The disease begins with changes in the articular cartilage, which causes the articular surfaces of the bones to slide.Malnutrition and loss of elasticity lead to degeneration and resorption, while the bone tissue of the articular surface 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) is irritated, leading to an increase in its volume in the joint (synovitis).Against the background of narrowing of the joint space, the joint volume decreases, synovial fluid protrudes on the posterior wall of the joint capsule, and Becker's cyst is formed (which, when it reaches a large size, 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 growth) are formed.Blood circulation in the periarticular tissue is disturbed, unoxidized metabolic products accumulate in it, irritating chemoreceptors, and a constant pain syndrome develops.Against the background of changes in the anatomy of the joints, dysfunction of the surrounding muscles occurs, hypotrophy and spasms appear, and gait is disturbed.A persistent limitation in the range of motion in the joint (contracture) appears, sometimes so pronounced that only rocking movements (stiffness) or a complete lack of movement (ankylosis) are possible.
Gonarthrosis is a relatively common disease: it affects 10% of the entire population of the planet, and over 60 years it affects every third person.
Causes of gonarthrosis
- Bone and joint injuries.
- Arthritis (rheumatoid, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes mellitus, parathyroid gland disease, hemochromatosis).
- Diseases of the muscular system 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 putting pressure on the lower limbs);
- age (mostly old people are affected by this disease);
- female gender (statistically, women get sick more often);
- increase in sports and professional physical activity.
Symptoms of osteoarthritis of the knee joint
- Pain that increases with walking and decreases with rest.
- Difficulty in normal movement, physiology in the joints.
- Characteristic "crunch" in the joints.
- Visible increase in joint size and deformity.
Stage of gonarthrosis
Clinical stages of arthrosis of the knee joint.This disease goes through several stages.
- In the first stage, a person feels only a slight discomfort or "heaviness" in the knee, which disturbs when walking long distances or increasing physical activity.X-ray examination will be uninformative: 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 a specialist, does not pay attention to the symptoms that appear.
- The second stage is characterized by significant pain, the severity of which decreases with rest.Difficulty in movement in the joints appears, and characteristic "creaking" is heard when walking (from patients you can hear a common phrase in everyday life: "creaky knees").X-rays reveal clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis moves to the next stage, the third stage, the pain will bother the patient continuously, including during rest, and a disturbance in the configuration of the joint occurs, i.e. deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate narrowing of the joint space 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 pain that does not stop and is debilitating.Minimal attempts to move become difficult for a person, deformation of the joints can be seen visually, and walking is very difficult.X-ray reveals significant changes: the joint space is practically not defined in the image, various rough osteophytes, "articular mice" (fragments of degenerated bone falling into the joint cavity) are revealed.This stage of gonarthrosis almost always involves disability: often the result of this disease is a complete fusion of the joint, its instability, and the formation of "false joints."
Who treats arthrosis of the knee joint?
Qualified medical care for gonarthrosis can be given to patients by therapists, rheumatologists and general practitioners (family doctors), but these specialists treat knee joints with uncomplicated arthrosis.When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, then you cannot do without the help of an orthopedic specialist.In situations where surgical care is required, the patient is sent to a specialized orthopedic and traumatology department.
How and with what to treat arthrosis of the knee joint?
The currently known methods of treating arthrosis of the knee joint are divided into conservative non-medical, medical and surgical.
Non-drug methods
Many patients ask the question: "How to cure arthrosis of the knee joint without pills?"Answering this question, we regret to say that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many existing non-pharmacological methods 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 you consult a doctor in time and the patient is motivated enough to heal, sometimes it is enough to eliminate negative factors.For example, it has been proven that losing excess weight reduces the manifestation of the main symptoms of this disease.
Eliminating pathological physical activity and, on the contrary, performing therapeutic exercises using a rational physical program reduces the intensity of pain.Exercises to increase quadriceps strength have been shown to have effects comparable to anti-inflammatory drugs.
If we treat arthrosis of the knee joint, then we must 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 passion for smoked meats, marinades, preservatives, preservatives, salt and salt.in the body and the accumulation of excess weight to obesity.
