<>Deforming osteoarthritis of the knee joints (also known as gonarthrosis or DOA abbreviation)- degenerative dystrophic disease of the knee joint, which is characterized by a chronic, progressively progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and joint ligaments) and leads to joint deformity, reduced range movement and often disability.
The disease starts with changes in the articular cartilage, due to which the articular surfaces of the bones slip. Malnutrition and loss of elasticity lead to dystrophy (thinning) and resorption, while the bone tissue of the joint surfaces is exposed, sliding is disturbed, the joint gaps in the knee narrow, the biomechanics of the joint change. 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, which leads to an increase in its amount in the joint (synovitis). In the context of joint space narrowing, joint volume decreases, synovial fluid projects the posterior wall of the joint capsule and a Becker's cyst is formed (which, reaching large sizes, can cause pain in the popliteal fossa) . The thin, 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, underoxidized metabolic products that irritate the chemoreceptors accumulate in them and the 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 in the range of motion in the joint (contracture), sometimes so pronounced that only rocking movements (rigidity) or complete absence of movement (ankylosis) are possible.
Regarding arthrosis of the knee joint, we can say that it is a very common disease: it affects 10% of the entire population of the planet and, at age 60, it 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, parathyroid gland diseases, hemochromatosis).
- Muscular system diseases and neuropathy (Charcot's disease).
In addition to the main reasons, there are also unfavorable background factors for the development of gonarthrosis, which include:
- overweight (literally putting pressure on the lower limbs);
- age (especially elderly people are susceptible to the disease);
- female sex (according to statistics, women get sick more often);
- increase in sports and professional physical activity.
Symptoms of Osteoarthritis of the Knee Joints
- Pain that increases with walking and decreases at rest.
- Difficulty in the usual physiological movements in the joints.
- The "crunchy" characteristic in the joints.
- Increased joint and visible deformity.
Stages of gonarthrosis
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There are several stages of arthrosis:
- In the first stage, a person experiences only symptoms such asslight discomfortor "heavy" on the knee, disturbing when walking long distances or increased physical exertion. 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, the person does not go to specialists, without giving special importance to the symptoms that have arisen.
- For the second stage of arthrosis of the knee joint,tangible pain, whose severity decreases at rest. There appears difficulty in movement in the joints, when walking, there is a characteristic "creaking" (the patient can hear a common phrase in everyday life - "creaking of knees"). When performing the radiography, a clearly distinguishable narrowing of the joint space and single osteophytes are found.
- With the transition from gonarthrosis to the next, third stage,pain symptoms will trouble the patient constantly, even at rest, there is a violation of the configuration of the joints, that is, deformation, aggravated by edema at the time of joint inflammation. On radiographs, a moderate narrowing of the joint space and multiple osteophytes are determined. In the third stage, many are already seeking medical care, as their quality of life is significantly affected by pain and difficulty in walking normally.
- The fourth stage of arthrosis of the knee joint is accompanied byunquenchable and exhausting pain. . . Minimal attempts at movement become a difficult test for a person, joint deformity is visually noticeable, walking is extremely difficult. Radiography reveals significant changes: the joint space is virtually undetectable on images, multiple thick osteophytes, "joint rats" (collapsing bone fragments falling into the joint cavity) are revealed. This stage of gonarthrosis almost always leads to disability: often the result of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who Treats Arthrosis 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 handle knee joint treatment for uncomplicated arthrosis.
When synovitis occurs or the treatment prescribed by the therapist does not produce the desired effect, the help of an orthopedist cannot be dispensed with. In situations where surgical care is needed, the patient with arthrosis of the knee joint is referred to a specialized orthopedic and trauma service.
How and how to treat arthrosis of the knee joint?
The currently known methods of treating patients with arthrosis of the knee joint are subdivided into non-drug conservatives, medical and surgical.
non-drug methods
Many patients ask themselves: "How to deal with arthrosis of the knee joint without pills? "In response, we have to sadly state that gonarthrosis is a chronic disease, it is impossible to eliminate it forever. However, many of the currently existing non-pharmacological (ie, drug-free) methods of dealing with this disease can significantly delay 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 the doctor and sufficient patient motivation to heal, it is sometimes sufficient to eliminate the negative factors. For example, it has been proven that reducing excess weight reduces the manifestation of the main symptoms of the disease.
Elimination of pathological physical activity and, on the contrary,therapeutic gymnasticswith the use of rational physical programs, they reduce pain intensity. Exercises to strengthen the quadriceps femoris have been shown to be comparable to anti-inflammatory medications.
If we are treating arthrosis of the knee joint, then it is necessary to fight forproper nutrition: to improve the elastic properties of articular cartilage it will help products containing a large amount of animal collagen (meat and fish diet types) and cartilage components (shrimp, crab, 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, potentiates the disturbance of the body's metabolic processes and the accumulation of excess weight to obesity.
