The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slip.Malnutrition and loss of elasticity cause their degeneration and resorption, while the bone tissue of the joint surfaces is exposed, gliding is impaired, the joint space narrows and the biomechanics of the joint changes.The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) becomes irritated, causing 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 protrudes from the posterior wall of the joint capsule and a Becker cyst forms (which, when it reaches a large size, can cause pain in the popliteal fossa).
The thin, delicate tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.Periarticular bone tissue grows and osteophytes (pathological bone growths) form.Blood circulation in the periarticular tissues is disturbed, poorly oxidized metabolic products accumulate in them, chemoreceptors are irritated, and a persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, a disturbance in the functioning of the surrounding muscles occurs, hypotrophy and spasms appear, and gait is disturbed.A persistent limitation in the range of motion of the joint (contracture) appears, sometimes so pronounced that only rocking movements (stiffness) or a complete lack of motion (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the entire population on the planet and after the age of 60 it affects one in three people.
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 underlying factors unfavorable for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower extremities);
- age (the disease mainly affects older people);
- female gender (statistically, women get sick more often);
- increase in sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints.
- Pain that increases when walking and decreases with rest.
- Difficulty in the usual physiological movements of the joints.
- A characteristic “crunch” in the joints.
- Increase in the size of the joints and their visible deformation.
Stages of gonarthrosis
Clinical stages of osteoarthritis of the knee joint.The disease goes through several stages.
- In the first stage, a person feels only a slight sensation of discomfort or "heaviness" in the knee, which bothers when walking long distances or increasing physical activity.An X-ray examination will not 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 turn to specialists and does not attach much importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the severity of which decreases with rest.Difficulty in the movement of the joints appears and a characteristic "crunch" is heard when walking (from the patient you can hear a common phrase in everyday life: "knees creak").Radiographs reveal clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis progresses to the next third stage, the pain will bother the patient constantly, even at rest, and an alteration will occur in the configuration of the joints, that is, a deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate joint space narrowing 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 walking normally.
- The fourth stage is accompanied by constant, debilitating pain.Minimal attempts to move become a difficult test for a person, deformation of the joints is visually noticeable, and walking is extremely difficult.The x-ray reveals significant changes: the joint space is practically not defined on the images, multiple thick osteophytes, "articular mice" (fragments of deteriorated bone that fall into the joint cavity) are revealed.This stage of gonarthrosis almost always entails disability: often the result of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who treats osteoarthritis of the knee joint?
A therapist, a rheumatologist and a general practitioner (family doctor) can provide the patient with qualified medical care for gonarthrosis, but these specialists treat the osteoarthritis knee joint without complications.When synovitis occurs or the treatment prescribed by the therapist does not produce the desired effect, one cannot do without the help of an orthopedist.In situations where surgical care is required, the patient is sent to a specialized orthopedic and trauma department.
How and with what to treat osteoarthritis of the knee joint?
The currently known methods of treating osteoarthritis of the knee joint are divided into conservative non-medicinal, medicinal and surgical.
Non-pharmacological methods
Many patients ask the question: "How to cure osteoarthritis of the knee joint without pills?"Answering this question, we regret to state that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many of the non-pharmacological methods that currently exist 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 a doctor is consulted in a timely manner and the patient is motivated enough to cure, sometimes it is enough to eliminate negative factors.For example, it has been proven that losing weight reduces the manifestation of the main symptoms of the disease.
Eliminating pathological physical activity and, on the contrary, performing therapeutic exercises through rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have comparable effects to anti-inflammatory medications.
If we are treating osteoarthritis of the knee joint, then we should strive for proper nutrition: products containing a large amount 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 the passion for smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, enhances metabolic disorders in the body and accumulationof excess weight in obesity.
When thinking about what is the most effective treatment for knee osteoarthritis, it is worth remembering a treatment and preventive method as effective as orthoses: the fixation of 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 osteoarthritis of the knee joint also involves the appointment of very effective physical procedures, even in advanced forms of the disease.When widely used in different categories of patients suffering from this disease, magnetic therapy has proven itself: after a few procedures, the intensity of pain decreases, as a result of improved blood circulation, reduced swelling and elimination of muscle spasms, joint mobility increases.The effect of magnetotherapy is especially pronounced when active inflammation develops in the joint: the severity of edema decreases significantly and the symptoms of synovitis recede.Not so popular, but no less effective in the treatment of the knee joint with osteoarthritis, are such physiotherapy methods as laser therapy and cryotherapy (exposure to cold), which have a pronounced analgesic effect.
Pharmacological treatment
Non-steroidal anti-inflammatory drugs (NSAIDs), available in forms for external use (various gels, ointments) and systemic (tablets, suppositories, solutions), have long proven effective 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 the progression of the disease.For the first 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 cannot do without pills.It should be remembered that long-term systemic use of NSAIDs can provoke 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 taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and periodically monitor laboratory parameters of the functioning of internal organs.
In case of advanced, "advanced" osteoarthritis, when a person experiences unbearable pain that does not go away even at rest, disrupts normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, opioid analgesics may be prescribed.These medications are used only with a doctor's prescription, who considers the convenience of prescribing them in each specific case.
Chondroprotectors (literally translated as "protective cartilage").This name refers to several drugs, united by one property - a structure-modifying effect, that is, the ability to slow down degenerative changes in cartilage and narrowing of the joint space.They are produced in forms for both oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these drugs do not work miracles and do not “grow” new cartilage, but they can stop its destruction.To achieve a long-lasting effect, it is necessary to use them for a long period, in regular courses, several times a year.
Surgical treatment of osteoarthritis of the knee joints.
There are often cases when, despite adequate comprehensive treatment, the disease progresses, constantly reducing a person's quality of life.In such situations, the patient begins to ask questions: "What to do if the prescribed medications do not help with osteoarthritis of the knee joint?", "Is surgical treatment indicated for osteoarthritis of the knee?", "How is osteoarthritis 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 dysfunction of the joint, which cannot be eliminated by complex conservative therapy.
The most popular type of surgical treatment for gonarthrosis is endoprostheses, that is, the removal of the joint itself 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 carrying out this type of surgical treatment is the absence of serious deformities of the joint, formed “false joints”, muscle contractures and pronounced muscle atrophy.
In case of severe osteoporosis (a significant decrease in bone mineral density), endoprostheses are also not indicated: the "sugar" bone will not resist the introduction of metal pins and rapid resorption of bone tissue will begin at the site of its installation, and pathological fractures may occur.Therefore, it seems so important to make a timely decision on the need to install an endoprosthesis: it should be made 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 endoprostheses, that is, the temporary duration of the absence of significant motor limitations and the maintenance of a decent quality of life, is about ten years.The best results of surgical treatment are observed in people aged 45 to 75 years with 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 complication rate is high.This is due to the design features of the endoprostheses and the complexity of the surgical intervention itself (hip arthroplasty is much simpler in technical terms).These include arthromedullary bypass surgery and corrective osteotomy.The arthromedullary shunt is a 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 penetrates into the knee joint, nourishing the cartilage and lubricating it, thus achieving a significant reduction in pain.
When the axis of the lower limb changes (but with the condition of a slight limitation of the range of motion), corrective osteotomy is effective: intersection of 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 by restoring the axis of the limb, 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 will eliminate it forever, nor other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its progression.