Deforming osteoarthritis of the knee joints (also known as gonarthrosis or DOA for short)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic and constant progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, joint capsule and ligaments) and leads to joint deformity , reduced range of motion, and often disability.
The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slip. Malnutrition and loss of elasticity lead to its dystrophy (thinning) and resorption, while the bone tissue of the articular surfaces is exposed, gliding is impaired, the knee joint spaces are narrowed, the biomechanics of the joint changes. The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and plays the role of a physiological lubricant) becomes 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 posterior wall of the joint capsule, and a Becker cyst is formed (which, reaching large sizes, can cause pain in the popliteal fossa ). The thin and delicate tissue of the joint capsule is replaced by thick connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed. Blood circulation in the periarticular tissues is impaired, poorly oxidized metabolic products that irritate chemoreceptors accumulate in them, and a persistent pain syndrome develops. Against the background of changes in the anatomy of the joint, a violation of the surrounding muscles occurs, hypotrophy and spasm appear, and gait is disturbed. There is a persistent limitation of the range of motion in the joint (contracture), sometimes so pronounced that only rocking movements (stiffness) or total absence of movements (ankylosis) are possible.
Regarding osteoarthritis of the knee joint, we can say that it is a fairly common disease: it affects 10% of the entire population of the planet and, after 60 years, affects one in three people.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, chlamydial arthritis, gout).
- Violation of 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 reasons, there are also unfavorable background factors for the development of knee osteoarthritis, including:
- being overweight (literally puts pressure on the lower extremities);
- age (mainly older people are susceptible to the disease);
- female sex (according to statistics, women get sick more often);
- increased professional and sports physical activity.
Symptoms of osteoarthritis of the knee joints.
- Pain that increases when walking and decreases when resting.
- Difficulty of the usual physiological movements in the joints.
- The characteristic "crack" in the joints.
- Joint enlargement and visible deformity.
Stages of knee osteoarthritis
.png)
There are several stages of osteoarthritis:
- In the first stage, a person experiences only symptoms likemild discomfortor "heaviness" in the knee, which is uncomfortable when walking long distances or increases physical effort. The X-ray examination will be of little information: only a slight narrowing of the joint space can be detected, there will be no other changes. At the beginning of the defeat of arthrosis of the knee joint, a person does not turn to specialists, without attaching special importance to the symptoms that have appeared.
- For the second stage of osteoarthritis of the knee joint,tangible pain, whose gravity decreases at rest. Difficulty in movements in the joints appears, when walking, a characteristic "crunch" is heard (a common phrase in everyday life can be heard from the patient: "crunch of the knees"). On radiography, a clearly distinguishable narrowing of the joint space and individual osteophytes are found.
- With the transition from gonarthrosis to the next, third stage,pain symptoms will constantly bother the patient, even at rest, there is a violation of the configuration of the joints, that is, deformation, aggravated by edema at the time of joining the inflammation. Moderate joint space narrowing and multiple osteophytes are seen on radiographs. In the third stage, many already seek medical help, because the quality of life is significantly affected by pain and difficulty in walking normally.
- The fourth stage of osteoarthritis of the knee joint is accompanied byinsatiable and exhausting pain. . . Minimal attempts to move become a difficult test for a person, the deformity of the joints is visually noticeable, walking is extremely difficult. Radiography reveals significant changes: the joint space is practically undetectable on the images, multiple macroscopic osteophytes, "articular mice" (collapsed bone fragments that fall into the joint cavity) are revealed. This stage of knee osteoarthritis almost always leads to disability: the disease often results in complete fusion of the joint, its instability, and the formation of a "false joint. "
Who treats osteoarthritis of the knee joint?
A therapist, rheumatologist, and general practitioner (family doctor) can provide the patient with qualified medical care for knee osteoarthritis, but these specialists deal with the treatment of the knee joint for uncomplicated osteoarthritis.
When a synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, the help of an orthopedist cannot be dispensed with. In situations where surgical care is required, a patient with osteoarthritis of the knee joint is referred to a department specializing in orthopedics and trauma.
How and how to treat osteoarthritis of the knee joint?
Currently known methods for the treatment of patients with osteoarthritis of the knee joint are subdivided into non-pharmacological, medical and surgical conservatives.
Non-pharmacological methods
Many patients wonder: "How to deal with osteoarthritis of the knee joint without pills? " Answering, we have to say with regret that knee osteoarthritis is a chronic disease, it is impossible to eliminate it forever. However, many of the currently existing non-pharmacological (that is, without the use of drugs) methods to treat 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. .
With a timely visit to a doctor and sufficient motivation of the patient to heal, it is sometimes enough to eliminate negative factors. For example, reducing excess weight has been shown to reduce the manifestation of the main symptoms of the disease.
Elimination of pathological physical activity and, conversely,therapeutic gymnasticsWith the use of rational physical programs, they reduce the intensity of pain. Exercises to strengthen the quadriceps femoris have been shown to have an effect comparable to anti-inflammatory drugs.
If we treat osteoarthritis of the knee joint, then it is necessary to strive toproper nutrition- improve the elastic properties of articular cartilage will help products containing a large amount of animal collagen (dietary types of meat and fish) and cartilage components (shrimp, crabs, krill), fresh vegetables and fruits saturated with vegetable collagen and antioxidants, and The passion for smoked foods, marinades, preservatives, sweet and savory dishes, on the contrary, enhances the alteration of metabolic processes in the body and the accumulation of excess weight until obesity.
