The disease begins with changes in the articular cartilage, as a result of which the joint surfaces of the bones slip.Malnutrition and loss of flexibility lead to degeneration and resorption, while the bone tissue of the joint surfaces is exposed, gliding is impaired, the joint space narrows, and the biomechanics of the joint changes.The synovial membrane that lines the joint and produces 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 the narrowing of the joint space, the volume of the joint decreases, the synovial fluid protrudes on 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 (abnormal bone growths) are formed.The blood circulation in the periarticular tissues is disrupted, underoxidized metabolic products accumulate in them, irritate the chemoreceptors, and a permanent pain syndrome develops.Against the background of the changes in the anatomy of the joint, the functioning of the surrounding muscles is disrupted, hypotrophy and spasms appear, and walking is interrupted.A permanent limitation of the range of motion (contracture) occurs in the joint, 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 population of the planet and affects every third person over 60 years of age.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, gout).
- Mineral metabolism disorders in various endocrinopathies (diabetes mellitus, parathyroid diseases, hemochromatosis).
- Musculoskeletal diseases and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which are as follows:
- excess weight (literally puts pressure on the lower limbs);
- age (the disease mostly affects older people);
- female gender (statistically, women get sick more often);
- increased sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulty in normal, physiological movements in the joints.
- A characteristic "crunch" in the joints.
- An increase in the size of the joints and their visible deformation.
Stages of gonarthrosis
Clinical stages of arthrosis of the knee joint.The disease goes through several stages.
- In the first stage, a person feels only slight discomfort or "heaviness" in the knee, which is disturbing when walking long distances or during intense physical activity.The X-ray examination will be informative: only a slight narrowing of the joint space can be detected, there will be no other changes.At the beginning of the disease, people do not consult a specialist, they do not attach much importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the severity of which decreases with rest.Difficulty in moving the joints appears, and a characteristic "creaking" is heard when walking (a common expression from the patient in everyday life is heard: "the knee creaks").X-rays show clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis reaches the next, third stage, the pain constantly bothers the patient, including at rest, and the configuration of the joints is disturbed, that is, deformation, which is aggravated by the swelling that occurs during inflammation.Radiographs show moderate joint space narrowing and multiple osteophytes.In the third stage, many people go to the doctor because... the quality of life deteriorates significantly due to pain and difficulties in walking normally.
- The fourth stage is accompanied by unrelieved, debilitating pain.Minimal movement attempts are a difficult ordeal for a person, the deformation of the joints is visually noticeable, and walking is extremely difficult.The X-ray reveals significant changes: the joint gap is practically undefined on the images, multiple rough osteophytes, "joint mice" (deteriorating bone fragments falling into the joint cavity) are revealed.This stage of gonarthrosis is almost always associated with disability: often the result of the disease is complete fusion of the joint, instability and the formation of a "false joint".
Who treats knee arthrosis?
Qualified medical treatment of gonarthrosis can be performed by therapists, rheumatologists and general practitioners (general practitioners), but these specialists treat the knee joint in case of uncomplicated arthrosis.If synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, you cannot do without the help of an orthopedist.In situations where surgical care is required, the patient is sent to a specialized orthopedic and trauma department.
How and with what should knee arthrosis be treated?
Currently known treatment methods for arthrosis of the knee joint are divided into non-medical conservative, medical and surgical methods.
Non-drug methods
Many patients ask the question: "How to cure arthrosis of the knee joint without pills?"In response to 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 the disease can significantly slow the progression of the disease and improve the patient's quality of life, especially in the early stages of the disease.If you consult a doctor in time and the patient is sufficiently motivated to recover, sometimes it is enough to eliminate negative factors.For example, it has been proven that reducing excess weight reduces the manifestation of the main symptoms of the disease.
Eliminating abnormal physical activity and, on the contrary, performing therapeutic exercises with rational physical programs reduces the intensity of pain.Exercises that improve quadriceps strength have been shown to have similar effects to anti-inflammatory drugs.
If we are treating knee arthrosis, we must strive for proper nutrition: products containing large amounts of animal collagen and chondroitin (shrimp, crab, krill), fresh vegetables and fruits rich in plant collagen and antioxidants improve the elastic properties of joint cartilage, and on the other hand, passion for smoked meats, sweet pickles, pickles, preservative salty foods, pickles,preservices marinade disorders in the body and the accumulation of excess weight to obesity.
