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 degeneration and resorption, while the bone tissue of the joint surfaces is exposed, sliding is impaired, the joint space narrows and the biomechanics of the joints changes.The synovial membrane lining the joint and producing synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) is irritated, leading to an increase in its quantity in the joint (synovitis).Against the background of narrowing of the joint space, the volume of the joint decreases, synovial fluid protrudes beyond the posterior wall of the joint capsule and a Becker cyst is formed (which, when reaching a large size, can cause pain in the popliteal fossa).
The thin, delicate tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.Periarticular bone tissue develops, osteophytes (pathological bone growths) are formed.Blood circulation in the periarticular tissues is disturbed, underoxidized metabolic products accumulate there, irritant chemoreceptors, and a persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, the functioning of the surrounding muscles is disrupted, hypotrophy and spasms appear, and gait is disturbed.A persistent limitation in the range of movement of the joint (contracture) appears, sometimes so pronounced that only swinging movements (rigidity) or a complete absence of movement (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the total population of the planet, and over the age of 60, it affects one in three people.
Causes of knee osteoarthritis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, gout).
- Mineral metabolism disorders in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Muscular system diseases and neuropathy (Charcot disease).
In addition to the main reasons, there are also background factors unfavorable for the development of gonarthrosis, including:
- excess weight (literally puts pressure on the lower limbs);
- age (the disease mainly 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 the usual physiological movements of the joints.
- A characteristic “crunch” in the joints.
- Increase in the size of joints and their visible deformation.
Stages of knee osteoarthritis
Clinical stages of osteoarthritis of the knee joint.The disease goes through several stages.
- Initially, a person feels only a slight feeling of discomfort or "heaviness" in the knee, which is worrying during long walking distances or increased physical activity.An X-ray examination will not 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, a person does not turn to specialists and does not attach much importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the intensity of which decreases with rest.Difficulties in movement in the joints appear and a characteristic “creak” is heard when walking (from the patient you can hear a common phrase in everyday life: “knees creak”).X-rays reveal clearly visible joint narrowing and isolated osteophytes.
- When gonarthrosis passes to the next third stage, the pain will constantly bother the patient, including at rest, and there will be a disruption in the configuration of the joints, that is, deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate joint space narrowing and multiple osteophytes.In the third stage, many people already consult a doctor, because...the quality of life suffers significantly due to pain and difficulty walking normally.
- The fourth stage is accompanied by persistent and debilitating pain.Minimal attempts at movement become a difficult ordeal for a person, deformation of the joints is visually noticeable, and walking is extremely difficult.The x-ray reveals significant changes: the joint space is practically not defined in the images, multiple coarse osteophytes, “joint mice” (fragments of deteriorated bone falling into the joint cavity) are revealed.This stage of knee osteoarthritis almost always leads to a disability: the outcome of the disease is often a complete fusion of the joint, its instability and the formation of a “false joint”.
Who treats knee osteoarthritis?
Qualified medical care for gonarthrosis can be provided to the patient by a therapist, a rheumatologist and a general practitioner (family doctor), but these specialists treat the knee joint in cases of simple osteoarthritis.When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, then you cannot do without the help of an orthopedist.In situations where surgical care is necessary, the patient is sent to a specialized orthopedics and trauma department.
How and with what to treat knee osteoarthritis?
Currently known methods of treating osteoarthritis of the knee joint are divided into conservative non-medicinal, medicinal and surgical methods.
Non-drug methods
Many patients ask the question: "How to cure knee osteoarthritis without pills?"Answering this question, we regret to state that knee osteoarthritis is a chronic disease and cannot be eliminated forever.However, many non-pharmacological methods currently existing to combat this disease can significantly slow down its progression and improve the patient's quality of life, especially when used 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, weight loss has been proven to reduce the manifestation of the main symptoms of the disease.
Removing pathological physical activity and, on the contrary, doing therapeutic exercises through rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have effects comparable to anti-inflammatory medications.
If we treat osteoarthritis of the knee joint, then we should 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 will help improve the elastic properties of articular cartilage, and passion for smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, potentiates metabolic disorders inthe body and the accumulation of excess weight until obesity.
When thinking about the most effective treatment for osteoarthritis of the knee, it is worth remembering such an effective method of treatment and prevention as orthotics: fixing knee pads, orthotics, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thereby reducing the intensity of pain.