Reflecting on the most effective treatment for knee osteoarthritis, it is worth remembering a treatment and prophylactic method as effective asorthosis: the fixation of knee braces, orthoses, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thus reducing the intensity of pain in it. The use of a cane is also recommended as an effective knee joint relief. It should be in the hand opposite the affected limb.
Comprehensive treatment of osteoarthritis of the knee joint also involves the appointment of very effective, even with advanced forms of the disease.physiotherapy. . . With widespread use in different categories of patients suffering from osteoarthritis of any degree, it has proven its effectiveness.magnetotherapy- After various procedures, the intensity of the pain decreases, as a result of the improvement of blood circulation, the reduction of edema and the elimination of muscle spasm, the mobility of the joint increases. The effect of magnetotherapy is especially pronounced with the development of active inflammation in the joint: the severity of the edema is significantly reduced, the symptoms of synovitis recede. Not so popular, but no less effective in treating the knee joint for osteoarthritis, are physiotherapy methods such aslaser therapyandcryotherapy(exposure to cold), which have a pronounced analgesic effect.
Drug treatment
In the schemes of effective treatment of osteoarthritis of the knee joint, the following drugs are used.
Non-steroidal anti-inflammatory drugs (NSAIDs), produced in forms for external use (various gels, ointments) and systemic (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. With the first manifestations of the disease, the local use of these drugs in combination with non-pharmacological methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills and sometimes injections of NSAIDs are a must. It should be remembered that prolonged systemic intake of NSAIDs can provoke the development and exacerbation of ulcerative processes in the gastrointestinal tract, and, in addition, adversely affect the function of the kidneys and liver. Therefore, patients who have been taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor the laboratory performance of internal organs.
Glucocorticosteroids (GCS)- Hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when NSAIDs previously prescribed to the patient do not resolve the elimination of the manifestations of inflammation. Being a powerful anti-inflammatory agent, GCS in the treatment of osteoarthritis have certain contraindications, as they can cause a number of important side effects. In systemic forms with gonarthrosis, they are practically not prescribed. As a general rule, for the effective treatment of osteoarthritis, GCS injections into the periarticular pain points are considered, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted side effects of the drug. This manipulation can be done by a rheumatologist or a trauma specialist. With concomitant synovitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single administration of GCS, the effect of such treatment lasts up to 1 month. According to national guidelines for the treatment of osteoarthritis, do not give more than three injections of the drug per year in the same joint.
With advanced "neglected" osteoarthritis, when a person experiences excruciating pain that does not go away even at rest, disrupts normal sleep, and is not eliminated with NSAIDs, GCS, and non-pharmacological methods, it is possible to prescribeopioid pain relievers. . . These drugs are used only with a doctor's prescription, which considers the suitability of your appointment in each case.
Chondroprotectors(literally translated as "protective cartilage"). This name is understood as several drugs, united by one property: a structural modification action, that is, the ability to slow down degenerative changes in the cartilage and the narrowing of the joint space. They are produced in forms both for oral administration and for introduction into the joint cavity. Of course, these drugs do not work miracles and do not "grow" new cartilage, but they can stop its destruction. To achieve a long-lasting effect, they must be applied for a long time, with regular courses several times a year.
Surgical treatment of osteoarthritis of the knee joints.
There are frequent cases in which, despite adequate complex treatment, the disease progresses, constantly reducing the quality of human life. In such situations, the patient begins to ask questions: "What to do if prescription drugs do not help with osteoarthritis of the knee joint? " "Is surgical treatment for osteoarthritis of the knee indicated? " By answering these questions , it should be clarified that the indications for the surgical treatment of osteoarthritis of the knee joints are intractable pain syndrome and significant joint dysfunction, which cannot be eliminated with the use of complex conservative therapy, which is possible with the last, fourth degree of the disease.
The most popular type of surgical care for third and fourth degree osteoarthritis isendoprosthesis, that is to say. removal of your own joint with the simultaneous installation of a replacement metal 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: the absence of severe joint deformities, formed "false joints", muscle contractures and severe muscle atrophy. In case of severe osteoporosis (a significant decrease in bone mineral density), the endoprosthesis is also not indicated: the "sugary" bone will not resist the introduction of metal pins, and the rapid resorption (reabsorption) of the bone tissue will begin instead of installation, pathological fractures may occur. Therefore, a timely decision on 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 the operation to be performed. According to the results of long-term studies, the duration of the effect of stents in patients with advanced osteoarthritis, that is, the temporary duration of the absence of significant motor limitations and the maintenance of a decent quality of life is about ten years. The best results of surgical treatment are seen in people aged 45 to 75 years with a low body weight (less than 70 kg) and a relatively high standard of living.
Despite the widespread use of knee replacement, the results of such operations are often unsatisfactory and the rate of complications is high. This is due to the design features of the stents and the complexity of the surgical procedure itself (hip joint replacement is much easier in technical terms). This dictates the need for organ preservation operations (joint preservation). These include arthromedullary bypass surgery and corrective osteotomy.
Arthromedullary bypass- connection of the medullary canal of the femur with the cavity of the knee joint by means of a shunt - a hollow metal tube. This allows the fatty bone marrow from the lower third of the femur to enter the knee joint, nourishing and lubricating the cartilage, significantly reducing pain.
When changing the axis of the lower limb (but with the condition of a slight restriction of the range of motion), it is effectivecorrective osteotomy- section of the tibia with correction of its axis, followed by fixation with a plate and screws in the desired position. At the same time, two goals are 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 the above, I would like to point out that the treatment of knee osteoarthritis is a complex social task. And although today medicine is not able to offer a drug that will eliminate it forever, or other ways to completely cure this ailment, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its progression.