Reflecting on the most effective treatment for knee arthrosis, it is worth remembering a treatment and prophylactic method as effective asorthotics: the fixation of knee braces, orthotics, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thus decreasing the intensity of pain in the joint. The use of a cane is also recommended as an effective knee joint relief. It should be placed in the hand opposite the affected limb.
Comprehensive treatment of arthrosis of the knee joint also implies naming very effective ones, even with the advanced forms of the disease.physiotherapy. . . With wide use in different categories of patients suffering from arthrosis of any degree, it has proven its effectivenessmagnetotherapy: after several procedures, pain intensity decreases, as a result of improved blood circulation, reduced edema and elimination of muscle spasm, joint mobility 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 regress. Not as popular, but no less effective in treating arthrosis of the knee joint, are physical therapy methods such aslaser therapyandcryotherapy(cold exposure), which have a pronounced analgesic effect.
drug treatment
In effective treatment regimens for arthrosis of the knee joint, the following medications are used.
Non-steroidal anti-inflammatory drugs (NSAIDs), produced in external (various gels, ointments) and systemic (tablets, suppositories, solutions) forms of use, have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by physicians. By blocking inflammation at an enzymatic level, they eliminate pain and swelling in the joints and slow down the progression of the disease. With the early manifestations of the disease, the local use of these drugs in combination with non-medication methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills and sometimes NSAID injections are indispensable. It should be remembered that prolonged systemic ingestion of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract and, furthermore, negatively affect kidney and liver function. 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 Organs internal organs.
Glucocorticosteroids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when NSAIDs previously prescribed to the patient do not help to eliminate inflammatory manifestations. As a powerful anti-inflammatory agent, GCS in the treatment of arthrosis has certain contraindications, as it can cause a series of significant side effects. In systemic forms with gonarthrosis, they are practically not prescribed. As a rule, for the effective treatment of arthrosis, injections of GCS are used in the periarticular pain points, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted side effects of the drug. This manipulation can be performed by a rheumatologist or 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 this treatment lasts up to 1 month. According to national guidelines for the treatment of osteoarthritis, do not have 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 subside even at rest, disrupts normal sleep, and is not removed by NSAIDs, GCS, and non-drug methods, it is possible to prescribeopioid analgesics. . . These medications are only used upon prescription, which considers the opportunity of your consultation in each case.
Chondroprotectors(literally translated as "cartilage protection"). This name is understood as several drugs, united by one property - a structural modifying action, that is, the ability to delay degenerative changes in cartilage and narrowing of the joint space. They are produced in forms for both oral administration and introduction into the joint cavity. Of course, these drugs don't work miracles and don't "grow" new cartilage, but they can prevent its destruction. To achieve a lasting effect, they must be applied for a long period, with regular courses several times a year.
Surgical treatment of arthrosis of the knee joints
There are frequent cases in which, despite adequate and complex treatment, the disease progresses, progressively reducing the quality of human life. In these situations, the patient begins to ask himself: "what to do if the prescribed medications do not help with arthrosis of the knee joint? ", "Is the surgical treatment indicated for arthrosis of the knee? "Answering these questions, it should be clarified that the indications for surgical treatment of knee joint osteoarthritis 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 treatment for third- and fourth-degree osteoarthritis isendoprosthesis, that is, removal of its own joint with the simultaneous installation of a metallic replacement prosthesis, whose design 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 gross joint deformities, "false joints" formed, muscle contractures and severe muscle atrophy. In case of severe osteoporosis (significant decrease in bone mineral density), the endoprosthesis is also not indicated: "sugar" bone will not resist the introduction of metal pins and the rapid resorption (resorption) of bone tissue will start at the installation site, it may pathological fractures occur. Therefore, a timely decision about the need to install an endoprosthesis appears to be so significant - it must be made when the age and general condition of the human body still allow the operation. According to the results of long-term studies, the duration of the endoprosthesis effect in patients with advanced arthrosis, 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 from surgical treatment are seen in people aged 45 to 75 years 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 percentage of complications is high. This is due to the design characteristics of the stent grafts and the complexity of the surgical intervention itself (the replacement of the hip joint is technically much easier). This determines the need to carry out organ preservation operations (preserving the joint). This includes coronary artery 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- transection 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 limb axis restoration, as well as the activation of blood circulation and metabolism during bone fusion.
In summary, I would like to note that the treatment of gonarthrosis is a complex social task. And although medicine today is not able to offer a drug that will eliminate it forever, or other ways to completely cure this disease, a healthy lifestyle, seeking medical help in a timely manner and following the doctor's recommendations can impede its progression. .