If we think about the most effective treatment for arthrosis of the knee joint, it is worth noting such an effective treatment and prevention method as orthosis: the fixation of knee pads, orthoses, elastic bandages and orthopedic insoles reduces and correctly distributes the load on the joint, thereby reducing the intensity of pain.
Comprehensive treatment of arthrosis of the knee joint includes the appointment of very effective physical procedures, even in advanced forms of the disease.If it is widely used in different categories of patients suffering from the disease, magnet therapy has proven its effectiveness: after just a few procedures, the intensity of pain decreases, the mobility of the joints increases as a result of improved blood circulation, reduction of swelling and cessation of muscle spasms.The effect of magnetic therapy is particularly pronounced when active inflammation develops in the joint: the severity of the edema decreases significantly and the symptoms of synovitis regress.Physiotherapy methods such as laser therapy and cryotherapy (cold exposure), which have a pronounced pain-relieving effect, are not as popular, but no less effective in the treatment of arthrosis of the knee joint.
Drug treatment
Available in external (various gels, ointments) and systemic (tablets, suppositories, solutions) forms, non-steroidal anti-inflammatory drugs (NSAIDs) have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By blocking inflammation at the enzyme level, they eliminate joint pain and swelling and slow down the progression of the disease.In case of early manifestations of the disease, the local application of these drugs in combination with non-pharmacological methods is effective.But with advanced osteoarthritis of the knee joints, you cannot do without the tablets.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 can also negatively affect the functioning of the kidneys and liver.Therefore, patients taking NSAIDs for a long time should be prescribed drugs that protect the gastric mucosa and regularly check the laboratory parameters of the internal organs.
In advanced, "advanced" osteoarthritis, when a person experiences excruciating pain that does not subside even at rest, interferes with normal sleep, and is not relieved by NSAIDs, corticosteroids, and non-pharmacological methods, it is possible to prescribe an opioid pain reliever.These medicines are used only with a doctor's prescription, who considers the expediency of their prescription in each case.
Chondroprotectors (literally translated as "cartilage protector").This name refers to different drugs that are united by a single property - a structure-modifying effect, i.e. slowing down degenerative changes in cartilage and narrowing the joint space.They are prepared both for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these drugs do not work miracles and do not "grow" new cartilage, but they can stop its destruction.To achieve a lasting effect, they must be used for a long time, in regular courses several times a year.
Surgical treatment of arthrosis of the knee joints
There are often cases when, despite appropriate comprehensive treatment, the disease progresses, constantly reducing the quality of life of a person.In such situations, the patient begins to ask questions: "What to do if the prescribed drugs do not help with arthrosis of the knee joint?", "Is surgical treatment recommended for arthrosis of the knee joint?", "How is arthrosis of the knee joint treated surgically?"When answering these questions, it should be clarified that the indication for surgical treatment of osteoarthritis of the knee joints is an intractable pain syndrome and a significant dysfunction of the joint, which cannot be eliminated by the use of complex conservative therapy.
The most popular surgical treatment for gonarthrosis is endoprosthesis, i.e. removal of the joint itself with the immediate installation of a replacement metal prosthesis, the structure of which is similar to the anatomy of the human knee joint.At the same time, the prerequisite for 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 (significant decrease in bone mineral density), endoprosthesis is also not indicated: the "sugary" bone cannot withstand the insertion of metal pins, and rapid resorption of bone tissue begins at the place of their insertion, and pathological fractures may occur.Therefore, it seems very important to make a timely decision about the need to install an endoprosthesis - it should 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 the endoprosthesis, i.e. the temporary duration of the absence of significant motor limitations and the maintenance of an adequate quality of life, is approximately ten years.The best results of surgical treatment can be achieved in people aged 45-75, 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 technically much simpler).These include arthromedullary bypass surgery and corrective osteotomy.Arthromedullary shunting is the connection of the medullary canal of the femur and the cavity of the knee joint with the help of a shunt - a hollow metal tube.Thanks to this, the fatty bone marrow from the lower third of the femur enters the knee joint, nourishing and lubricating the cartilage, thereby achieving a significant reduction in pain.
When the axis of the lower limb changes (but with a slight limitation of the range of movements), corrective osteotomy is effective - the intersection of the tibia with the correction of its axis, then fixation with a plate and screws in the desired position.In this case, two goals can be achieved - the normalization of biomechanics due to the restoration of the axis of the limb, and the activation of blood circulation and metabolism during bone fusion.And although today medicine cannot offer a drug that will get rid of it forever or other methods to completely cure the disease, a healthy lifestyle, timely medical help and compliance with the doctor's recommendations can stop its progression.