When thinking about what is the most effective treatment for knee arthrosis, it is necessary to remember effective methods of treatment and prevention such as orthotics: prescribing knee pads, orthoses, elastic bandages and orthopedic insoles reduce and distribute the load on the joint correctly, thereby reducing the intensity of pain in it.
Comprehensive treatment of arthrosis of the knee joint also involves the appointment of very effective physical procedures, even in the advanced form of the disease.When widely used in various categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after only a few procedures, the intensity of pain decreases, due to better blood circulation, reduced swelling and elimination of muscle spasms, joint mobility increases.The effect of magnetic therapy is particularly noticeable when active inflammation in the joint develops: the severity of edema is significantly reduced, and the symptoms of synovitis subside.Not so popular, but no less effective in treating knee joints with arthrosis, are physiotherapy methods such as laser therapy and cryotherapy (cold exposure), which have a clear analgesic effect.
Drug treatment
Non-steroidal anti-inflammatory drugs (NSAIDs), available 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 the progression of the disease.For early manifestations of the disease, the local use of these drugs in combination with non-medical methods is effective.But with advanced osteoarthritis of the knee joint, you can't do without pills.It should be remembered that the prolonged systemic use of NSAIDs can cause the development and worsening of the ulcerative process in the gastrointestinal tract, and in addition, negatively affect the function of the kidneys and liver.Therefore, patients who take NSAIDs for a long time should also be given drugs that protect the gastric mucosa and constantly monitor laboratory parameters of internal organ function.
In the case of advanced, "advanced" osteoarthritis, when a person experiences unbearable 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 painkillers.These drugs are used only with a prescription from a doctor, who considers the appropriateness of prescribing them in each specific case.
Chondroprotectors (literally translated as "protects cartilage").This name refers to various drugs, united by one property - the effect of structural modification, namely the ability to slow down degenerative changes in the cartilage and narrowing of the joint space.It is produced in the form both for oral administration (glucosamine, chondroitin sulfate, piascledine) 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 lasting effect, they must be used for a long time, in a regular course several times a year.
Surgical treatment of arthrosis of the knee joint
There are often cases when, despite adequate comprehensive treatment, the disease progresses, continuously reducing a person's quality of life.In such situations, patients begin to ask questions: "what to do if the prescribed drugs do not help with arthrosis of the knee joint?", "Is surgical treatment indicated for arthrosis of the knee?", "How is arthrosis of the knee joint treated surgically?"In answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joint are uncontrollable pain syndrome and significant joint dysfunction, which cannot be eliminated with the use of complex conservative therapy.
The most popular type of surgical care for gonarthrosis is endoprosthetics, which 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, the prerequisite for carrying out this type of surgical treatment is the absence of gross deformities of the joints, forming "false joints", muscle contractions and significant muscle atrophy.
In cases of severe osteoporosis (significant decrease in bone mineral density), endoprosthetics are also not indicated: "sugar" bone will not withstand 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, a timely decision on the need to install an endoprosthesis seems to be very important - 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 a long-term study, the duration of the effect of endoprosthetics, that is the temporary period of absence of significant motor limitations and maintaining a good quality of life is about ten years.The best results of surgical treatment are observed in people aged 45-75 years 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 complication rate is high.This is due to the design features of the endoprosthesis and the complexity of the surgical intervention itself (hip replacement is technically easier).These include arthromedullary bypass surgery and corrective osteotomy.Arthromedullary shunting is the connection of the medullary canal of the femur with the knee joint cavity using a shunt - a hollow metal tube.Thanks to this, fatty bone marrow from the lower third of the femur enters the knee joint, nourishing the cartilage and lubricating it, thereby achieving a significant reduction in pain.
When the axis of the lower limb changes (but with a slight limitation of the range of motion), effective corrective osteotomy - tibia junction with its axis correction, followed by fixation with plates and screws in the desired position.In this case, two goals are achieved - the normalization of biomechanics due to the restoration of the axis of the limb, as well as the activation of blood circulation and metabolism during bone fusion.And although today's medicine cannot offer a drug that eliminates it forever, or another way to completely cure this disease, a healthy lifestyle, seeking medical help in time and following the doctor's recommendations can stop its development.