The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slide.Malnutrition and loss of elasticity lead to its degeneration and resorption, and the bone tissue of the joint surfaces is exposed, gliding is difficult, the joint space narrows, and the biomechanics of the joint changes.The synovial membrane that covers the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) is irritated, which leads 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 back wall of the joint capsule, and Becker's 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.Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed.The blood circulation in the periarticular tissues is disturbed, insufficiently oxidized metabolic products accumulate in them, they irritate the chemoreceptors and persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, there is a disturbance in the functioning of the surrounding muscles, hypotrophy and spasm appear, and gait is disturbed.There is a permanent limitation in the range of motion in the joint (contracture), sometimes so pronounced that only rocking movements are possible (rigidity) or a complete lack of movement (ankylosis).
Gonarthrosis is a fairly common disease: it affects 10% of the entire population of the planet, and at the age of 60 it affects every third person.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes mellitus, parathyroid gland diseases, hemochromatosis).
- Diseases of the muscular system and neuropathy (Charcot's disease).
In addition to the main reasons, there are unfavorable background factors for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower limbs);
- age (mainly older people 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 when walking and decreases at rest.
- Difficulty in normal, physiological movements in the joints.
- Characteristic "crunching" in the joints.
- 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 a slight feeling of discomfort or "heaviness" in the knee, which is disturbing when walking long distances or increased physical activity.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, the person does not turn to specialists, not giving much importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the intensity of which decreases with rest.There are difficulties in movement in the joints, and a characteristic "creaking" is heard when walking (you can hear a common phrase from the patient in everyday life: "knees creak").X-rays reveal clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis moves to the next, third stage, pain will constantly torment the patient, including at rest, and there is also a disorder in the configuration of the joints, i.e. deformation, increased by swelling at the time of inflammation.Radiographs show moderate joint space narrowing and multiple osteophytes.In the third stage, many people already seek medical help, because... the quality of life suffers significantly due to pain and difficulty in normal walking.
- The fourth stage is accompanied by unrelieved, debilitating pain.Minimal attempts to move become a difficult trial for a person, joint deformation is visually noticeable, and walking is extremely difficult.The X-ray reveals significant changes: the joint space is practically not defined on the images, multiple rough osteophytes, "joint mice" (fragments of decaying bone that fall into the joint cavity) are revealed.This stage of gonarthrosis almost always leads to disability: often the outcome of the disease is a complete fusion of the joint, its instability and the creation of a "false joint".
Who treats osteoarthritis of the knee joint?
Qualified medical care for gonarthrosis can be provided to the patient by a therapist, rheumatologist and general practitioner (family doctor), but these specialists treat the knee joint in uncomplicated arthrosis.When synovitis appears 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 required, the patient is sent to a specialized orthopedic-traumatology department.
How and with what to treat arthrosis of the knee joint?
Currently known methods of treating arthrosis of the knee joint are divided into non-medical conservative, medical and surgical.
Methods without drugs
Many patients ask the question: "How to cure arthrosis of the knee joint without pills?"Answering this question, we regret to state that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many currently existing non-pharmacological methods of controlling this disease can significantly slow its progression and improve the quality of life of patients, especially when used in the early stages of the disease.If you consult a doctor in a timely manner and if the patient is motivated enough to heal, sometimes it is enough to remove 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 with the use of rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have comparable effects to anti-inflammatory drugs.
If we treat arthrosis of the knee joint, then we must strive for a proper diet: products containing large amounts of animal collagen and chondroitin (shrimp, crabs, krill), fresh vegetables and fruits rich in plant collagen and antioxidants will help improve the elastic properties of joint cartilage, and on the contrary, on the diet, sweet and smoky marijuana, it enhances metabolic disorders in the body and the accumulation of excess weight to obesity.
When you think about what is the most effective treatment for knee arthrosis, it is worth remembering such an effective treatment and preventive method as orthosis: fixing knee pads, orthosis, elastic bandages and orthopedic insoles reduce and properly distribute the load on the joint, which reduces the intensity of pain in it.
