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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 damaging effect on the cartilage of the knee joint.

When such a disease arises, the doctor observes a serious disturbance in the process of blood circulation in the bone vessels, as a result of which deformation and destruction of cartilage tissue occurs, the person feels severe pain that prevents the movement of his legs and knees, and observes swelling and changes in the appearance of the knees.

To avoid the development of serious consequences of gonarthrosis (deformation of limbs and ankylosis - joint immobilization), when only joint replacement surgery can help the patient, the disease must be identified and treated immediately.Moreover, do not treat independently with folk methods and advertised drugs, but under the supervision of a qualified doctor.

What is the reason?

The mechanism of arthrosis in medicine is usually divided into:

  • Main- which occurs in old age from the natural aging of body tissues and against the background of several factors that cause this disease, such as obesity (10% of cases), heredity, and increased stress throughout life.
  • Secondary- It accounts for 30% of all cases of knee joint arthrosis;It usually manifests itself after an injury, tibia fracture, torn ligament, or damage to the meniscus.Moreover, with arthrosis of the knee joint, symptoms of the disease in most cases appear after 3-4 years, but after a serious injury, maybe after 2-3 months.

In 50-60% of cases, the cause of arthrosis of the knee joint is muscle spasm of the anterior surface of the thigh.

What happens to the knee joint with arthrosis?

With normal overload, genetic predisposition, metabolic disorders in the body, muscle spasms and prolonged injuries, the knee cartilage loses its smoothness and begins to thin.The gentle sliding of articulated bones is replaced by strong friction, and the first stage of gonarthrosis develops, where the cartilage loses its shock-absorbing properties.

The degradation process continues to develop, and poor shock absorption leads to the bone surface with the formation of osteophytes in the form of bone growth.In this case, the disease already has a second degree and is accompanied by deterioration of the synovial membrane and joint capsule.Lack of pumping atrophy and movement The structure of the knee joint, the consistency of the knee fluid becomes more viscous, the cartilage nutrition process is disturbed, which causes a greater deterioration of the patient's condition.

Thinning cartilage leads to a reduction of the distance between the articulated bones by up to 80%.During walking, due to abnormal friction and the absence of shock absorbers, the destructive process in the joint increases rapidly, this quickly leads to the development of the third stage of arthrosis with symptoms called:

  • 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 sore joint.
  • Severe cases of this disease require the use of crutches or crutches.

The third degree of arthrosis of the knee joint is characterized by an almost complete absence of cartilage tissue, which leads to a decrease in joint mobility to a minimum.Therefore, no magical methods, super medicines or ointments can restore worn-out 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

Stage of arthrosis

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

  • The initial stage, or stage 1, is often called compensation, because there are no obvious clinical signs of pathology.Patients may feel discomfort in the knee after physical activity, which quickly disappears after rest;The joint is still fully functional.
  • With degree 2 arthrosis, subcompensated, the symptoms of the disease are increasing.A clear pain syndrome is formed, which, however, is relieved by topically applied anesthetic ointments and gels.Motor activity is impaired and joint instability appears.In most cases, the patient turns to the doctor at this stage.
  • The 3rd degree, decompensated, can also be called deformation.The knee joint is twisted, unstable, immobile, and completely dysfunctional.The pain syndrome is constant and requires serious medical intervention.To unload the joint and move, one needs crutches.

First Symptoms and Signs

Depending on the severity of the symptoms, the development of the disease is divided into 3 stages.Symptoms of the early development of gonarthrosis are very different and non-specific.

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

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

Next, the characteristic symptoms of stages 2 and 3 appear (in increasing order):

  • The pain becomes acute and prolonged;
  • swelling in the joint area;
  • fluid may appear in the joints;
  • between the articular surfaces, pinching of particles of cartilage, meniscus, synovial villi is possible, as a result of which sharp immobility occurs (it can also pass abruptly);
  • it is difficult to step on your feet;
  • Joint immobility develops.

Consequences

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

  • Joint disability.As a matter of fact, joint deformation is more likely not a complication, but the last stage of the disease.
  • Infection in the joints.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 bloodstream or lymph from other areas.This often happens after an infectious disease.
  • Dislocations and fractures.This complication is explained by knee joint dysfunction.With arthrosis, there is no uniform distribution of the load from the femur to the bones of the lower leg.Ligaments that normally strengthen the joint also weaken it.Because of this, at certain moments (even during normal walking) the bones of the lower leg may be subjected to excessive pressure, which will cause a fracture or dislocation.To avoid this, people with severe structural and functional problems in the knee joint should move with the help of crutches or a cane.
  • Ankylosis.Ankylosis is the fusion of two bones where a joint once existed.This complication is probably the worst, because the joint just disappears.The tibia and femur gradually come together, and the tibia is fixed in one position.Movement, of course, is impossible.

