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Knee arthritis

Osteoarthritis of the knee (knee osteoarthritis, degenerative joint deformity)

Osteoarthritis of the knee is a disease of the musculoskeletal system, including the deformation and destruction of the cartilage tissue of the joint, so the structure and function of the cartilage is disturbed. This disease has several names - gonarthrosis, osteoarthritis deformity. There is no one clear plan or single medication that can help all people with the problem in the same way. Since arthropathy is a progressive disease, it is commonly observed in overweight women, venous disease, and the elderly. Treatment is manufactured and prescribed individually for each patient.

Knee osteoarthritis can be unilateral or bilateral (depending on whether the disease develops in one or both legs). At the first symptoms, adequate treatment is required, since ignoring this problem can lead to the eventual destruction of the exposed cartilage and bone and, as a result, a person's disability.

There are three stages of the disease:

  1. The initial stage of knee effusion is characterized by loss of cushioning properties and as a result, the cartilages rub against each other during movement, causing severe discomfort to the patient. In the advanced stages of the disease, the cartilage becomes rough, deformed, dries out - even becomes covered with cracks.
  2. Due to the decrease in value, bone deformation begins, which leads to the formation of osteoblasts (growths on the surface of the bone) - this is the second stage of the disease. The synovial membrane of the joint and the joint capsule are also deformed, the knee joint gradually atrophy due to stiff movement. There are also changes in the density of joint fluid (becoming thicker, more viscous), circulatory disorders, and impaired ability to provide nutrients to the knee joint. The thinning of the lining between the articular cartilage reduces the distance between the bones.
  3. The disease progresses rapidly and quickly moves to stage 3, the patient is almost unable to move due to constant pain in the knee. Global and irreversible changes occur in the cartilage tissue, resulting in a person's disability.

Usually, joint disease or gonarthrosis develops after an injury or bruise, while a person feels constant severe pain in the knee, which significantly interferes with their movement.

The reasons for the development of joint disease

Knee osteoarthritis, which takes a long time to treat, can manifest itself due to the following factors:

  1. genetic predisposition.
  2. Trauma: dislocation, bruise, fracture. When treating an injured knee, the joint is immobilized and the person is unable to bend and flex the leg for a certain period of time. This leads to a decrease in blood circulation, which often causes the development of post-traumatic gonarthrosis.
  3. Cut off the meniscus.
  4. Excessive physical activity that does not correspond to a person's age, leads to trauma or minor trauma, as well as hypothermia of the joints. For example, running on asphalt or squatting is not recommended for older people, because in these exercises, the knee joint will create a significant amount of pressure, causing the knee joint to wear down with age and become unbearable. so loaded.
  5. Overweight and obesity. This factor leads to damage to the meniscus, injuries that cause the development of knee osteoarthritis.
  6. Loose or weak ligaments.
  7. Arthritis or other acquired joint diseases. The inflammatory process can cause synovial fluid accumulation in the joint cavity or swelling. This causes the destruction of the cartilage tissue of the knee, leading to the dryness of the knee joint.
  8. Metabolic disorders in the human body. Insufficient calcium intake aggravates the condition of bone and cartilage tissues 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 Osteoarthritis of the Knee

The clinical picture of the disease has the following symptoms:

  1. Feel pain. The pain comes on suddenly, depending on the physical load on the knee joint. Pain can be of a different nature. In the early stages, these are weak back pain that patients often do not pay much attention to. Periodic mild pain can be observed for months, and sometimes years, until the disease progresses to a more severe stage.
  2. Visible deformity of the knee. This symptom appears at a later stage. At first, the knee may look swollen or edematous.
  3. Accumulation of synovial fluid in the joint cavity or Baker's cyst. This is a dense formation in the back wall of the knee joint.
  4. Crack the connections. Cracking sounds, accompanied by pain, are observed in patients at the second and third stages of the development of the disease.
  5. Inflammatory response in the joint synovial fluid, as a result of which the cartilage swells and increases in volume.
  6. Reduced joint mobility. seen in later stages. It becomes almost impossible to bend the knee and is accompanied by severe pain. In the final stage, the knee may be completely immobilized. A person's movements become difficult or completely impossible (some patients move with bent legs).

Diagnosis of knee osteoarthritis

If obvious or minor symptoms of knee arthritis appear, it's best to contact an orthopedist or rheumatologist immediately. Diagnosis usually involves taking a patient's history and analyzing their general health. To get a more accurate conclusion, they also resort to X-ray examination or an MRI of the knee. Patients also receive referrals for laboratory tests - general blood and urine tests. Based on the data obtained, the doctor makes a conclusion and prescribes the necessary treatment.