Comprehensive treatment of knee osteoarthritis also involves the appointment of highly effective physical procedures, even in advanced forms of the disease.Widely used in different categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after just a few interventions, the intensity of pain decreases, thanks to better blood circulation, reduction of swelling and elimination of muscle spasms, joint mobility increases.The effect of magnetic therapy is especially pronounced when active inflammation of the joint develops: the severity of edema significantly decreases and the symptoms of synovitis regress.Physiotherapy methods such as laser therapy and cryotherapy (exposure to cold), which have a pronounced analgesic effect, are not so popular, but no less effective in the treatment of osteoarthritis of the knee.
Drug treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), available 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.For early manifestations of the disease, local use of these drugs in combination with non-medicinal methods is effective.But with advanced osteoarthritis of the knee joints, you cannot do without pills.It should be remembered that prolonged systemic use of NSAIDs can provoke the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, negatively affect the function of the kidneys and liver.Therefore, patients taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor laboratory parameters of the functioning of internal organs.
In case of advanced, "advanced" osteoarthritis, when a person experiences unbearable pain that does not subside even at rest, disrupts normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, it is possible to prescribe opioid analgesics.These medications are only used on the prescription of a doctor, who examines the advisability of prescribing them in each specific case.
Chondroprotectors (literally translated as “protective cartilage”).This name refers to various drugs, united by one property: a structure-modifying effect, that is, the ability to slow down degenerative changes in cartilage and narrowing of the joint space.They are produced in forms both for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these medications do not work miracles and do not “grow” new cartilage, but they can stop its destruction.To obtain a lasting effect, they must be used for a long time, in regular treatment several times a year.
Surgical treatment of osteoarthritis of the knee joints
It often happens that, despite comprehensive and adequate treatment, the disease progresses, gradually reducing a person's quality of life.In such situations, the patient begins to ask questions: “what to do if the prescribed medications do not relieve knee osteoarthritis?”», “Is surgical treatment indicated for knee osteoarthritis?», “How is knee osteoarthritis treated surgically?Answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are insurmountable pain syndrome and significant dysfunction of the joint, which cannot be eliminated by the use of complex conservative treatment.
The most popular type of surgical care for gonarthrosis is endoprosthesis, that is, the removal of one's own joint with the immediate installation of a metal prosthesis replacing it, the design of which is similar to the anatomy of the human knee joint.At the same time, a prerequisite for carrying out this type of surgical treatment is the absence of gross deformities of the joint, formed “false joints”, muscle contractures and pronounced muscle atrophy.
In cases of severe osteoporosis (significant decrease in bone mineral density), endoprostheses are also not indicated: the “sugar” bone will not withstand the introduction of metal pins, and rapid resorption of bone tissue will begin at the site of their installation, and pathological fractures may occur.Therefore, it seems so important to make a timely decision on the need to install an endoprosthesis - it should be made when the age and general condition of the human body still allows the operation to be performed.According to the results of long-term studies, the duration of the effect of endoprostheses, that is, the temporary duration of the absence of significant motor limitations and the maintenance of a decent quality of life, is approximately ten years.The best results of surgical treatment are observed in people aged 45 to 75 years old with low body weight (less than 70 kg) and a relatively high standard of living.
Despite the widespread use of knee arthroplasty, the results of these operations are often unsatisfactory and the complication rate is high.This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (hip arthroplasty is much simpler in technical terms).These include artromedullary bypass and corrective osteotomy.Arthromedullary shunt is a connection of the medullary canal of the femur with the socket of the knee joint using a shunt - a hollow metal tube.Thanks to this, fatty bone marrow from the lower third of the femur enters the knee joint, nourishing the cartilage and lubricating it, thus achieving a significant reduction in pain.
When the axis of the lower limb changes (but under the condition of a slight limitation in the range of movements), a corrective osteotomy is effective - intersection of the tibia with correction of its axis, followed by fixation by plate and screws in the desired position.In this case, two goals are achieved: normalization of biomechanics through restoration of the limb axis, as well as activation of blood circulation and metabolism during bone fusion.And although today medicine is not able to offer a drug that eliminates it forever, or other ways to completely cure this disease, a healthy lifestyle, timely medical consultation and compliance with the doctor's recommendations can stop its progression.