Osteoarthritis of the knee joints (aka gonarthrosis or abbreviated DOA)Degenerative-dystrophic disease of the knee joint, characterized by a chronically stable progressive course, with damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and ligaments of the knee) and causes joint deformity with frequent movement and reduced dip.
The disease begins with a change in the articular cartilage, causing the articular surfaces of the bones to slip. Inadequate nutrition and loss of elasticity lead to its dystrophy (thinning) and resorption, while the bone tissue of the joint surface is exposed, movement is impaired, knee joint defects are narrowed, joint biomechanics are changed. The synovial membrane, which covers the joint and produces synovial fluid (which nourishes the cartilage and performs physiological lubrication) causes irritation, which leads to its numberGrowth in the joint (synovitis). Against the background of narrowing of the joint space, the volume of the joint decreases, synovial fluid protrudes from the posterior wall of the joint capsule and forms a Becker cyst (which reaches large size, can cause pain in the popliteal fossa). Periarticular bone tissue grows, osteophytes (abnormal bone formations) are formed. Blood circulation in the periarticular tissues is impaired, they accumulate a lack of irritating metabolism of chemoreceptors and develop persistent pain syndrome. Against the background of changes in the anatomy of the joint occurs disruption of the surrounding muscles, there is hypotrophy and spasm, and gait is impaired. There is a permanent limitation in the range of motion in the joint (contracture), sometimes so pronounced that only shaking movements (stiffness) or complete absence of movements (ankylosis) are possible.
Regarding osteoarthritis of the knee joint, we can say that it is quite a common disease: it affects 10% of the total population of the planet, and people over the age of 60 - every third person.
Causes of gonarthrosis
- Injuries to bones and joints.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the musculoskeletal system and neuropathy (Charcot's disease).
In addition to the main causes, there are unfavorable factors for the development of gonarthrosis, which include:
- Excess weight (literally puts pressure on the lower extremities);
- Age (mostly older people are susceptible to the disease);
- Female sex (according to statistics, women get sick more often);
- Increased sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- The pain increases while walking and decreases during rest.
- Difficulty with normal, physiological movements in the joints.
- The characteristic "crunch" in the joints.
- Joint enlargement and visible deformation.
Stages of gonarthrosis
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There are several stages of osteoarthritis:
- In the first stage, a person experiences only symptoms such asSlight discomfortOr "heaviness" in the knee, annoying when walking long distances or with increased physical activity. X-ray examination will be small information: only a small narrowing of the joint space can be detected, there will be no other changes. At the beginning of the defeat of osteoarthritis of the knee joint, a person does not turn to specialists, without attaching special importance.
- For the second stage of osteoarthritis of the knee joint,Tangible pain, Whose severity decreases during rest. Difficulty moving in the joints occurs when a characteristic "crack" is heard while walking (from the patient you can hear the usual phrase in everyday life - "knees rot"). On radiography, there is a noticeable narrowing of the joint space and single osteophytes.
- After gonarthrosis, with the transition to the third stage,Symptoms of pain constantly bother the patient, Including during rest, there is a violation of the configuration of the joints, e. ი. Deformation, exacerbated by swelling at the junction of inflammation. Radiography reveals moderate narrowing of the joint space and multiple osteophytes. In the third stage, many are already seeking medical help because the quality of life is significantly affected by pain and difficulty walking normally.
- It accompanies the fourth stage of knee joint arthrosisIrresistible, exhausting pain. . . Minimal attempt to move becomes a difficult test for a person, deformation of the joints is noticeable visually, walking is extremely difficult. Radiography reveals significant changes: the space of the joints is practically invisible in the images, revealing numerous rough osteophytes, "joint mice" (fragments of bone falling into the joint cavity). This stage of gonarthrosis almost always leads to disability: often the disease results in 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 by a therapist, rheumatologist and general practitioner (family doctor), but these specialists have been able to treat the knee joint in uncomplicated arthrosis.