Comprehensive treatment of arthrosis of the knee joint implies the appointment of very effective physical procedures, even in advanced forms of the disease.Widely used in various categories of patients suffering from this disease, magnetotherapy has proven its effectiveness: after just a few procedures, the intensity of pain decreases, as a result of improved blood circulation, reduction of swelling and elimination of muscle spasm, joint mobility increases.The effect of magnetic therapy is especially pronounced when active inflammation develops in the joint: the severity of the edema is significantly reduced, and the symptoms of synovitis subside.Not so popular, but no less effective in the treatment of the knee joint with arthrosis, are such physiotherapy methods as laser therapy and cryotherapy (exposure to cold), which have a pronounced analgesic effect.
Drug 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 blocking inflammation at the enzymatic level, they eliminate pain and joint swelling and slow down the progression of the disease.For early manifestations of the disease, local application of these drugs in combination with non-medical methods is effective.But with advanced osteoarthritis of the knee joints, you can't do without pills.It must be remembered that long-term systemic use of NSAIDs can cause the development and worsening of ulcerative processes in the gastrointestinal tract, and in addition, negatively affect the function of the kidneys and liver.Therefore, patients who take 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 the case of advanced, "advanced" osteoarthritis, when a person feels unbearable pain that does not subside even at rest, disturbs normal sleep, and is not relieved by NSAIDs, corticosteroids and non-medication methods, it is possible to prescribe opioid painkillers.These drugs are used only on the prescription of a doctor, who considers the advisability of prescribing them in each specific case.
Chondroprotectors (literally translated as "cartilage protection").This name refers to different drugs, united by one property - structural-modifying action, that is, the ability to slow down degenerative changes in cartilage and narrow the joint space.They are produced in forms both for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injections 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.In order to achieve a lasting effect, they must be used for a long time, with regular courses several times a year.
Surgical treatment of arthrosis of knee joints
There are often cases when, despite adequate comprehensive treatment, the disease progresses, constantly reducing a person's quality of life.In such situations, the patient begins to ask questions: "What to do if prescribed drugs do not help with arthrosis of the knee joint?", "Is surgical treatment of knee arthrosis indicated?", "How is arthrosis of the knee joint surgically treated?"Answering these questions, it is necessary to clarify that the indications for surgical treatment of osteoarthritis of the knee joints are the syndrome of intelligible pain and significant dysfunction of the joint, which cannot be eliminated by the application of complex conservative therapy.
The most popular type of surgical treatment of gonarthrosis is endoprosthetics, i.e. removal of one's own joint with the immediate installation of a metal prosthesis that replaces it, the design of which is similar to the anatomy of the human knee joint.At the same time, the prerequisite for performing this type of surgical treatment is the absence of gross joint deformities, formed "false joints", muscle contractures and pronounced muscle atrophy.
In the case of severe osteoporosis (significant decrease in bone mineral density), endoprosthetics is also not indicated: the "sugar" bone will not withstand the introduction of metal needles, and at the place of their insertion, rapid resorption of bone tissue will begin and pathological fractures may occur.Therefore, a timely decision on the need to install an endoprosthesis seems so important - 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 endoprosthetics, i.e. the temporary duration of the absence of significant motor limitations and 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 complication rate is high.This is due to the design characteristics of endoprostheses and the complexity of the surgical intervention itself (hip replacement is technically much simpler).These include arthromedullary bypass and corrective osteotomy.Arthromedullary shunting is the connection of the medullary canal of the femur with the cavity of the knee joint using a shunt - a hollow metal tube.Thanks to this, the fatty bone marrow from the lower third of the femur enters the knee joint, nourishes the cartilage and lubricates it, which achieves a significant reduction in pain.
When the axis of the lower extremity changes (but with the condition of slight limitation of the range of motion), corrective osteotomy is effective - a section of 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 - 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.And although medicine today is not able to offer a medicine that will solve it forever, nor other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its progression.