Osteoarthritis of the knee joints (aka gonarthrosis or abbreviated DOA)- Degenerative-dystrophic disease of the knee joint, chronic, a progressive course, characterized by damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and joint ligaments) and causes articular deformation, movement and frequent disability.
The disease begins with changes in articular cartilage due to slippage of the articular surfaces of the bones. Malnutrition and loss of elasticity lead to its dystrophy (thinning) and resorption, the bone tissue of the joint surfaces is exposed, the slide is broken, the joint knee cavities narrow, and the biomechanics of the joint change. The synovial membrane, which connects the joint and produces synovial fluid (which nourishes cartilage and acts as a physiological lubricant), is irritated, causing an increase in the amount in the joint (synovitis). Against the background of narrowing of the joint space, the volume of the joint decreases, synovial fluid removes the posterior wall of the joint capsule, and Becker cyst is formed (reaching large sizes can cause pain in the popliteal fossa). The thin and delicate tissue of the joint capsule is replaced by coarse connective tissue, changing the shape of the joint. Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed. Circulation in the periarticular tissues is disrupted, non-oxidized metabolic products that irritate chemoreceptors accumulate, and persistent pain syndrome develops. Against the background of changes in joint anatomy, the surrounding muscles are disrupted, hypotrophy and spasm appear, and gait is impaired. There is a constant restriction in the range of motion in the joint (contracture), sometimes so clearly expressed that only swaying movements (stiffness) or complete absence of movements (ankylosis) is possible.
About osteoarthritis 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 every third person over the age of 60.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the musculoskeletal system and neuropathy (Charcot's disease).
In addition to the main causes, there are unfavorable background factors for the development of gonarthrosis:
- overweight (as if putting pressure on the lower extremities);
- age (mostly older people are susceptible to the disease);
- female sex (according to statistics, women get sick more often);
- increasing sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Increased pain while walking and decreased at rest.
- The difficulty of habitual, physiological movements in the joints.
- Characteristic "crisis" in the joints.
- Joint expansion and visible deformation.
Stages of gonarthrosis
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There are several stages of osteoarthritis:
- In the first stage, a person experiences symptoms just like thatslight discomfortor "heaviness" in the knee, causing discomfort when walking long distances or with increased physical strength. The X-ray examination will contain very little information: only a slight narrowing of the joint space can be detected, there will be no other changes. At the onset of the defeat of osteoarthritis of the knee joint, a person does not consult a specialist without paying special attention to the symptoms that occur.
- For the second stage of osteoarthritis of the knee joint,felt painintensity decreases at rest. There is difficulty in movement in the joints, a characteristic "creaking" is heard while walking (you can hear a general expression from the patient in everyday life - "knees throbbing"). X-rays reveal a clearly differentiated narrowing of the joint cavity and single osteophytes.
- With the transition of gonarthrosis to the next, third stage,pain symptoms will constantly bother the patientthere is a violation of the configuration of the joints, including at rest, ie. deformity aggravated by edema during inflammation. X-rays show moderate narrowing of the joint space and multiple osteophytes. In the third stage, many are already seeking medical attention, because the quality of life is significantly affected by pain and difficulty walking normally.
- It is accompanied by the fourth stage of osteoarthritis of the knee jointinexhaustible, tiring pain. . . Minimal attempts to move become a difficult test for a person, the deformation of the joints is visually noticeable, it is extremely difficult to walk. Radiography reveals significant changes: the images do not reveal a joint cavity, many rough osteophytes, "articular mice" (bone fragments falling into the joint cavity). This stage of gonarthrosis almost always leads to disability: often the result of the disease is complete articulation of the joint, instability and the formation of "false joints".
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 deal with the treatment of uncomplicated osteoarthritis of the knee joint.
If synovitis occurs or the treatment prescribed by a therapist does not give the desired effect, you can not do without the help of an orthopedist. A patient with osteoarthritis of the knee joint is referred to a special orthopedics and trauma department if surgery is needed.
How and when to treat osteoarthritis of the knee joint?
Currently known methods of treatment of patients with osteoarthritis of the knee joint are divided into non-conservative, medical and surgical.
Non-drug methods
Many patients ask themselves: "How to deal with osteoarthritis of the knee joint without pills? " In response, we must say with regret that gonarthrosis is a chronic disease that can not be eliminated forever. However, many currently non-pharmacological (ie drug-free) methods of combating this disease, especially when used in the early stages of the disease, can significantly slow its progression and improve the patient's quality of life.
It is sometimes enough to visit the doctor on time and eliminate the negative factors with enough motivation for the patient's recovery. For example, weight loss has been shown to reduce the onset of the main symptoms of the disease.
Eliminate pathological physical activity and vice versatherapeutic gymnasticsreduces the intensity of pain with the use of rational physical programs. Exercises to strengthen the quadriceps femoris have been shown to be comparable in effect to anti-inflammatory drugs.
If we treat osteoarthritis of the knee joint, it is necessary to make an effortproper nutrition: Products containing large amounts of animal collagen (meat and fish species) and cartilage components (shrimp, crustaceans, krill), fresh vegetables and fruits saturated with vegetable collagen and antioxidants will help to improve the elastic properties of articular cartilage. The passion for smoked meat, marinades, preservatives, sweet and salty foods, on the contrary, intensifies the disruption of metabolic processes in the body and the accumulation of excess weight until obesity.
Considering the most effective treatment for osteoarthritis of the knee, it is worth remembering such an effective method of treatment and prevention.orthosis: Correction of knee pads, orthoses, elastic bandages and orthopedic soles reduces the load on the joint and distributes it properly, thereby reducing the severity of pain. The use of a shoulder bar is also recommended as an effective relaxation of the knee joints. It should be on the opposite side of the affected joint.