When synovitis occurs or treatment prescribed by a therapist does not give the desired effect, then it can not be done without the help of an orthopedist. In situations where surgical treatment is required, a patient with osteoarthritis of the knee is referred to a special orthopedic and traumatology department.
How and how to treat osteoarthritis of the knee joint?
Currently known methods of treating patients with osteoarthritis of the knee are divided into non-medical conservative, medical and surgical methods.
No drugs
Many patients ask themselves the question: "How to deal with osteoarthritis of the knee joint without pills? " To answer it, we must regret that gonarthrosis is a chronic disease, it can not be eliminated forever. However, a number of pharmacological methods of dealing with this disease (i. e. without the use of medication) can significantly slow its progression and improve a patient’s quality of life, especially when used in the early stages of the disease.
With a timely visit to the doctor and sufficient motivation to heal the patient, sometimes it is enough to eliminate the negative factors. For example, it has been proven that losing excess weight reduces the manifestation of the main symptoms of the disease.
Eliminate abnormal physical activity and, conversely,In therapeutic gymnasticsBy using rational physical programs, they reduce the intensity of pain. Quadriceps thigh bone strengthening exercises have been shown to be relatively effective with anti-inflammatory drugs.
If we are treating osteoarthritis of the knee joint, then aspiration is essentialProper nutritionTo improve the elastic properties of articular cartilage, the products contain a large amount of animal collagen (dietary types of meat and fish) and cartilage components (shrimp, crabs, krill), fresh vegetables and fruits saturated with plant collagen, antioxidantsAnd salty foods, on the contrary, enhances the disruption of metabolic processes in the body and the accumulation of excess weight leading to obesity.
Considering the most effective treatment for knee osteoarthritis, we must remember such an effective treatment and prophylactic method asOrthotics: Fixing knee pads, orthoses, elastic bands and orthopedic braces reduces and distributes the load correctly on the joint, thus reducing the intensity of pain in it. The use of a walking stick is also recommended as an effective relief for knee joints. It should be on the affected limb opposite the hand.
Comprehensive treatment of osteoarthritis of the knee also involves the appointment of very effective, even advanced forms of the diseasePhysiotherapy. . . It has proven its effectiveness when widely used in various categories of patients with osteoarthritisMagnetotherapy: After several procedures the pain intensity decreases, joint mobility increases as blood circulation improves, swelling decreases and muscle spasm is eliminated. The effect of magnetotherapy is especially pronounced with the development of active inflammation in the joint: the severity of the swelling is significantly reduced, the symptoms of synovitis are reduced. Not so popular, but no less effective for the treatment of osteoarthritis of the knee joint, are physiotherapy methods such asLaser therapyAndCryotherapy(Exposure to cold), which have a pronounced analgesic effect.
Drug treatment
The following drugs are used in effective treatment regimens for osteoarthritis of the knee joint.
Nonsteroidal anti-inflammatory drugs (NSAIDs)MadeIn external (various gels, ointments) and systemic forms (tablets, suppositories, solutions), their effectiveness in the treatment of osteoarthritis has long been proven and is widely prescribed by physicians. By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling and slow the progression of the disease. With early detection of the disease, topical use of these medications in combination with non-therapeutic methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, injections of pills and sometimes nonsteroidal anti-inflammatory drugs are necessary. It should be borne in mind that long-term systemic intake of nonsteroidal anti-inflammatory drugs can lead to the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, adversely affect the work of the kidneys and liver. Therefore, patients who have been taking nonsteroidal anti-inflammatory drugs for a long time should also be prescribed medications that protect the gastric mucosa and regularly monitor the laboratory work of internal organs.