Treatment of knee osteoarthritis

Treatment of knee osteoarthritis needs to be comprehensive. To date, there are no medical drugs that relieve this disorder. One of the most important conditions for successful treatment is a timely diagnosis. The sooner a knee effusion is treated, the more likely it is to prolong remission and prevent destruction and deformation of cartilage and bone tissues.

During treatment, doctors and patients face several tasks:

  1. Eliminate or relieve pain;
  2. Establish the supply of nutrients to the knee joint and thus enhance the restorative function of the knee joint;
  3. Activate blood circulation in the knee joint area;
  4. Strengthens the muscles around the joints;
  5. Increases joint mobility;
  6. Try to increase the distance between the joints.

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

Conservative treatment of arthritis of the knee joint

Anti-inflammatory pain reliever

To alleviate or relieve pain, patients are usually prescribed a course of non-steroidal anti-inflammatory drugs (NSAIDs). It can be pills, ointments and injections. The most common pain relievers can be used in two ways - internally or locally.

Usually, patients prefer topical treatment in the form of gels, ointments, warm patches. The effects of these pain relievers do 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 drugs do not treat the disease, but only relieve the pain syndrome, since it is not possible to initiate treatment to relieve the pain.

Painkillers should be taken according to the doctor's prescription, should only be used for severe pain, because prolonged and frequent use can lead to side effects, even accelerate the destruction of cartilage tissue. of the joint. In addition, with prolonged use of these drugs, the risk of adverse reactions is increased, including gastric ulcer, duodenal ulcer, impaired normal liver and kidney function, and allergic manifestations. Skin reactions in the form of dermatitis may also occur.

Due to the limited scope of use, NSAIDs are prescribed with extreme caution, especially in elderly patients. The average course of taking an NSAID is about fourteen days. As an alternative to non-steroidal drugs, doctors sometimes offer selective drugs. They are usually prescribed for long-term use over a period of weeks to years. They do not cause complications and do not affect the cartilage tissue structure of the knee joint.

Hormonal

Sometimes, in the treatment of arthritis of the knee joint, a course of hormonal drugs is prescribed. They are prescribed if the NSAID has become less effective 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 hormone therapy is usually short and is indicated during severe exacerbations, when inflammatory fluid accumulates in the joints. Hormones are injected into the joint approximately every ten days.

Chondroprotectors

To restore and nourish cartilage tissue in the early stages of the disease, a dose of glucosamine and chondroitin sulfate, called chondroprotectors, is prescribed. It is by far the most effective treatment for osteoarthritis. They have almost no contraindications, and side effects appear in rare cases.

Glucosamine stimulates the restoration of cartilage, improves metabolism, protects cartilage tissue from further destruction, provides it with normal nutrition. Chondroitin sulfate disables enzymes that destroy cartilage tissue, stimulates the production of collagen protein, helps to saturate water in cartilage, and helps keep this substance inside. The effect of chondroprotectors is absent in the final stages of the disease, because of the fact that cartilage tissue has already been destroyed and cannot be restored. The daily dose of glucosamine is 1500 milligrams, chondroitin sulfate is 1000 milligrams. The use of these drugs must be rigorously systematic in order to achieve the desired results. 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, powders, capsules, gels; chondroitin - in ampoules, tablets, ointment, gel. There are also combination preparations including chondroprotectors. There are also so-called third-generation chondroprotectors, which combine a chondroprotector and one of the NSAIDs.

Vasodilators

To reduce spasm of small vessels, improve blood circulation and supply nutrients to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. They are used together with chondroprotectors. If the knee effusion is not accompanied by fluid retention, you should also use ointments, gels, or warm liquids.

Hyaluronic Acid

The second name of this drug is intra-articular translator. The composition of hyaluronic acid is very similar to that of intra-articular fluid. When the drug is injected into the joint, it forms a membrane to prevent the cartilage from rubbing against each other during movement. The course of treatment with hyaluronic acid is indicated only after eliminating the pain and eliminating the exacerbation.

Physical therapy

A course of exercise can be very helpful and produces good results only when prescribed by a doctor and performed under supervision, as recommended by a specialist or trainer. Self-medication is very dangerous to health. Exercise therapy is used as a means of preventing further destruction of cartilage tissue, slowing the development of stiffness, relaxing painful muscle spasms. During exacerbation of exercise therapy is contraindicated. A special course of 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.

Physical therapy

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

Patients need to closely control their diet, as excess weight puts extra 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, simple exercise therapy is necessary. Orthopedists recommend wearing comfortable shoes with special linings, using canes to facilitate movement. There are many techniques developed by experts in the field of rheumatology and orthopedics for the treatment of knee osteoarthritis.

