Deforming osteoarthritis of the knee joints (aka gonarthrosis or abbreviated DOA)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic, steadily progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and joint ligaments) and leads to articular deformity, reduced range of motion and often disability.
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 dystrophy (thinning) and resorption, while the bone tissue of the articular surfaces is exposed, sliding is disturbed, the articular knee gaps narrow, the biomechanics of the joint changes. The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and plays the role of physiological lubricant) becomes 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 protrudes the back wall of the joint capsule, and a Becker cyst is formed (which, 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, the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed. Blood circulation in the periarticular tissues is impaired, under-oxidized metabolic products that irritate chemoreceptors accumulate in them, and persistent pain syndrome develops. Against the background of changes in the anatomy of the joint, a violation of the surrounding muscles occurs, hypotrophy and spasm appear, and the gait is disturbed. There is a persistent limitation of the range of motion in the joint (contracture), sometimes so pronounced that only rocking movements (rigidity) or complete absence of movements (ankylosis) are possible.
About arthrosis of the knee joint, we can say that this is a fairly common disease: it affects 10% of the total population of the planet, and over the age of 60, it affects every third person.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
- Violation of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular apparatus and neuropathy (Charcot's disease).
In addition to the main reasons, there are also unfavorable background factors for the development of gonarthrosis, which include:
- overweight (literally puts pressure on the lower limbs);
- age (mainly elderly people are susceptible to the disease);
- female sex (according to statistics, 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 at rest.
- Difficulty of habitual, physiological movements in the joints.
- The characteristic "crunch" in the joints.
- Joint enlargement and visible deformity.
Stages of gonarthrosis
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There are several stages of arthrosis:
- At the first stage, a person experiences only symptoms such asslight discomfortor "heaviness" in the knee, disturbing when walking for long distances or increased physical exertion. X-ray examination will be of little information: only a slight narrowing of the joint space can be detected, there will be no other changes. At the beginning of the defeat of arthrosis of the knee joint, a person does not turn to specialists, without attaching special importance to the symptoms that have appeared.
- The second stage of arthrosis of the knee joint is characterized bytangible pain, the severity of which decreases at rest. Difficulty of movements in the joints appears, when walking, a characteristic "creak" is heard (from the patient you can hear a common phrase in everyday life - "knees creak"). When carrying out radiography, a clearly distinguishable narrowing of the joint space and single osteophytes are found.
- With the transition of gonarthrosis to the next, third stage,pain symptoms will bother the patient constantly, including at rest, there is a violation of the configuration of the joints, i. e. deformation, aggravated by edema at the time of joining inflammation. On radiographs, a moderate narrowing of the joint space and multiple osteophytes are determined. At the third stage, many already seek medical help, becausethe quality of life is significantly affected by pain and difficulty walking normally.
- The fourth stage of arthrosis of the knee joint is accompanied byunquenchable, exhausting pain. . . Minimal attempts to move become a difficult test for a person, deformation of the joints is noticeable visually, walking is extremely difficult. Radiography reveals significant changes: the joint space is practically undetectable in the images, multiple coarse osteophytes, "articular mice" (fragments of collapsing bone falling into the joint cavity) are revealed. This stage of gonarthrosis almost always entails disability: often the outcome of the disease is complete fusion of the joint, its instability, and the formation of a "false joint".
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 deal with the treatment of the knee joint for uncomplicated arthrosis.
When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, then one cannot do without the help of an orthopedist. In situations where surgical care is required, a patient with arthrosis of the knee joint is sent to a specialized orthopedic and trauma department.
How and how to treat arthrosis of the knee joint?
The currently known methods of treating patients with arthrosis of the knee joint are subdivided into non-drug conservative, medical and surgical.
Non-drug methods
Many patients ask themselves the question: "How to deal with arthrosis of the knee joint without pills? "Answering it, we have to state with regret that gonarthrosis is a chronic disease, it is impossible to eliminate it forever. However, many of the currently existing non-pharmacological (i. e. , without the use of drugs) methods of dealing with this ailment can significantly slow down its progression and improve the patient's quality of life, especially when used in the early stages of the disease.
With a timely visit to a doctor, and sufficient motivation of the patient to heal, sometimes it is enough to eliminate negative factors. For example, it has been proven that reducing excess weight reduces the manifestation of the main symptoms of the disease.
Elimination of pathological physical activity and, on the contrary,therapeutic gymnasticswith the use of rational physical programs, they reduce the intensity of pain. Exercises to strengthen the quadriceps femoris have been shown to be comparable in effect to anti-inflammatory drugs.
If we treat arthrosis of the knee joint, then it is necessary to strive forproper nutrition: to improve the elastic properties of articular cartilage will help products containing a large amount of animal collagen (diet types of meat and fish) and cartilage components (shrimp, crabs, krill), fresh vegetables and fruits saturated with vegetable collagen and antioxidants, and a passion for smoked meats, marinades, preservatives, sweet and salty dishes, on the contrary, potentiates the disturbance of metabolic processes in the body and the accumulation of excess weight up to obesity.