Glucocorticosteroids (GCS)- Hormonal drugs with pronounced anti-inflammatory effect. They are recommended when previously prescribed nonsteroidal anti-inflammatory drugs for patients do not manage to eliminate the manifestations of inflammation. As a potent anti-inflammatory agent, GCS has some contraindications in the treatment of osteoarthritis as they can cause a number of important side effects. In systemic forms of gonarthrosis they are practically not established. Typically, effective treatment for osteoarthritis involves GCS injections at the periarticular pain points, which increases the intensity of the fight against inflammation and reduces the risk of unwanted side effects of the drug. This manipulation can be performed by a rheumatologist or trauma specialist. With concomitant synovitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single dose of GCS, the effect of such treatment lasts up to 1 month. According to the National Osteoarthritis Treatment Guidelines, do not inject more than three medications into the same joint per year.
With advanced, "neglected" osteoarthritis, when a person experiences unbearable pain that does not subside even at rest, disrupts normal sleep, and is not relieved by nonsteroidal anti-inflammatory drugs, GCS and non-medical methods, it is possible to prescribeOpioid analgesics. . . These drugs are used only with a doctor's prescription, which in each case considers the appropriateness of their appointment.
Chondroprotectors(Literally translated as "cartilage protection"). This name is understood as a different remedy, combined with one feature - structural-modified action, e. ი. Ability to slow down degenerative changes in cartilage tissue and narrow the joint space. They are produced in the form of both for oral administration and for entry into the joint cavity. Of course, these drugs do not work wonders and do not "grow" new cartilage, but they can stop its destruction. To achieve a long-lasting effect, they should be used for a long time, at regular courses several times a year.
Surgical treatment of osteoarthritis of the knee joints
There are frequent cases when, despite adequate complex treatment, the disease progresses, steadily reducing the quality of human life. In such situations, the patient begins to ask questions: "What should be done if the prescribed medication does not contribute to osteoarthritis of the knee joint? " "Is surgical treatment indicated for osteoarthritis of the knee? "Significant joint dysfunction that cannot be eliminated by using complex conservative therapy, possibly the last, fourth degree disease.
It is the most popular type of surgical care for third and fourth degree arthrosisEndoprosthesis, E. ი. Removal of one's own joint by simultaneous installation of a metal replacement prosthesis, the design of which is similar to the anatomy of the human knee joint. In this case, a prerequisite for this type of surgical treatment is: gross deformity of the jointAbsence, formed "false joints", muscle contracture and severe muscle atrophy. In case of severe osteoporosis (significant reduction of bone mineral density), endoprosthetics are also not indicated: the "sugar" bone can not withstand the introduction of metal pins and at the site of their installation will begin rapid resorption (resorption) of bone tissue, abnormal fractures may occur. Thus, a timely decision about the need to install an endoprosthesis seems to be so important - it must be made when the age and general condition of the human body still allow for surgery. According to the results of long-term studies, the duration of the endoprosthetic effect in patients with advanced arthrosis, e. g. ი. The temporary duration of the absence of significant motor limitations and a decent quality of life is about ten years. The best results of surgical treatment are observed 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 surgeries are often unsatisfactory and the complication rate is high. This is due to the design features of the endoprosthesis and the complexity of the surgical intervention itself (hip replacement is much easier technically). This dictates the need for organ protection operations (fundraising). These include arthromedular bypass surgery and corrective osteotomy.
Arthromedular bypass- Connection of the medullary canal of the thigh to the knee joint cavity using a shunt - hollow metal tube. This allows fatty bone marrow from the lower third of the thigh to enter the knee joint, nourishing and lubricating the cartilage, thereby significantly reducing pain.
When changing the lower extremity axis (but with a slight limitation of the range of motion), it is effectiveCorrective osteotomy- Cross the shin bone by correcting its axis, followed by fixation with a plate and screws in the desired position. At the same time, two goals have been achieved - the normalization of biomechanics due to the restoration of the limb axis, as well as the activation of blood circulation and metabolism during bone fusion.
Summarizing all the above, I would like to point out that the treatment of gonarthrosis is a difficult social task. And while medicine today may not offer a cure that will get rid of it forever, or other ways to completely cure this disease, a healthy lifestyle, seeking timely medical care, and following your doctor’s recommendations can stop its progression.