Physiotherapy for pain relief includes:

  1. Medium wave UV irradiation (SUV irradiation). Exposure of UV radiation to the skin of the knee continues until a slight redness occurs. Substances formed in the tissues reduce the sensitivity of nerve fibers, thereby achieving an analgesic effect. The duration of the course of treatment is prescribed by the doctor depending on the symptoms, frequency and intensity of the pain. On average, each treatment session is about 7-8 sessions.
  2. Local magnetic therapy is aimed at the general recovery of the patient's body. This procedure reduces inflammation, eliminates pain, neutralizes muscle spasms. Effectively used for early stage knee osteoarthritis. Treatments are usually limited to 20-25 procedures, each lasting about half an hour.
  3. Infrared laser therapy, low intensity UHF therapy, centimeter wave therapy (CMW therapy).
  4. Ultrasound, darsonvalization, therapeutic baths, interventional therapy, are indicated to improve blood circulation in the joints.

Equally important is the hygienic treatment - convalescence. Such treatment is prescribed for degenerative and dystrophic osteoarthritis. Such treatments, as well as those listed earlier, have their own contraindications, so the attending physician carefully studies the patient's history before recommending a suitable method of convalescence. born to him.

Osteoarthritis of the knee surgery

This is a radical treatment for knee osteoarthritis, helping to restore part or all of the joint function. The method and form of surgical intervention depend on the extent of joint damage, as well as the patient's history.

Late knee osteoarthritis is treated with surgery only - the knee joint is completely or partially replaced with an organ. Surgical treatment allows not only to improve the state of health but also to restore the patient's ability to work in the final stages of osteoarthritis of the knee. A significant drawback of this operation, many consider the prolonged recovery time when using exercise therapy, mechanical therapy, and other means.

There are several types of surgery for osteoarthritis of the knee:

  1. Arthrodesis of the joints. The principle of operation is to fix the lower limb in the most functional position for it and to immobilize the knee joint. Damaged firmware is completely removed. This is a radical method, used in extreme cases. As a result, the pain is gone, but the patient is disabled for life.
  2. Arthroscopic resection. This surgical intervention has a temporary but long-lasting effect. It is used mainly in the second stage of the development of the disease. During surgery, damaged cartilage tissue is removed, thereby eliminating pain. The effect after operation is maintained for two to three years.
  3. Endogenous drugs. The most common treatment for this disease. The knee joint is completely or partially amputated. And in its place is an endocrine made of ceramic, metal or plastic. As a result, the patient restores motor activity, eliminating pain. The effectiveness of the operation has been maintained for more than fifteen to twenty years.

Recovery time

Recovery from such an operation takes about three months. The purpose of recovery is:

  1. Restoration of movement.
  2. Improves muscle and joint performance.
  3. Provides protection for the prosthesis.

The drainage is removed on the second or third day after surgery. Special preparations with a cooling effect are used to eliminate pain. Mobility activity is recommended to begin immediately after drainage is removed. One week later, the patient was transferred to the rehabilitation center. The physiotherapist monitors the patient's condition.

Some time after surgery (about a year), the patient still feels pain, which is caused by compression of the prosthesis. The older the patient, the longer the process of attaching the prosthesis. NSAIDs are prescribed to reduce inflammation and relieve pain. Sometimes doctors prescribe hormonal drugs that ensure a stable effect.

A mandatory item is the exercise routine. Classes should be tailored to each patient and be rigorously conducted on a daily basis. Increase physical activity gradually to avoid injury.

After discharge, the patient must follow some guidelines on how to live further away. Physical activities such as dancing or yoga are allowed six months after surgery. Loads that could damage the prosthesis (fast running, jumping, power sports) are strictly prohibited. After the activity, it is not recommended to lift objects weighing more than 25 kg. In the home where the patient will be staying, all stair rails should be reinforced, shower rails fitted, and all chairs and other furniture checked carefully to ensure usability. By following these simple recommendations, the restoration will last a long time.

Despite compliance with recommendations and prescriptions, post-operative knee sclerosis is most often observed after such surgical interventions (after about 2-3 years).

Prevention of dry joints of the knee joint

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

  1. Proper nutrition and weight loss. It is necessary to exclude harmful foods from your diet - fats, fried foods, alcohol, but it is better to consult a dietician who will help you choose a diet. suitable diet.
  2. When playing sports, monitor the load on the joints, reduce if necessary.
  3. Monitor health and promptly treat infectious diseases, avoiding the disease becoming chronic.
  4. Timely and complete treatment of diseases of the spine, if any, development of correct posture.
  5. Sports activities (cycling, swimming, walking, special exercises for joints).
  6. Do not self-treat! At the first symptoms of knee osteoarthritis, contact the clinic.
  7. Avoid stress, get a good night's sleep.
  8. Systematically increase immunity (strengthen or at least take a course of vitamins 2-3 times a year).
  9. Avoid hypothermia, especially the lower extremities.

A healthy lifestyle and prompt treatment are the best ways to prevent knee osteoarthritis.