Diagnostics

To diagnose gonarthrosis use:

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

The most important diagnostic method to confirm the diagnosis of gonarthrosis is radiography.Although it is not possible to study the early stage of the disease and the state of cartilage tissue on X-ray, however, stage 2 and 3 bone changes are clearly visible.This:

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

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

Ultrasound and MRI help detect changes in the soft tissue of the knee joint during early arthrosis.This method also provides a good indication of the condition of cartilage tissue, synovium and fluid.

How to treat arthrosis?

Treatment for arthrosis of the knee joint is long and sometimes painful.This period is due to the fact that once the disease has shown itself, it will always remind itself as long as the person lives.

Therefore, to properly treat gonarthrosis, a relatively strong financial and discipline basis is required.An important role is played by how seriously the patient takes the treatment, because often, to reduce the frequency of disease hunting, the patient has to change his daily activities, favorite profession, engage in joint development, stop smoking and drinking alcoholic beverages.

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

The first stage of treatment includes:

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

The second stage of treatment includes:

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

The third stage of treatment includes:

  • use of oral NSAID courses;
  • intra-articular injections with hormonal anti-inflammatory drugs;
  • additional use of drugs with a significant analgesic effect;
  • Surgical replacement of diseased joints with implants.

Along with 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 selected according to the level of disease development and physical fitness of the individual patient.
  2. Ozone therapy.This is the effect on painful knee joints using ozone.With this physiotherapy treatment method, this substance can be administered by injection or used externally.
  3. supplemental food.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 fully restored.
  5. Trainingallows you to improve blood circulation in the knee joint, restore the elasticity of the ligaments, improve the nutrition of cartilage tissue cells, and promote its recovery.

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 development of 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

Drug treatment of arthrosis begins with the elimination of pain.They are the ones who cause the greatest moral and physical suffering to the patient and cause the loss of the ability to work.Nonsteroidal anti-inflammatory drugs (NSAIDs) have worked well among pain relievers.

Medicines can be used in two ways - topically or orally (in tablets).Local (preferred) treatments often include patches, ointments, or gels.The analgesic effect, as a rule, occurs on days 3-4, and the maximum develops on days 7-10.

The course of treatment with nonsteroidal drugs should be limited to 10-14 days.NSAIDs have a limited range of uses and are used with caution in the treatment of elderly patients.

Hormonal drugs

In cases where NSAID treatment is insufficient and the disease continues to progress, the doctor may prescribe hormone injections.They belong to the "heavy artillery" means and help to quickly relieve pain, relieve inflammation and swelling of surrounding tissues.

Due to the many side effects, hormonal drugs are prescribed in short courses, only during the period of acute illness, when inflammatory fluid accumulates in the joint cavity.This medicine is administered to the joint space no more than once every 10 days.

Chondroprotectors

To prevent the destruction of the cartilaginous surface of the joint, chondroprotectors are prescribed.

These drugs also help reduce pain and reduce signs of inflammation in the surrounding soft tissue.In addition, chondroprotectors slow down the destruction of articular tissue and stabilize the disease due to their shock absorbing and lubricating functions.Chondroprotectors improve cartilage nutrition, normalize the composition and properties of intra-articular fluid, and protect pain receptors from excessive irritation.

Hyaluronic acid

Hyaluronic acid is called an intra-articular fluid prosthesis.In its nature, it is similar to the natural synovial (intra-articular) fluid, which nourishes the cartilage tissue and cushions the knee joint during movement.

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

Exercise therapy and exercises for arthrosis

Physical exercise helps restore joint function and strengthen it.They should be done slowly and carefully so as not to cause flickering and not 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 thigh and calf muscles.The load must not be allowed to be transferred to the back.You can't raise your legs too high either.The main thing is to tense your muscles at the top point;
  2. This exercise is the same as the first one, only now you have to lift your legs with your knees bent.At the top, the thigh muscles need to be strengthened again.This exercise must be done at the same time on each leg;
  3. Lie on the floor (on your stomach), lift your straight legs, and then spread them and bring them together.This exercise requires strong and trained abdominal muscles, so it is not suitable for all patients.In addition, performing it can increase blood pressure.For patients suffering from hypertension or other diseases of the cardiovascular system, it is better to avoid it;
  4. To do the next exercise, you need to lie on your side, bend your legs lying on the floor at the knees, and slowly lift the other and hold it at the top point.It is important that the angle when performing 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 climb your tiptoe while holding onto the back of a chair or bed.As with other exercises, you need to linger at the top point for a few seconds and also raise your leg muscles;
  7. Smooth movement from foot to heel allows you to activate blood circulation in the lower part of the foot.Such movements should be done alternately: while one foot rests on the foot, the other on the heel and vice versa.All movements must be smooth;
  8. Leaning back on a chair or bed, stand on your heels for a minute, raising your toes.If you cannot stand in this position for the specified time, you should start with less, gradually increasing it;
  9. Massage performed in a standing position.Legs should be rubbed with strong movements directed from the knees to the thighs.It should complete the massage by stroking the skin.