Thinking about which treatment of knee arthrosis is the most effective, it is worth remembering such an effective treatment and prophylactic method asorthotics: fixing knee pads, orthoses, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thereby reducing the intensity of pain in it. The use of a walking stick is also recommended as an effective relief of the knee joints. It should be in the hand opposite to the affected limb.
Comprehensive treatment of arthrosis of the knee joint also implies the appointment of very effective, even with advanced forms of the diseasephysiotherapy. . . With widespread use in different categories of patients suffering from arthrosis of any degree, it has proven its effectivenessmagnetotherapy: after several procedures, the intensity of pain decreases, as a result of improving blood circulation, reducing edema and eliminating muscle spasm, the mobility of the joint increases. The effect of magnetotherapy is especially pronounced with the development of active inflammation in the joint: the severity of edema is significantly reduced, the symptoms of synovitis regress. Not so popular, but no less effective in treating the knee joint for arthrosis, are physiotherapy methods such aslaser therapyandcryotherapy(exposure to cold), which have a pronounced analgesic effect.
Drug treatment
In the schemes of effective treatment of arthrosis of the knee joint, the following drugs are used.
Non-steroidal anti-inflammatory drugs (NSAIDs), produced in forms for 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 enzymatic level, they eliminate joint pain and swelling, and slow down the progression of the disease. With early manifestations of the disease, the local use of these drugs in combination with non-drug methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills, and sometimes injections of NSAIDs, are indispensable. It must be remembered that prolonged systemic intake 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 who have been taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa, and regularly monitor laboratory performance of internal organs.
Glucocorticosteroids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when the previously prescribed NSAIDs to the patient do not cope with the elimination of the manifestations of inflammation. Being a powerful anti-inflammatory agent, GCS in the treatment of arthrosis have certain contraindications, since they can cause a number of significant side effects. In systemic forms with gonarthrosis, they are practically not prescribed. As a rule, for the effective treatment of arthrosis, GCS injections into the periarticular pain points are meant, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted 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. With a single administration of GCS, the effect of such treatment lasts up to 1 month. In accordance with national guidelines for the treatment of osteoarthritis, do not perform more than three injections of the drug per year in the same joint.
With advanced, "advanced" osteoarthritis, when a person experiences unbearable pains that do not subside even at rest, disrupt normal sleep, and are not removed by NSAIDs, GCS and non-drug methods, it is possible to prescribeopioid pain relievers. . . These drugs are used only with a doctor's prescription, who considers the appropriateness of their appointment in each case.
Chondroprotectors(literally translated as "protecting cartilage"). This name is understood as various medicines, united by one property - a structural-modifying action, i. e. the ability to slow down degenerative changes in cartilage and narrowing of the joint space. They are produced in forms both for oral administration and for introduction into the joint cavity. 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 applied for a long time, with regular courses several times a year.
Surgical treatment of arthrosis of the knee joints
There are frequent cases when, despite adequate complex treatment, the disease progresses, steadily reducing the quality of human life. In such situations, the patient begins to ask questions: "what to do if prescribed medications do not help with arthrosis of the knee joint? ", "Is surgical treatment indicated for knee arthrosis? "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 dysfunction of the joint, which cannot be eliminated with the use of complex conservative therapy, which is possible with the last, fourth degree of the disease.
The most popular type of surgical care for third and fourth degree arthrosis isendoprosthetics, i. e. removal of your own joint with the simultaneous installation of a replacement metal prosthesis, the design of which is similar to the anatomy of the human knee joint. In this case, a prerequisite for this type of surgical treatment are: the absence of gross deformities of the joint, formed "false joints", muscle contractures and severe muscle atrophy. In case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics is also not indicated: "sugar" bone will not withstand the introduction of metal pins, and rapid resorption (resorption) of bone tissue will begin at their installation site, pathological fractures may occur. Therefore, a timely decision on the need to install an endoprosthesis seems to be so significant - 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 in patients with advanced arthrosis, i. e. the temporary duration of the absence of significant motor limitations and maintaining a decent quality of life is about ten years. The best results of surgical treatment are observed in people 45-75 years old with 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 percentage of complications is high. This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (replacement of the hip joint is much easier in technical terms). This dictates the need to perform organ-preserving operations (preserving the joint). These include arthromedullary bypass surgery and corrective osteotomy.
Arthromedullary bypass- connection of the medullary canal of the femur with the cavity of the knee joint using a shunt - 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.
When changing the axis of the lower limb (but with the condition of a slight restriction of the range of motion), it is effectivecorrective osteotomy- transection of the tibia with correction of its axis, followed by fixation 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.
Summing up the above, I would like to note that the treatment of gonarthrosis is a complex social task. And although today medicine is not able to offer a drug that will get rid of it forever, or other ways to completely cure this ailment, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its progression.