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Osteoarthritis of the knee joint

arthrosis of the knee joint on x-ray

Osteoarthritis of the knee joint is a specific disease that has a destructive effect on the cartilage of the knee joint.

When such a disease appears, doctors observe serious disturbances in the blood circulation processes in the bone vessels, as a result of which the cartilaginous tissue is deformed and destroyed, the person feels severe pain that restricts any movement of the legs and knees, and observes swelling and changes in the appearance of the knees.

To prevent the development of the serious consequences of gonarthrosis (deformation of the limb and ankylosis - immobilization of the joint), when only joint replacement surgery can help the patient, the disease must be promptly identified and treated.Also, do not treat independently with folk methods and advertised remedies, but under the supervision of qualified doctors.

What are the reasons?

The mechanisms of arthrosis in medicine are usually divided into:

  • Primary- which occurs in old age due to the natural aging of body tissues and against the backdrop of some factors that cause this disease, such as obesity (10% of cases), heredity and increased stress throughout life.
  • Secondary- is responsible for 30% of all cases of arthrosis of the knee joint;It usually manifests itself after an injury, tibial fracture, ligament rupture or meniscus injury.In addition, with such arthrosis of the knee joint, symptoms of the disease in most cases appear after 3-4 years, but after a serious injury it is possible even after 2-3 months.

In 50-60% of cases, the cause of arthrosis of the knee joint is a spasm of the muscles of the anterior surface of the thigh.

What happens to the knee joint with osteoarthritis?

With regular excessive loads, genetic predisposition, metabolic disorders in the body, prolonged muscle spasms and injuries, the knee cartilage loses its smoothness and begins to thin.The smooth sliding of the articulating bones is replaced by strong friction, and the first degree of gonarthrosis develops, in which the cartilage loses its shock-absorbing properties.

The degradation process continues to progress and poor shock absorption leads to the flattening of bone surfaces with the formation of osteophytes in the form of bone growths.In this case, the disease already has a second degree and is accompanied by degeneration of the synovial membrane and joint capsule.The lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the process of nourishing the cartilage is disturbed, which leads to an even greater deterioration in the patient's condition.

The thinning of the cartilage leads to a reduction in the distance between the articulating bones by up to 80%.When walking, due to abnormal friction and the absence of a shock absorber, destructive processes in the joint rapidly increase, which quickly leads to the development of the third degree of arthrosis with pronounced symptoms:

  • Pain when moving, especially when going up or down stairs.
  • Pain during exercise and at rest, morning stiffness.
  • The patient begins to limp, trying to spare the painful joint.
  • Severe cases of the disease require the use of crutches or a cane.

The third degree of arthrosis of the knee joint is characterized by an almost complete absence of cartilaginous tissue, which leads to a minimal decrease in joint mobility.Therefore, no magical methods, supermedicines or ointments can restore worn-out cartilaginous tissue, and given the degree of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.

destruction of the knee joint due to osteoarthritis

Stages of osteoarthritis

As osteoarthritis progresses, the following stages or degrees are distinguished:

  • The initial stage, or stage 1, is often called compensated, since there are no pronounced clinical signs of pathology yet.The patient may feel discomfort in the knees after physical activity, which disappears quickly after rest;the joints are still fully functional.
  • In grade 2 osteoarthritis, subcompensated, the symptoms of the disease intensify.A pronounced pain syndrome is formed, which, however, is relieved by topical anesthetic ointments and gels.Motor activity is impaired and joint instability appears.In the vast majority of cases, patients turn to doctors at this stage.
  • 3rd degree, decompensated, can also be called deforming.The knee joint is twisted, unstable, immobile and completely non-functional.The pain syndrome is constant and requires serious medical intervention.To unload the joint and move around, the person needs a cane.

Symptoms and first signs

Depending on the severity of the symptoms, the development of the disease is divided into 3 phases.Symptoms of the initial development of gonarthrosis vary greatly and are not specific.

At the first stage of pathology, the following signs are possible:

  1. knee pain when squatting or climbing stairs;
  2. joint pain after prolonged exercise or cooling;
  3. the knee may hurt at the end of the day or in the morning;
  4. stiffness and pain in the morning disappear after daily work.

Later, symptoms characteristic of stages 2 and 3 appear (in ascending order):

  • the pain becomes sharp and prolonged;
  • swelling in the joint area;
  • fluid may appear in the joint;
  • between the articular surfaces it is possible to pinch particles of cartilage, meniscus, synovial villi, resulting in pronounced immobility (it can also pass abruptly);
  • it is difficult to step on toes;
  • joint immobility develops.