Comprehensive treatment of osteoarthritis of the knee joint involves a very effective diagnosis, even with advanced forms of the disease.physiotherapy. . . It has proven to be effective in a wide range of patients suffering from osteoarthritis of any degreemagnetotherapyAfter several procedures, the intensity of pain decreases, blood circulation improves, edema decreases, and joint mobility increases as a result of muscle spasm. The effect of magnetotherapy is manifested especially with the development of active inflammation in the joint: the severity of edema is significantly reduced, synovitis is delayed. Although not very popular in the treatment of osteoarthritis of the knee joint, physiotherapy methods are less effective.laser therapyandcryotherapyhaving a pronounced analgesic effect (exposure to colds).
Drug treatment
The following medications are used in effective treatment regimens for osteoarthritis of the knee joint.
Non-steroidal anti-inflammatory drugs (NSAIDs)It is produced in external (various gels, ointments) and forms for systemic use (tablets, suppositories, solutions), has long been proven effective in the treatment of osteoarthritis and is widely prescribed by doctors. By preventing inflammation at the enzymatic level, they relieve joint pain and swelling and slow down the progression of the disease. With the early manifestations of the disease, the use of these drugs in combination with non-pharmacological methods (therapeutic exercises, magnetotherapy) is effective. However, pills and sometimes NSAID injections are essential in advanced osteoarthritis of the knee joints. It should be remembered that long-term systemic administration of NSAIDs can lead to the development and exacerbation of ulcerative processes in the gastrointestinal tract, and in addition can adversely affect the function of the kidneys and liver. Therefore, patients taking NSAIDs for a long time should be prescribed drugs that protect the gastric mucosa and the laboratory performance of internal organs should be monitored regularly.
Glucocorticosteroids (GCS)- Hormonal drugs with a pronounced anti-inflammatory effect. Previously prescribed NSAIDs are recommended if the patient is unable to cope with the elimination of inflammatory manifestations. GCS, a powerful anti-inflammatory tool in the treatment of osteoarthritis, has certain contraindications as it can cause a number of significant side effects. It is practically not prescribed in systemic forms of gonarthrosis. As a rule, effective treatment of osteoarthritis involves GCS injections into periarticular pain points, which increase the intensity of the fight against inflammation and minimize the risk of undesirable 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. Once GCS is applied, the effect of such treatment lasts up to 1 month. According to national guidelines for the treatment of osteoarthritis, do not inject more than three drugs per year in the same joint.
In advanced, "indifferent" osteoarthritis, it is possible to write a prescription when a person is experiencing unbearable pain that does not even sleep at rest, disrupts normal sleep and is not eliminated by NSAIDs, GCS and non-pharmacological methods.opioid painkillers. . . These drugs are used only with a doctor's prescription, taking into account the expediency of prescribing in each case.
Chondroprotectors(literally translated as "protective cartilage"). This name is understood as a variety of drugs, combined with one feature - the action of structural changes, ie. degenerative changes in cartilage and the ability to slow the narrowing of the joint space. It is produced for both oral application and access to the joint cavity. Of course, these drugs do not work wonders and do not "grow" new cartilage, but they can stop their destruction. To achieve a lasting effect, it should be applied for a long time, several times a year with regular courses.
Surgical treatment of osteoarthritis of the knee joints
Despite a fairly complex treatment, there are frequent cases where the disease progresses and the quality of human life continues to decline. In such cases, the patient begins to ask: "What to do if the prescribed medication does not help with osteoarthritis of the knee joint? " "Is surgical treatment for knee osteoarthritis? " By answering these questions, it is necessary to clarify thatis a pain syndrome and significant joint dysfunction that cannot be eliminated with the help of complex conservative treatment. fourth degree of the disease.
It is the most popular type of surgical treatment for third and fourth degree osteoarthritisendoprosthesisRemoval of your own joint with the simultaneous installation of a metal prosthesis similar to the anatomy of the human knee joint. In this case, a prerequisite for such surgical treatment is the absence of rough deformations of the joint, the resulting "false joints", muscle contractures and severe muscle atrophy. In the case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthesis is also not indicated: "sugar" bone will not withstand the application of metal pins, and rapid resorption (resorption) of bone tissue will begin where they are located, pathological fractures may occur. Therefore, a timely decision on the need to place an endoprosthesis seems very important - the age and general condition of the human body must still be made when surgery is allowed. According to the results of long-term studies, the duration of action of endoprosthesis in patients with advanced arthrosis, ie. the absence of significant motor limitations and a temporary period of maintaining a decent quality of life is about ten years. The best results of surgical treatment are observed in people aged 45-75 years, with low body weight (less than 70 kg) and a relatively high standard of living.
Despite the prevalence of knee arthroplasty, the results of such surgeries are often unsatisfactory and the percentage of complications is high. This is due to the design features of the endoprosthesis and the complexity of the surgical intervention (replacement of the hip joint is technically easier). This dictates the need for the body to perform protective operations (joint protection). These include arthromedullary bypass surgery and corrective osteotomy.
Arthromedullary bypass- a shunt of the medullaral canal of the femur with the cavity of the knee joint - closure with 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, thereby significantly reducing pain.
It is effective when changing the axis of the lower extremity (but with a slight restriction of range).corrective osteotomy- Cut the tibia by straightening the axis, then fix it with a plate and screws in the desired position. At the same time, 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.
Summarizing the above, I would like to note that the treatment of gonarthrosis is a complex social task. And while today's medicine may not offer a cure or a cure for the disease, a healthy lifestyle, timely medical care, and adherence to a doctor's advice can stop its development.