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 articular surfaces is exposed, gliding is reduced, the joint space narrows and the biomechanics of the joint changes.The synovial membrane that lines the joint and produces the synovial fluid (which nourishes the cartilage and acts as a normal lubricant) becomes irritated, which leads to an increase in its amount in the joint (arthritis).As part of the narrowing of the joint space, the volume of the joint decreases, synovial fluid protrudes into the posterior 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 sensitive tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.The peri-articular bone tissue grows, osteophytes (pathological bone growths) are formed.Blood circulation in the peri-articular tissues is disturbed, hypooxidized metabolic products accumulate in them, irritating chemoreceptors and persistent pain syndrome develops.As part of the changes in the anatomy of the joint, the function of the surrounding muscles is disturbed, scholarship and spasm appear, and the gait is disturbed.A persistent limitation in range of motion occurs at the joint (contraction), sometimes so severe that only rocking movements (stiffness) or a complete lack of movement (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the total population of the planet and over 60 affects every third person.
Causes of gonoarthrosis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatism, gout).
- Disorders of metal metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular system and neuropathy (Charcot disease).
In addition to the main reasons, there are also unfavorable factors for the development of gonoarthrosis, which include:
- excess weight (literally puts pressure on the lower extremities);
- age (mainly the elderly are affected by the disease).
- 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, normal joint movements.
- Characteristic "creaking" in the joints.
- Increase in the size of joints and their visible deformation.
Stages of gonoarthrosis
Clinical stages of arthrosis of the knee joint.The disease goes through several stages.
- In the first stage, a person feels only a slight feeling of discomfort or "heaviness" in the knee, which is annoying when walking long distances or increasing 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 onset of the disease, a person does not turn to specialists, not paying much attention 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 (from the patient you can hear a common phrase in everyday life: "knees creak").Radiographs reveal a clearly visible narrowing of the joint space and isolated osteophytes.
- When gonoarthrosis passes to the next, third stage, pain will constantly bother the patient, even in a state of rest, and there is a disorder in the formation of the joints, that is, deformation, which is aggravated by swelling at the time of inflammation.Radiographs show moderate joint space narrowing and multiple osteophytes.In the third stage, many already seek medical help, because... the quality of life suffers significantly due to pain and difficulty in walking normally.
- The fourth stage is accompanied by unrelenting, debilitating pain.The slightest attempts at movement become a difficult test for a person, the deformation of the joints is visually noticeable, and walking is extremely difficult.X-ray reveals significant changes: the joint space is practically not defined in the images, multiple coarse osteophytes, "joint mice" (wearing bone fragments that fall into the joint cavity) are revealed.This stage of gonoarthritis almost always involves disability: often the result of the disease is the complete fusion of the joint, its instability and the formation of a "false joint".
Who is treated with osteoarthritis of the knee joint?
Specialist medical care for the knee joint can be provided to the patient by a therapist, rheumatologist and general practitioner (family doctor), but these specialists treat the knee joint with uncomplicated arthropathy.When arthritis appears or the treatment prescribed by the therapist does not give the desired result, then you cannot do without the help of an orthopedic surgeon.In cases where surgical care is required, the patient is sent to a specialized orthopedic and trauma department.
How and with what is arthropathy of the knee joint treated?
The currently known methods of treating arthropathy of the knee joint are divided into non-drug conservative, drug and surgical.
Non-pharmacological methods
Many patients ask the question: "How to treat arthrosis of the knee joint without pills?"In answer to this question, we regret to state that gonadarthrosis is a chronic disease and cannot be eradicated forever.However, many currently available non-pharmacological methods of combating 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.If you consult a doctor in time and the patient is sufficiently motivated to treat, 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.
Eliminating pathological physical activity and, on the contrary, performing therapeutic exercises using rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have comparable results to anti-inflammatory drugs.
If we are treating arthropathy of the knee joint, then 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 will help improve the elastic properties of articular cartilage, and the passion for smoked, candied and sweet meats.On the contrary, it enhances metabolic disorders in the body and the accumulation of excess weight in obesity.
