint space is practically not defined in the images, several coarse osteophytes, "articular mice" (fragments of deteriorated bone falling into the joint cavity) are revealed.This stage of gonarthrosis almost always causes disability: often the result of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who treats osteoarthritis of the knee joint?
Qualified medical care for gonarthrosis can be provided to the patient by a therapist, rheumatologist and general practitioner (family doctor), but these specialists treat the knee joint with uncomplicated arthrosis.When synovitis occurs, or the treatment prescribed by the therapist does not produce the desired effect, then you cannot do without the help of an orthopedist.In situations where surgical treatment is required, the patient is sent to a specialized orthopedic and trauma department.
How and with what should you treat osteoarthritis in the knee joint?
Currently known methods of treating osteoarthritis of the knee joint are divided into non-medical conservative, medical and surgical.
Non-drug methods
Many patients ask the question: "How to cure osteoarthritis of the knee joint without pills?"In answering this question, we regret to state that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many currently existing non-pharmacological methods to combat this disease can significantly slow its progression and improve the patient's quality of life, especially when used in the early stages of the disease.If you consult a doctor in a timely manner and the patient is sufficiently motivated to heal, sometimes it is enough to eliminate negative factors.For example, it has been proven that losing excess weight reduces the manifestation of the main symptoms of the disease.
Eliminating pathological physical activity and, on the contrary, doing therapeutic exercises using rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have comparable effects to anti-inflammatory medications.
If we treat osteoarthritis of the knee joint, then we must strive for proper nutrition: products containing large amounts of animal collagen and chondroitin (shrimp, crabs, krill), fresh vegetables and fruits rich in plant collagen and antioxidants will help improve the elastic properties of the joint cartilage, and a passion for smoked meat, preservative dishes, preservative dishes, sweet dishes, preservatives.reinforces metabolic disorders in the body and accumulation of excess weight to obesity.
When thinking about what is the most effective treatment for knee arthrosis, it is worth remembering such an effective treatment and prevention method as orthosis: fixation of knee protectors, orthoses, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thereby reducing the intensity of pain in it.
Comprehensive treatment of arthrosis of the knee joint also involves the appointment of very effective physical procedures, even in advanced forms of the disease.When it is widespread in different categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after just a few procedures, pain intensity decreases, as a result of improved blood circulation, reduced swelling and elimination of muscle spasms, joint mobility increases.The effect of magnetic therapy is especially pronounced when active inflammation of the joint develops: the severity of edema decreases significantly and the symptoms of synovitis regress.Not so popular, but no less effective for the treatment of the knee joint with arthrosis, are such methods of physiotherapy as laser therapy and cryotherapy (cold exposure), which have a pronounced pain-relieving effect.
Medical treatment
Non-steroidal anti-inflammatory drugs (NSAIDs), available in forms for external (various gels, ointments) and systemic use (tablets, suppositories, solutions), have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling and slow the progression of the disease.For early manifestations of the disease, local use of these drugs in combination with non-medical methods is effective.But with advanced osteoarthritis in the knee joints, you cannot do without pills.It should be remembered that long-term systemic use of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, negatively affect the functioning of the kidneys and liver.Therefore, patients taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor laboratory parameters of the functioning of internal organs.
In the case of advanced, "advanced" osteoarthritis, when a person experiences excruciating pain that does not subside even at rest, disturbs normal sleep and is not relieved by NSAIDs, corticosteroids and non-medical methods, it is possible to prescribe opioid pain relievers.These medicines are used only on the prescription of a doctor who considers it advisable to prescribe them in each individual case.
Chondroprotectors (literally translated as "protect cartilage").This name refers to different drugs, united by one property - a structure-modifying effect, i.e.the ability to slow degenerative changes in cartilage and narrowing of the joint space.They are produced in forms both for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these medications do not perform a miracle and do not "grow" new cartilage, but they can stop its destruction.To achieve a lasting effect, they must be used for a longer period of time, on fixed courses several times a year.
Surgical treatment of osteoarthritis in the knee joints
There are often cases where the disease progresses despite sufficiently comprehensive treatment, steadily reducing a person's quality of life.In such situations, the patient begins to ask questions: "what to do if the prescribed medicine does not help with arthrosis of the knee joint?", "Is surgical treatment indicated for the knee joint?", "How is arthrosis of the knee joint treated surgically?"When answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are intractable pain syndrome and significant dysfunction of the joint, which cannot be eliminated by the use of complex conservative therapy.
The most popular form of surgical treatment for gonarthrosis is endoprosthetics, i.e.removal of one's own joint with immediate installation of a metal prosthesis to replace it, the design of which resembles the anatomy of the human knee joint.At the same time, a prerequisite for performing this type of surgical treatment is the absence of gross deformities of the joint, formed "false joints", muscle contractures and pronounced muscle atrophy.
In case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics is also not indicated: the "sugar" bone will not withstand the introduction of metal pins, and rapid resorption of bone tissue begins at the site of their installation, and pathological fractures may occur.Therefore, a timely decision on the need to install an endoprosthesis seems so important - it should be taken when the age and general condition of the human body still allows the operation to be performed.According to the results of long-term studies, the duration of the effect of endoprosthetics, i.e.the temporary duration of absence of significant motor limitations and maintenance of a decent quality of life around ten years.The best results of surgical treatment are seen in people aged 45-75 years with a low body weight (less than 70 kg) and a relatively high standard of living.
Despite the widespread use of knee arthroplasty, the results of such operations are often unsatisfactory and the rate of complications is high.This is due to the design features of endoprostheses and the complexity of the surgical procedure itself (hip replacement is much simpler in technical terms).These include arthromedullary bypass surgery and corrective osteotomy.Arthromedullary shunting is a connection of the medullary canal of the femur with the cavity of the knee joint using a shunt - a hollow metal tube.Thanks to this, fatty bone marrow from the lower third of the femur enters the knee joint, nourishes the cartilage and lubricates it, thereby achieving a significant reduction in pain.
When the axis of the lower limb is changed (but with the condition of a small limitation of the range of motion), corrective osteotomy is effective - cutting the tibia with correction of its axis, followed by fixation with a plate and screws in the desired position.In this case, two goals are achieved - normalization of biomechanics due to restoration of the limb axis, as well as activation of blood circulation and metabolism during bone fusion.And although medicine today is not able to offer a drug that will get rid of it forever, or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its development.