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, as the bone tissue on the joint surfaces is exposed, gliding is disturbed, the joint gap narrows, the biomechanics of the joint changes.The synovial membrane covering the joint and producing 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 narrowing of the joint space, the volume of the joint decreases, the synovial fluid protrudes the back wall of the joint capsule and Becker's cyst is formed (which, when it reaches large sizes, 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.Blood circulation in the periarticular tissues is disturbed, insufficiently oxidized metabolic products accumulate in them, which irritate the chemoreceptors and a constant pain syndrome develops.Against the background of changes in the anatomy of the joint, the functioning of the surrounding muscles is disturbed, hypotrophy and spasms appear, the gait is disturbed.There is a permanent limitation of the range of motion in the joint (contracture), sometimes so pronounced that only wobbly movements (rigidity) or a complete lack of movement (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the entire population of the planet, and every third person over the age of 60 is affected.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular system and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which include:
- overweight (literally puts pressure on the lower limbs);
- age (primarily 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 with walking and decreases with rest.
- Difficulties with the usual, physiological movements in the joints.
- Characteristic "creaking" 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.
- At 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 be uninformative: 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 without giving great importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the severity of which decreases with rest.Difficult movement in 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").X-ray shows clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis progresses to the next, third stage, the pain will torment the patient constantly, including at rest, and a violation of the configuration of the joints occurs, i.e.deformity aggravated by swelling during inflammation.Radiographs show moderate joint space narrowing and multiple osteophytes.At the third stage, many people already seek medical help because... the quality of life significantly deteriorates due to the pain and difficulty in walking normally.
- The fourth stage is accompanied by unrelenting, debilitating pain.Minimal attempts to move become a difficult test for a person, the deformation of the joints is visually noticeable, and walking is extremely difficult.Radiography reveals significant changes: the joint gap is practically not defined in the images, numerous rough osteophytes, "joint mice" (fragments of deteriorated bone falling into the joint cavity) are revealed.This stage of gonarthrosis almost always leads to damage: often the result of the disease is 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, rheumatologist and general practitioner (family doctor), but these specialists treat the knee joint with uncomplicated arthrosis.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 assistance is required, the patient is sent to a specialized department of orthopedics and traumatology.
How and with what to treat arthrosis of the knee joint?
Currently, the known methods of treating arthrosis of the knee joint are divided into non-medicinal conservative, medicinal and surgical.
Non-drug methods
Many patients ask the question: "How to treat arthrosis of the knee joint without pills?"Answering this question, we regret to note that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many currently existing 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 motivated enough to heal, sometimes it is enough to eliminate the negative factors.For example, it has been shown 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 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 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 joint cartilage, and the passion for smoked meat, marinades, preservatives, sweet and salty dishes, on the contrary, potentiates metabolic disorders in the body and accumulation of excess weight toobesity.
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 an orthosis: knee braces, orthoses, elastic bandages and orthopedic insoles reduce and properly distribute the load on the joint, thereby reducing the intensity of pain in it.
The 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 it is widely used in different 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 improving blood circulation, reducing swelling and eliminating muscle spasm, joint mobility increases.The effect of magnetotherapy is particularly pronounced when active inflammation develops in the joint: the severity of the swelling significantly decreases and the symptoms of synovitis regress.Not so popular, but no less effective in the treatment of knee joint with arthrosis, are such methods of physiotherapy as laser therapy and cryotherapy (cold exposure), which have a pronounced analgesic effect.
Drug treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), available in the form of 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 enzyme level, they eliminate joint pain and swelling and slow the progression of the disease.In early manifestations of the disease, the local use of these drugs in combination with non-medicinal methods is effective.But with advanced arthrosis of the knee joints, you cannot do without pills.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, in addition, negatively affect the function of the kidneys and liver.Therefore, patients taking NSAIDs for a long time should also prescribe 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 experiences unbearable pain that does not subside even at rest, disturbs normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, it is possible to prescribe opioid pain relievers.These drugs are used only according to a doctor's prescription, who assesses the expediency of prescribing them in each specific case.
Chondroprotectors (literally translated as "cartilage protection").This name refers to various drugs united by one property - structural-modifying effect, i.e.the ability to slow down degenerative changes in cartilage and narrowing of the joint space.They are produced in the form 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, on regular courses several times a year.
Surgical treatment of arthrosis of the knee joints
There are often cases when, despite adequate overall 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 the prescribed drugs do not help with arthrosis of the knee joint?", "Is surgical treatment indicated for arthrosis of the knee joint?", "How is arthrosis of the knee joint treated surgically?"Answering these questions, it should be clarified that the indications for surgical treatment of arthrosis of the knee joints are unbearable pain syndrome and significant dysfunction of the joint, which cannot be eliminated with the help of complex conservative therapy.
The most popular type of surgical assistance for gonarthrosis is endoprosthetics, i.e.the removal of the 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, a prerequisite for performing this type of surgical treatment is the absence of gross deformations of the joint, formed "false joints", muscle contractures and pronounced muscle atrophy.
In the case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics is also not indicated: the "sugar" bone will not withstand the introduction of metal pins, and at the site of their installation, rapid resorption of bone tissue will begin and pathological fractures may occur.That is why the timely 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 effect of endoprosthesis, i.e.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 of surgical treatment are observed in people aged 45-75 years with a low body weight (under 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 incidence of complications is high.This is due to the design characteristics of endoprostheses and the complexity of the surgical intervention itself (replacing the hip joint is much simpler from a technical point of view).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 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, nourishes the cartilage and lubricates it, thereby achieving a significant reduction in pain.
When the axis of the lower limb is changed (but on the condition of slight limitation of the range of movements), corrective osteotomy is effective - crossing 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 - normalization of biomechanics due to restoration of the axis of the limb, as well as activation of blood circulation and metabolism during bone fusion.And although medicine today is not able to offer a drug that will get 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.