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 damaged, the joint space narrows and the biomechanics of the joint changes.The synovial membrane that covers the joint and produces the 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 flows out of the back 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 delicate tissue of the joint capsule is replaced by tough connective tissue and the shape of the joint changes.Periarticular bone tissue grows, osteophytes (pathological bone growth) are formed.Blood circulation in the periarticular tissues is interrupted, hypooxidized metabolic products accumulate in them, irritating chemoreceptors and a constant pain syndrome develops.Against the background of changes in the anatomy of the joint, there is a disruption of the functioning of the surrounding muscles, hypotrophy and spasm appear, and walking is interrupted.There is a persistent limitation in the range of motion in the joint (contracture), sometimes so pronounced that only swinging movements (stiffness) or complete lack of movement (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the entire population of the planet and over the age of 60 it affects every third.
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 reasons, there are also unfavorable background factors for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower limbs);
- age (mainly the elderly are affected by the disease);
- female gender (statistically, women get sick more often);
- increase in physical activity and professional sports.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulty in normal, physiological joint movements.
- A characteristic "chewing" 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 increasing physical activity.An 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, 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 joint movement appears, and a characteristic "crack" is heard when walking (from the patient you can hear a common phrase in everyday life: "knees creak").X-rays reveal a clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis passes to the next, third stage, the pain will constantly bother the patient, including at rest, and there is a disturbance in the configuration of the joints, that is, deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate narrowing of the joint space 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 associated with constant, debilitating pain.Minimal efforts to move become a difficult test for a person, the deformation of the joints is visible visually, and walking is extremely difficult.X-rays reveal significant changes: the joint space is practically not defined in the images, numerous thick osteophytes, "articular mice" (deteriorated bone fragments falling into the joint cavity) are revealed.This stage of gonarthrosis almost always brings disability: often the result of the disease is the 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 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 and traumatology department.
How and with what to treat arthrosis of the knee joint?
The currently known methods of treating arthrosis of the knee joint are divided into non-medical, medical and surgical conservatives.
Non-drug methods
Many patients ask the question: "How to cure arthrosis of the knee joint without pills?"Answering this question, we regret to say that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many existing non-pharmacological methods to combat 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 the doctor at the right time and the patient is motivated enough to get well, 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 pain intensity.Exercises to improve quadriceps strength have been shown to have comparable effects to anti-inflammatory medications.
If we treat arthrosis of the knee joint, then we must strive for the right food: 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 a passion for swamps, smoked meat, smoked meat and meat.on the contrary, it strengthens metabolic disorders in the body and the accumulation of excess weight up 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, orthoses, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thus 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 various categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after only 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 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 are reduced.Not so popular, but no less effective in the treatment of arthrosis of the knee joint, are such physiotherapy methods as laser therapy and cryotherapy (cold exposure), which have a pronounced analgesic effect.
Drug treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), available in forms for external use (various gels, ointments) and systemic (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 joint pain and swelling and slow down the progression of the disease.For the early manifestations of the disease, the local use of these drugs in combination with non-medicinal methods is effective.But with advanced osteoarthritis of the knee joints, you can't do without pills.It should be remembered that prolonged 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 experiences unbearable pain that does not subside even at rest, disrupts normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, it is possible to prescribe opioid sedatives.These drugs are used only with a doctor's prescription, who considers the advisability of their prescription in each specific case.
Chondroprotectors (literally translated as "cartilage protector").This name refers to different drugs, united by one property - a structure-modifying effect, i.e. the ability to slow down degenerative changes in cartilage and the narrowing of the joint space.They are produced in forms for oral administration (glucosamine, chondroitin sulfate, piascledine) and for injection into the joint cavity (hyaluronate).Of course, these medications do not work miracles and do not "grow" new cartilage, but they can stop its destruction.To achieve a lasting effect, they should be used for a long time, in regular courses several times a year.
Surgical treatment of arthrosis of the knee joints
There are often cases when, despite adequate comprehensive treatment, the disease progresses, steadily reducing a person's quality of life.In such situations, the patient begins to ask questions: "what should you do if the prescribed medications do not help with arthrosis of the knee joint?", "Is surgical treatment indicated for arthrosis of the knee?", "How is arthrosis 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 intractable pain syndrome and significant joint dysfunction, which cannot be eliminated with the use of complex conservative therapy.
The most popular type of surgical care for 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, a prerequisite for performing this type of surgical treatment is the absence of large joint deformations, the formation of "false joints", muscle contractions and pronounced muscle atrophy.
In case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics are also not indicated: the "sugar" bone will not withstand the insertion of metal pins, and rapid resorption of bone tissue will begin at the site of their installation, and pathological fractures may occur.Therefore, a 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 endoprosthetics, i.e. the temporary duration of the absence of significant motor limitations and maintaining a good quality of life, is about ten years.The best results of surgical treatment are observed in people 45-75 years old with low body weight (less than 70 kg) and with 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 is high.This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (hip replacement is much simpler from a technical point of view).These include arthromedullary bypass surgery and corrective osteotomy.Arthromedullary shunting is a connection of the medullary canal of the femur to 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, nourishing the cartilage and lubricating it, thus achieving a significant reduction in pain.
When the axis of the lower limbs changes (but with the condition of a slight 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 - the normalization of biomechanics due to the restoration of the axis of the limbs, as well as the activation of blood circulation and metabolism during bone fusion.And although today medicine is not able to offer a drug that saves him forever, or other ways to completely cure this disease, a healthy lifestyle, seeking medical help in time and following the doctor's recommendations can stop its progress.