One of the most common pathologies of the musculoskeletal system is osteoarthritis of the knee joint (if not gonartrose) is a chronic disease, accompanied by dystrophy and destruction of the joint structures of the knee.
The result of destructive processes is a strong restriction or a complete loss of joint mobility, and therefore - a decrease in performance, disability.
It is possible to prevent the harmful consequences that if you are diagnosed early and that you therapy in time.
Reasons
Originally, osteoarthritis of the knee is primary and secondary.Primary develops as an independent disease, is more often diagnosed in the elderly and, in this case, is due to age -related changes in tissues.Secondary gonarthrosis becomes the result of other diseases and body disorders.
The development of gonarthrosis contributes to:
- injuries (dislocations, fractures, damage caused by the meniscus);
- diseases of the musculoskeletal system (congenital deformation of the legs, knee dysplasia, chondrocalcinosis, arthritis, osteoporosis);
- High constant charges on the articulation due to professional activities, professional sports;
- overweight, obesity;
- Endocrine diseases, including diabetes, hypothyroidism, acromigalie;
- metabolic disorders;
- Genetic predisposition.
Symptoms
Inflammation with osteoarthritis of the knee joint is accompanied by two main clinical manifestations - pain and edema.The intensity and frequency of the appearance of pain depends on the depth of damage to joint structures.At the initial stage, the pain is only felt with a load, quickly goes to rest.With advanced gonarthrosis, painful pain is constantly present, intensifies during movements, with a change of time.
Other signs of osteoarthritis of the knee joint:
- Crunch while moving;
- stiffness in the joint, violation of the motor function;
- Knee deformation (with neglected gonarthrosis).
Gonarthrosis can be accompanied by synovitis (accumulation of liquid in the joint cavity) and the subsequent formation of a baker cyst (elastic formation at the back of the knee).
Degree of osteoarthritis
The symptoms of osteoarthritis of the knee joint differ depending on the depth of damage to the structures of the knee, and therefore the 3 stages of the pathology are distinguished.
- Osteoarthritis of the knee joint 1 degreeIt manifests itself by low pain in the loads (at rest passes both), with a slight stiffness after sleep.In the radiographic image, an insignificant narrowing of the joint gap (less than a third), the presence of unique osteophytes (bone growths) is noted.
- Osteoarthritis of the 2 degree knee jointIt is accompanied by pain and characteristic crisis during movements.The pain persists for a while at rest.Morning stiffness, the restriction of the amplitude of the movements is noted.Diagnostic procedures reveal a pronounced narrowing of the joint difference (more than half) and multiple osteophytes.
- Knee osteoarthritis 3 degreesIt is accompanied by constant painful pain which, during movements and at night, intensifies.Morning stiffness remains longer than an hour with an exacerbation of inflammation and at least half an hour - during periods of remission.The mobility of the joint is highly limited or completely lost.In the radiographic image, several large osteophytes, the cysts are visible.The joint space is reduced by more than two thirds of the standard.
Depending on the degree of osteoarthritis of the knee joint, the patient is prescribed by a conservative or surgical treatment.
Diagnosis
The diagnosis of osteoarthritis of the knee joint includes a visual examination, the analysis of patient complaints, laboratory tests (urine analysis, general and biochemical blood tests) and instrumental examination methods.
The following diagnostic procedures allow you to confirm or refute the diagnosis:
- radiography;
- Ultrasound (ultrasound);
- MRI (magnetic resonance imaging);
- CT (computed tomography);
- Arthroscopy and scintigraphy (with suspicion of a tumor).
Using these methods, it is possible to detect the narrowing of the joint difference, the degree of slimming and deformation of the cartilage, the presence of liquid in the joint cavity, the structural changes in the synovial membrane, the growth of osteofite and the ossification fireplaces of the cartilage.
Preservative
Conservative treatment methods can reduce pain and inflammation, improve blood circulation and nutrition of peritate tissue, strengthen muscle apparatus.
To this end, they are held:
- drug therapy;
- blockade;
- Physiotherapy and manual therapy;
- Medical physical education.
An important element in the treatment of osteoarthritis is respect for a therapeutic diet.
The conservative treatment of osteoarthritis of the knee joint will be effective in the initial stage of the disease, when minor dystrophic cartridges of the cartilage, inflammation and altered functions of the synovial shell are noted.
Drug
The drug treatment includes the appointment:
- Non-steroidal anti-inflammatory drugs (NSAIDs);
- chondroprotectors;
- Hyaluronic acid.
NSAID
Non -steroidal anti -inflammatory drugs help relieve inflammation, reduce its main symptoms - edema and pain.
The preparations are prescribed in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration).The capsules and the osteoarthritis tablets of the group's knee joint of the NSAID group are followed in short courses, as drugs have a strong irritating effect on the gastric mucosa and can cause the development of the gastro-duodenal ulcer, have many other side effects.
In addition, prescribed external drugs (ointments, gels, creams) based on non-steroidal anti-inflammatory components.Local therapy can be done longer.
NSAIDs have a pronounced anti-inflammatory effect, but with prolonged use, contribute to the additional destruction of cartilage.
NSAIDs are symptomatic therapy.They help eliminate unpleasant symptoms of the disease, but do not affect the state of cartilage.Unlike these products, chondroprotectors and hyaluronic acid accelerate the processes of regeneration of the cartilage fabric and slow down its destruction.
Chondroprotector
Chondroprotective group drugs contain chondroitin and glucosamine (structural cartilage elements) and help restore the knee with the knee joint.They are available in the form of tablets, powder for oral administration, a solution for injection.