Consequences

If left untreated, the following complications of knee osteoarthritis may occur:

  • Joint deformity.In fact, it is more likely that joint deformation is not a complication, but the last stage of the disease.
  • Infection in a joint.Infection usually occurs due to microtrauma.Small fissures in the cartilaginous tissue can be considered.Pathogenic microorganisms are introduced into the joint through the flow of blood or lymph from other areas.This often occurs after infectious diseases.
  • Dislocations and fractures.These complications are explained by dysfunction of the knee joint.In osteoarthritis, there is no uniform distribution of the load from the femur to the leg bones.The ligaments that normally strengthen the joint also weaken.Therefore, at a certain point (even during normal walking), the leg bones may experience excessive stress, which will lead to a fracture or dislocation.To avoid this, people with serious structural and functional deficiencies in the knee joint must move with the aid of a crutch or cane.
  • Ankylosis.Ankylosis is the fusion of two bones where a joint previously existed.This complication is perhaps the most serious, as the joint simply disappears.The tibia and femur gradually fuse and the tibia is fixed in one position.Movement, of course, is impossible.

Diagnosis

To diagnose gonarthrosis use:

  • blood tests (general and biochemical);
  • radiography;
  • arthroscopy;
  • Ultrasound;
  • MRI.

The most important diagnostic method to confirm the diagnosis of gonarthrosis is radiography.Although it is not possible to examine the initial stages of the disease and the state of cartilaginous tissue on x-rays, bone changes of stages 2 and 3 are clearly visible.That:

  1. narrow joint space;
  2. marginal spines located along the contour of the bones, edges of the patella - osteophytes;
  3. changes in the periosteum;
  4. change in the height of one of the condyles and others.

However, changes can be examined in more detail using arthroscopy.

Ultrasound and MRI help detect changes in the soft tissues of the knee joint during the onset of osteoarthritis.These methods also provide a good indication of the condition of the cartilaginous tissue, synovium, and fluid.

How to treat osteoarthritis?

Treatment for osteoarthritis of the knee joint is long and sometimes painful.The duration is due to the fact that once the disease manifests itself, it will be constantly remembered as long as the person lives.

Therefore, to adequately treat gonarthrosis, a very solid financial base and discipline are necessary.An important role is played by how seriously the patient takes treatment, because often, in order to reduce the frequency of exacerbations of the disease, the patient is forced to change his daily activity, preferred profession, engage in joint development, stop smoking and drinking alcoholic beverages.

There are three main stages in the treatment of deforming osteoarthritis of the knee joint.

The first stage of treatment includes:

  • communicate to patients the essence of their disease, risk factors and secondary prevention measures;
  • daily gymnastics with stretching elements;
  • contrast shower;
  • swim in the pool 2 to 3 times a week;
  • weight loss.

The second stage of treatment includes:

  • external fixation of the joint with calipers, bandages, elastic bandages and orthoses;
  • the use of ointments and creams based on non-steroidal anti-inflammatory drugs to relieve inflammation and pain;
  • the use of drugs from the chondroprotector group to reduce the rate of cartilage destruction.

The third stage of treatment includes:

  • clear use of oral NSAIDs;
  • intra-articular injections with hormonal anti-inflammatories;
  • additional use of medications with a pronounced analgesic effect;
  • surgical replacement of a diseased joint with an implant.

Along with drug treatment, modern medicine uses methods such as:

  1. Kinesiotherapy.In this case, the treatment of arthrosis of the knee joint is carried out using special exercises.The load is selected depending on the degree of development of the disease and the physical fitness of the individual patient.
  2. Ozone therapy.This is an effect on a sore knee joint using ozone.With this method of physiotherapeutic treatment, the substance can be administered by injection or used externally.
  3. dietary supplement.Biologically active supplements are a valid alternative to other medications.
  4. Homeopathy.It involves taking medication in small doses.The course of treatment lasts only a few weeks, but during this time, provided that medications are properly selected, blood circulation and normal nutrition of cartilage tissue cells are completely restored.
  5. Exercisesallow you to improve blood circulation in the knee joint, restore the elasticity of the ligaments, improve the nutrition of cartilaginous tissue cells and promote their restoration.

Drug treatment

All medications used to treat gonarthrosis can be divided into those that help eliminate the main symptoms of the disease and those that restore the function of the knee joint and prevent the progression of the pathology.The first type of medications includes nonsteroidal anti-inflammatory drugs and hormonal medications.The second group includes chondroprotectors and hyaluronic acid.

Nonsteroidal anti-inflammatory drugs

Drug treatment for osteoarthritis begins with eliminating pain.They are the ones that cause the greatest moral and physical suffering to patients and lead to the loss of ability to work.Nonsteroidal anti-inflammatory drugs (NSAIDs) have worked well among pain relievers.