When you think about what is the most effective treatment for knee arthropathy, it is worth remembering such an effective treatment and preventive method as orthosis: the fixation of knee pads, orthoses, elastic bandages and orthopedic insoles reduces and properly distributes the load on the joint, thereby reducing the intensity of pain in it.
Comprehensive treatment of arthrosis of the knee joint also includes the appointment of very effective physical procedures, even in advanced forms of the disease.When widely used in different categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after just a few procedures, the intensity of pain decreases, as a result of improving blood circulation, reduced swelling and elimination of muscle spasm, increases joint mobility.The effect of magnetic therapy is particularly pronounced when active inflammation develops in the joint: the severity of the swelling is significantly reduced and the symptoms of arthritis subside.Not so popular, but no less effective for the treatment of the knee joint with joints, are such physiotherapy methods as laser therapy and cryotherapy (exposure to cold), which have a strong analgesic effect.
Pharmaceutical treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), available in forms for external (various gels, ointments) and systemic use (tablets, suppositories, solutions), have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By inhibiting inflammation at the enzymatic level, they eliminate pain and swelling in the joints and slow down the progression of the disease.For early manifestations of the disease, the local use of these drugs in combination with non-pharmacological methods is effective.But with advanced osteoarthritis of the knee joints, you cannot do without pills.It must be remembered that the prolonged systemic use of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, negatively affect the functioning of the kidneys and liver.Therefore, patients receiving NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor the laboratory parameters of the functioning of internal organs.
In case of advanced, "advanced" osteoarthritis, when a person feels excruciating pain that does not subside even at rest, disturbs normal sleep and is not relieved by NSAIDs, corticosteroids and non-pharmacological methods, it is possible to prescribe opioid pain relievers.These drugs are used only with a doctor's prescription, who takes into account the expediency of their prescription in each specific case.
Cartilage protectors (literally translates as "cartilage protector").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, piasclidine) and for injection into the joint cavity (hyaluronic).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 knee joints
There are often cases where, despite adequate comprehensive treatment, the disease progresses, steadily reducing the person's quality of life.In such cases, the patient begins to ask questions: "what to do if the prescribed drugs do not help arthropathy of the knee joint?", "Is surgical treatment indicated for arthropathy of the knee?", "How is arthropathy of the knee joint treated surgically?"Answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are the syndrome of intractable pain and significant dysfunction of the joint, which cannot be eliminated using complex conservative treatment.
The most popular type of surgical care for knee osteoarthritis is endoprosthetic, that is, the removal of the joint with the immediate placement of a metal prosthesis that replaces it, the design of which resembles the anatomy of the human knee joint.At the same time, a condition for carrying out this type of surgical treatment is the absence of gross deformations of the joint, formed "false joints", muscle spasms and strong muscle atrophy.
In case of severe osteoporosis (significant decrease in bone density), endoprosthetic is also not indicated: the "sugar" bone will not withstand the insertion of metal pins, and the rapid absorption of bone tissue will begin at the place of their installation, and pathological fractures may occur.Therefore, an early decision about the need to install an endoprosthesis seems so important - it should be taken 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 endoprosthetic effect, i.e. the temporary duration of the absence of significant movement limitations and the maintenance of 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 operations are often unsatisfactory and the rate of complications high.This is due to the design features of endoprostheses and the complexity of the surgery itself (hip replacement is much simpler from a technical point of view).These include spinal cord bypass surgery and corrective osteotomy.Arthromedullary drainage is a connection of the medullary canal of the femur to the cavity of the knee joint using a drain - a hollow metal tube.Thanks to this, the 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 with the condition of a small limitation of the range of motion), corrective osteotomy is effective - crossing the tibia with correction of its axis, followed by fixation with a plate and screws in the desired position.In this case, two goals are achieved - normalization of biomechanics due to 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 gets rid of it forever or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its progression.