The minimum course of taking tablets and powder is 3 months.After a break, the course is repeated 2-3 times.The course of treatment with a solution includes 12 to 15 injections, is repeated 2 to 3 times a year.
The first positive results of treatment with chondroprotectors are only perceptible a few months after the start of treatment.
Hyaluronic acid
Hyaluronic acid is introduced injected into the affected joint.The remedy against osteoarthritis of the knee joint plays the role of lubrication - envelops the joint surfaces, thus reducing friction between them.
Therapeutic drugs with hyaluronic acid help increase the elasticity of the cartilage fabric, prevents additional destruction of joint structures, which improves the mobility of the joint, the symptoms of inflammation are reduced.The drugs are well tolerated, do not cause side effects.Their drawback is the high cost.
The course of treatment with hyaluronic acid generally includes 3-4 injections, which are carried out with ruptures of 10 to 14 days.
Blockade
If with non -steroidal anti -inflammatory drugs, it is not possible to relieve knee pain with osteoarthritis, a blocking is carried out - a treatment method in which the drugs are injected directly into the tissues affected to relieve pain and inflammation.In osteoarthritis therapy, joint blockages (injections in the joint cavity) and periarticular (in the periarticular cavity) are used.
The main advantage of the method is a useful instant action, because with such an introduction, the maximum concentration of the active substance is created precisely in the inflammation area.In addition, drugs do not fall into the systemic blood circulation, which considerably reduces the risk of adverse reactions.
In the last stages of gonartrose, the joint difference is narrowed, the osteophytes develop, the joint surfaces are deformed, therefore, only the particular blocking is authorized.
The blocking of the knee joint for osteoarthritis can be carried out using anesthetics and corticosteroids.
Anesthetics are generally introduced in combination with steroid hormones to reduce procedure pain.
Hyaluronic acid and chondroprotectors can also be introduced directly into the joint.But in this case, we are not talking about blocking, but an intra-articular injection, because these drugs do not block pain pulses, but trigger the processes of regeneration of the cartilage fabric.
Physiotherapy and manual therapy
The main methods of the physiotherapeutic effects used in the treatment of osteoarthritis include:
- laser treatment;
- ultrasound therapy;
- Cryotherapy;
- Therapy with paraffin and ozokerite;
- Mud.
The main task of all physiotherapeutic procedures is to stimulate blood circulation in nearby tissues, to improve the nutrition of cartilage.
Exercise therapy
Pain syndrome obliges a patient with gonartrose to limit motor activity, as a result of ligaments and muscles nearby.This condition negatively affects joint tissues, because it is during movement that nutrients penetrate synovial fluid into cartilage.If the articulation is constantly at rest, the dystrophic processes are aggravated.
This is why physiotherapy exercises are an integral part of conservative therapy.Moderate physical activity allows you to strengthen muscle apparatus, improve the power of joint structures, eliminate rigidity and improve the motor function of the knee.
The therapeutic exercise exercises are developed individually by the doctor for each patient, taking into account the depth of the lesion and the functional state of the joint structures.
General recommendations for leading exercise therapy for osteoarthritis of knee joint:
- Start courses only after stopping signs of acute inflammation;
- Perform all the exercises gently, without sudden movements;
- The load gradually increases;
- Eliminate high loads on the seal (improved knee bending / extension);
- If pain or discomfort appears, stop training.
Diet
With gonarthrosis, products containing: container:
- Amino acids (dairy products, varieties of low -fat meat);
- collagen (dishes with gelatin);
- irreplaceable fatty acids (vegetable oils, fish);
- Sulfur and selenium (legumes, cereals, cabbage and apples, beef, chicken, eggs).
It is also important:
- Eliminate the use of smoked meats, pickles, marinades;
- limit salt consumption;
- adhere to a regime of 5 times;
- Observe the alcohol consumption mode.
Excess body weight is one of the main factors causing the development of osteoarthritis in the knee joint.Consequently, the task of patients with an excess weight is a decrease in body weight.In this case, you can only obtain the result with the help of a diet, because intensive sports are harmful to the inflamed joint.
To reduce body weight, it is recommended to exclude menu:
- fat varieties of meat and fish;
- Cream, homemade cream and other dairy products with a high percentage of fatty content;
- Margarine, mayonnaise, various sauces;
- confectionery;
- fast food;
- Sweet drinks.
Surgical treatment
The osteoarthritis of the knee joint of the 3rd degree does not lend itself to conservative therapy, so the operation is the only way out for the patient.
There are two options for surgery:
- Corrective osteotomy- is carried out at the initial stage of the development of the 3rd stage of gonarthrosis, if the cartilage is partially destroyed, it is possible to eliminate osteophytes;
- Endoprosthetics- replacement of the articulation or its destroyed parts is carried out by the complete destruction of the cartilage.
Forecast
The pathological changes in joint structures are progressive, irreversible.However, with early diagnosis and appropriate treatment, you can completely stop inflammation and stop the dystrophic changes in the cartilage fabric - osteoarthritis of the 1st degree knee joint lends itself well to conservative therapy.
With 2nd degree osteoarthritis, which is accompanied by the destruction of cartilage and the formation of osteophytes, conservative methods allow you to slow down or suspend the deformation of cartilage, stop inflammation and improve motor activity.However, doctors are often forced to use the blockade, arthroscopy.
It is impossible to cure osteoarthritis of the knee joint of 3 degrees in a conservative manner.The only way to restore knee mobility is surgery.