Medicines can be used in two ways - topically or orally (in tablets).Local (preferred) treatments usually include patches, ointments or gels.The analgesic effect, as a rule, occurs on the 3-4th day, and its maximum develops on the 7-10th day.

The course of treatment with non-steroidal drugs should be limited to 10-14 days.NSAIDs have a limited range of use and are used with great caution in the treatment of elderly patients.

Hormonal drugs

In cases where treatment with NSAIDs is not sufficient and the disease continues to progress, the doctor may prescribe hormonal injections.They belong to the means of “heavy artillery” and help to quickly eliminate pain, relieve inflammation and swelling of surrounding tissues.

Due to the large number of side effects, hormonal drugs are prescribed in short courses, only during the acute period of the disease, when inflammatory fluid accumulates in the joint cavity.The medicine is administered into the joint space no more than once every 10 days.

Chondroprotectors

To prevent further destruction of the cartilaginous surfaces of the joint, chondroprotectors are prescribed.

These medications also help reduce pain and signs of inflammation in the surrounding soft tissues.Furthermore, chondroprotectors slow down the destruction of joint tissues and stabilize the disease due to their shock-absorbing and lubricating functions.Chondroprotectors improve cartilage nutrition, normalize the composition and properties of intra-articular fluid and protect pain receptors from excessive irritation.

Hyaluronic acid

Hyaluronic acid is called intra-articular fluid fluid prosthesis.In its properties, it is similar to natural synovial (intra-articular) fluid, which nourishes cartilaginous tissue and cushions the knee joint during movements.

Hyaluronic acid preparations are injected into the joint, thereby creating a thin protective film that prevents the cartilage surfaces from rubbing against each other.Injections are performed only after the acute phase of the disease has passed.

Exercise therapy and exercises for arthrosis

Physical exercise helps restore joint function and strengthen it.They must be carried out slowly and carefully so as not to cause sprains and not exceed the permitted load.

The following exercises are considered the most effective:

  1. Slowly raise your straight legs one at a time while lying on your stomach.This exercise uses your thigh and calf muscles.The load must not be transferred to the back.You shouldn't raise your legs too high either.The main thing is to tense the muscles at the top;
  2. This exercise is similar to the first, only now you must lift your leg with your knee bent.At the top point, your thigh muscles should be even more tense.The exercise must be performed the same number of times on each leg;
  3. Lying on the floor (face down), lift your legs straight up, then spread them apart and bring them together.This exercise requires strong and trained abdominal muscles, so it is not suitable for all patients.Furthermore, performing it can increase blood pressure.For patients suffering from hypertension or other diseases of the cardiovascular system, it is best to avoid it;
  4. To perform the next exercise, you need to lie on your side, bend the leg resting on the floor at the knee and slowly lift the other and hold it at the top point.It is important that the execution angle on each leg is the same;
  5. You will need a chair for this exercise.Sitting on it, the legs are stretched one by one, lifted and kept in the stretched position for as long as possible;
  6. It is helpful to stand on your toes while holding the back of a chair or bed.As with other exercises, you need to stay at the top point for a few seconds and additionally strain your leg muscles;
  7. The gentle movement from toes to heel allows you to activate blood circulation in the lower extremities.Such movements should be performed alternately: while one leg rests on the toe, the other on the heel and vice versa.All movements must be smooth;
  8. Leaning on the back of a chair or bed, stand on your heels for a minute, lifting your toes.If you cannot stay in this position for the specified time, you should start with less, gradually increasing;
  9. A massage performed standing up.The legs must be rubbed with vigorous movements directed from the knee to the thigh.It is necessary to complete the massage by stroking the skin.

The doctor will carry out several sessions in the office and show basic techniques for the patient to massage the problem knee on their own.Competent actions improve the condition of the damaged area.

Massage and self-massage

Self-massage with the palm of your hand, the edge of your palm, your fingertips or your fist.Act gently on the painful knee, maintain strong pressure on the affected area: strong pats, blows and active kneading of tissues often worsen the condition.

Basic techniques:

  • the first stage is done with light clockwise movements, the second stage is circular movements in a counterclockwise direction;
  • Press one palm on the painful knee and tap lightly with the fingertips of the other hand;
  • maintain the initial position of the palm, hitting not with your fingers, but with the edge of the palm;
  • gently stroke the knee in a circle, gradually increase the pressure (but in moderation);
  • During therapy, massage the affected area twice a day for 10–15 minutes.For preventive purposes, it is enough to do a light massage once every 7 days.

Before the procedure, apply an ointment or gel with an anti-inflammatory effect to the sore knee.

Physiotherapy treatment

All physiotherapy methods can be divided into several groups:

  1. Reducing pain;
  2. Reducing inflammation;
  3. Restoring joint nutrition and accelerating the restoration of joint function.