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

Massage and self-massage

Perform self-massage with your palms, the sides of your palms, your fingertips, or your fists.Gently act on the painful knee, maintaining strong pressure on the affected area: strong patting, punching, active kneading of the tissue often worsens the condition.

Basic Techniques:

  • The first stage is a clockwise stroking light, the second stage is a counterclockwise circular movement;
  • Press one palm to the sore knee, tap lightly with the fingertips of the other hand;
  • Maintaining the initial position of the palm, tapping not with your fingers, but with the edge of your palm;
  • Slowly bend the knees in a circle, gradually increasing the pressure (but moderately);
  • During 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, use an ointment or gel with an anti-inflammatory effect on the sore knee.

Physiotherapy treatment

All physiotherapy methods can be divided into several groups:

  1. Reduces pain;
  2. Reduces inflammation;
  3. Restores nutrition to the joints and accelerates the recovery of joint function.

Doctors can determine the type of treatment a patient needs based on symptoms and co-morbidities.

Surgery for arthrosis

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

  1. Arthroscopyrefers to the gentlest surgical treatment method.This technique is less traumatic and can be used as a therapeutic measure even in the early stages of arthrosis.The main goal is to extend the life of the damaged joint.Arthroscopy is performed using an endoscope - a flexible probe with a camera at the end.A small incision is made in the knee joint, where the endoscope and additional instruments are inserted.During the operation, the damaged tissue area that causes pain is removed.This operation is most suitable for young people and, if necessary, can be repeated several times.
  2. Endoprostheticsrefers to the most radical surgical technique.In this case, complete restoration of joint function occurs by replacing the entire knee joint or part of it with an implant.This method is the best alternative to the existing technique - arthrodesis (complete immobilization of the damaged joint).Currently, endoprosthesis replacement provides up to 90% positive results and significantly improves the patient's quality of life.
  3. OsteotomyIt is used when a significant deformation has developed in the joint and the function of the joint is affected.Osteotomy involves making an artificial fracture in a pre-planned location.Next, the bone parts are aligned in the correct physiological position and allowed to grow together.Sometimes during the operation, artificial fixation of bone fragments can be used, which contributes to a more stable position of the bone.

People's recovery

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

  1. Burdock leaves.Take 5 burdock leaves and hold them over boiling water to steam them.Lubricate sore knees with vegetable oil and use steamed leaves.Wrap your feet 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 and applied to the feet.The therapeutic effect is enhanced by insulation made of fleece or plastic film.This product is suitable for people of all age groups.
  3. Eggshells, kefir.Roll the shells of 2 eggs and mix with 1 spoon of kefir.Apply the mixture to your knees, wrap them in cloth and cling film, and lie under the blanket.Leave it like this for a few hours, then rinse the composition with water.This treatment can be used daily.
  4. Horseradish compress.According to this folk recipe, to increase the medicinal properties of radish, it is recommended to crush and boil first.Then it must be applied to the affected area.
  5. Turpentine- An excellent warming agent for sore joints.The knees are rubbed with turpentine before going to bed and tied with a woolen scarf.Already after the first procedure, the patient experienced significant relief.The course of treatment is selected individually for each person.

Diet

A therapeutic diet involves avoiding or eating a minimum of canned, smoked and fried foods (to suppress appetite).To restore damaged cartilage, it is necessary to provide the body with complex carbohydrates (porridges, wholemeal products).Juice (carrot, beetroot, apple) should also be included in the diet.They will remove toxins from the body and reduce the effects of the inflammatory process.

The diet should include fish and aspic, which act as a type of chondroprotector and help make new cartilage.Keep in mind that you cannot prescribe a diet for yourself - only a nutritionist (dietitian) 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, boiled vegetables, tea without sugar;
  • Afternoon snack: Cottage cheese Casserole with nuts, a glass of fruit juice;
  • Dinner: Vegetable salad, apple, tea without sugar;
  • Second dinner: a glass of low-fat kefir.

Prevention

Prevent joint diseases:

  • dose of load on your legs during active sports;
  • Create a diet that includes foods and dishes containing calcium, magnesium, gelatin;
  • If the work involves lifting or moving heavy objects, follow safety rules and do not carry loads beyond certain limits;
  • Do it yourself regularly to prevent arthrosis, especially with constant pressure on your feet;
  • Eat right, limit "dangerous" foods;
  • weight control (excess weight means extra pressure on the joints);
  • Get regular exams and treat acute and chronic illnesses.

Forecast

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

In the absence of the necessary treatment, and also when the patient fails to follow the doctor's instructions, arthrosis of the knee joint becomes a cause of disability.