The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slip.The loss of nutrition and elasticity leads to its degeneration and resorption, during which the bone tissue of the joint surfaces is opened, sliding is disturbed, the joint space narrows, and the biomechanics of the joint changes.The synovial membrane that surrounds 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, synovial fluid removes the back wall of the joint capsule, and Becker's cyst is formed (when it reaches a large size, it can cause pain in the popliteal fossa).
The thin and delicate tissue of the articular 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 is disrupted in periarticular tissues, low-oxidized metabolic products accumulate in them, irritate chemoreceptors, and persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, the activity of the surrounding muscles is disturbed, hypotrophy and spasm appear, and gait is disturbed.In the joint (contracture), there is a continuous limitation in the range of motion, sometimes so obvious that only dangling movements (stiffness) or complete immobility (ankylosis) are possible.
Gonarthrosis is a very common disease: it affects 10% of the entire population of the planet and affects every third person over the age of 60.
Causes of gonarthrosis
- Damage to bones and joints.
- Inflammatory joint diseases (rheumatoid, gout).
- Violation of mineral metabolism in various endocrinopathies (diabetes, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular system and neuropathy (Charcot's disease).
In addition to the main causes, there are unfavorable background factors for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower extremities);
- age (mainly older people are affected by the disease);
- female sex (statistically, women get sick more often);
- increased sports and professional physical activity.
Symptoms of arthrosis of the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulty in normal, physiological movements in the joints.
- A characteristic "creaking" in the joints.
- An increase in the size of 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 discomfort or "heaviness" in the knee, which is uncomfortable when walking long distances or during increased physical activity.X-ray examination will 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, a person does not pay much attention to the emerging symptoms and does not turn to specialists.
- The second stage is characterized by noticeable pain, the intensity of which decreases with rest.There is difficulty in moving the joints, and a characteristic "creaking" is heard when walking (you can hear a common expression from the patient in everyday life: "knees are torn").X-rays reveal clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis moves to the next, third stage, the pain will bother the patient constantly, including at rest, and the configuration of the joints is disturbed, that is, deformation aggravated by swelling occurs during inflammation.Radiographs show moderate narrowing of the joint space and multiple osteophytes.In the third stage, many people already consult a doctor because... the quality of life deteriorates significantly due to 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 it is quite difficult to walk.X-ray reveals significant changes: the joint cavity is practically not defined in the images, many coarse osteophytes, "joint mice" (fragments of deteriorating bone falling into the joint cavity) are revealed.This stage of gonarthrosis almost always causes disability: often the result of the disease is the complete fusion of the joint, its instability and the formation of "false fusion".
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 treat the knee joint with uncomplicated arthrosis.When synovitis occurs or the treatment prescribed by the therapist does not have the desired effect, you cannot do without the help of an orthopedist.In cases where surgical treatment is required, the patient is sent to a special department of orthopedics and traumatology.
How and with what can arthrosis of the knee joint be treated?
At present, the known methods of treatment of arthrosis of the knee joint are divided into non-drug conservative, drug 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 say that gonarthrosis is a chronic disease and it cannot be eliminated forever.However, many existing non-pharmacological 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.Sometimes it is enough to eliminate negative factors if you consult a doctor in time and if the patient has sufficient motivation for recovery.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 the intensity of pain.Exercises to increase quadriceps strength have been shown to have comparable effects to anti-inflammatory drugs.
If we are treating arthrosis of the knee joint, then we should try to eat properly: a large amount of animal collagen and chondroitin (shrimp, crab, krill), fresh vegetables and fruits rich in plant collagen and antioxidants will help to improve the elastic properties of the joint cartilage, and passion, smoked salts, sweets, sweets and sweets.on the contrary, it increases metabolic disturbances in the body and accumulation of excess weight to obesity.
When thinking about what is the most effective treatment for knee arthrosis, it is worth remembering an effective treatment and preventive method such as orthosis: tightening of knee pads, orthoses, elastic bandages and orthopedic traces reduces and properly distributes the load on the joint, thereby reducing the intensity of pain.
Comprehensive treatment of arthrosis of the knee joint also involves the appointment of very effective physical procedures 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 several procedures, the intensity of pain decreases, blood circulation improves, swelling decreases and muscle spasm is eliminated, joint mobility increases.The effect of magnetic therapy is especially noticeable when active inflammation develops in the joint: the severity of edema decreases significantly and the symptoms of synovitis subside.Physiotherapy methods such as laser therapy and cryotherapy (cold exposure), which have a clear analgesic effect, are not so popular in the treatment of arthrosis of the knee joint, but are no less effective.
Drug treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs) available in external (various gels, ointments) and systemic (tablets, suppositories, solutions) forms 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 swelling in the joints and slow down the progression of the disease.For early manifestations of the disease, the local use of these drugs together with non-drug methods is effective.But with advanced osteoarthritis of the knee joints, you can't do without pills.It should be remembered that the long-term systemic use of NSAIDs can lead to the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, can negatively affect the work of the kidneys and liver.Therefore, patients taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor the laboratory parameters of internal organs.
In the case of advanced, "advanced" osteoarthritis, when a person feels excruciating 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 pain relievers.These drugs are used only with the prescription of a doctor who takes into account the expediency of their appointment in each specific case.
Chondroprotectors (literally translated as "cartilage protector").This name refers to various drugs that are united by one feature - a structural-modifying effect, that is, the ability to slow down degenerative changes in cartilage and the narrowing of the joint space.They are produced both in forms for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these drugs do not perform 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 knee joints
It is often the case that, 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 to do if prescribed drugs do not help arthrosis of the knee joint?", "Is surgical treatment for knee arthrosis indicated?", "How is arthrosis of the knee joint treated surgically?"When answering these questions, it is necessary to clarify that indications for surgical treatment of osteoarthritis of knee joints are pain syndrome and significant dysfunction of the joint that cannot be eliminated by the use of complex conservative therapy.
The most popular type of surgical treatment for gonarthrosis is endoprosthetics, that is, the removal of one's own joint with the immediate installation of a metal prosthesis, the design of which is similar to the anatomy of the human knee joint.At the same time, an important condition for carrying out such surgical treatment is the absence of gross deformation of the joint, the absence of formed "false joints", muscle contractures and open muscle atrophy.
Endoprosthetics are also not indicated in the case of severe osteoporosis (significant decrease in bone mineral density): the "sugar" bone will not withstand the application 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 on the need to install an endoprosthesis seems very important - it should be taken when the age and general condition of the human body still allow the operation.According to the results of long-term studies, the period of effect of endoprosthetics, that is, the temporary period of the absence of significant motor limitations and the preservation of a decent quality of life, is about ten years.The best results of surgical treatment are observed in people aged 45-75 who have 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 frequency of complications is high.This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (hip replacement is technically simpler).These include arthromedullary bypass surgery and corrective osteotomy.Arthromedullary maneuver 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 and lubricates the cartilage, and thereby achieves a significant reduction in pain.
Corrective osteotomy is effective when the axis of the lower extremity changes (but with a slight limitation of the range of motion) - intersection of the tibia with axis correction, then fixation in the desired position with plates and screws.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.Although medicine today cannot offer a drug that will eliminate it 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 development.