The doctor can determine what type of treatment the patient needs based on existing symptoms and concomitant illnesses.

Surgery for osteoarthritis

Surgical treatment refers to radical methods that partially or completely restore the functioning of the knee joint.Surgical treatment methods differ in the degree of intervention in the affected joint.

  1. Arthroscopyrefers to the gentlest methods of surgical treatment.This technique is less traumatic and can be used as a therapeutic measure even in the early stages of osteoarthritis.Its main objective is to extend the life of the damaged joint.Arthroscopy is performed using an endoscope - a flexible probe with a camera at the end.Small punctures are made in the knee joint, through which an endoscope and auxiliary instruments are inserted.During the operation, damaged areas of tissue that cause pain are removed.The operation is more suitable for young people and, if necessary, can be repeated several times.
  2. Endoprosthesesrefers to the most radical surgical techniques.In this case, complete restoration of joint function occurs by replacing the entire knee joint or part of it with an implant.This method is the best alternative to the previously existing technique - arthrodesis (complete immobilization of the injured joint).Currently, endoprosthesis replacement provides up to 90% positive results and significantly improves patients' quality of life.
  3. OsteotomyIt is used when significant deformities develop in the joint and joint function is visibly affected.Osteotomy involves creating an artificial bone fracture in a pre-planned location.Subsequently, the parts of the bone are aligned in the correct physiological position and can grow together.Sometimes, during the operation, artificial fixators of bone fragments can be used, which contribute to a more stable position of the bone.

Folk remedies

Traditional medicine will also help you.The use of various lotions to relieve swelling and pain has been practiced by many patients for a long time.Here are some useful recipes:

  1. Burdock leaves.Take 5 burdock leaves and place them over boiling water to steam them.Lubricate the sore knee with vegetable oil and apply steamed leaves.Wrap the leg in plastic wrap and a warm scarf.Leave the lotion for a few hours.
  2. Cabbage leaf lotion.It is made with fresh cabbage leaves soaked in May honey and applied to the leg.The therapeutic effect is enhanced by insulation made of woolen fabric or plastic film.This product is suitable for people of all age groups.
  3. Eggshells, kefir.Grind the shells of 2 eggs and mix with 1 tablespoon of kefir.Apply the mixture to your knee, wrap it in a cloth and plastic wrap and lie down under a blanket.Leave it like this for a few hours and then rinse the composition with water.This treatment can be used daily.
  4. Horseradish compress.According to this popular recipe, to enhance the medicinal properties of horseradish, it is recommended to first crush and boil it.It must then be applied to the affected area.
  5. Turpentine– an excellent warming agent for joint pain.The knee is rubbed with turpentine before bed and tied with a woolen scarf.Already after the first procedure, the patient feels significant relief.The course of treatment is selected individually for each person.

Diet

The therapeutic diet involves avoiding or minimally consuming canned, smoked and fried foods (to suppress appetite).To restore damaged cartilage, it is necessary to provide the body with complex carbohydrates (porridge, whole grain products).Juices (carrot, beetroot, apple) should also be included in the diet.They will remove toxins from the body and reduce the impact of inflammatory processes.

The diet should include fish and formaldehyde, which act as a kind of chondroprotector and help in the formation of new cartilage.It is worth remembering that you cannot prescribe a diet for yourself - only a nutritionist (diet specialist) can choose the best option.

Sample menu:

  • Breakfast: oatmeal with water without butter or sugar, fruit juice, boiled egg;
  • Second breakfast: a glass of low-fat natural yogurt;
  • Lunch: steamed meat or fish, boiled vegetables, unsweetened tea;
  • Afternoon snack: curd casserole with nuts, a glass of fruit juice;
  • Dinner: vegetable salad, apple, unsweetened tea;
  • Second dinner: a glass of low-fat kefir.

Prevention

Prevent joint diseases:

  • dose the load on the legs during active sports;
  • create a diet that includes foods and dishes containing calcium, magnesium, gelatin;
  • If the work involves lifting or moving heavy objects, follow safety rules and do not transport loads that exceed a certain limit;
  • Do self-massage regularly to prevent osteoarthritis, especially with constant stress on the legs;
  • eat well, limit “harmful” foods;
  • body weight control (excess weight means additional stress on the joints);
  • Get regular checkups and treat acute and chronic illnesses.

Forecast

Provided that arthrosis of the knee joint is diagnosed early, the cause of the pathological process is eliminated and adequate treatment is provided, the prognosis is favorable.The therapy provided allows you to achieve long-term remission, but treatment is usually lifelong.

In the absence of the necessary treatment, as well as when the patient does not follow the doctor's instructions, osteoarthritis of the knee joint becomes a cause of disability.