Deforming osteoarthritis of the knee joints (aka gonarthrosis or abbreviated DOA)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic, continuously progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structure, synovial membrane, capsule and ligaments of the joints) and leads to joint deformity, reduction in range of motion and often disability.
The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slide. Malnutrition and loss of elasticity lead to dystrophy (thinning) and its resorption, as the bone tissue of the articular surfaces is exposed, slippage is disturbed, the gaps of the articular knee narrow, the biomechanics of the joint change. The synovial membrane that lines the joint and produces synovial fluid (which nourishes cartilage and plays the role of physiological lubricant) is 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 node decreases, synovial fluid protrudes beyond the posterior wall of the joint capsule and a Becker cyst forms (which, reaching large sizes, can cause pain in the popliteal fossa) MeIndi ithin and delicate of the joint capsule is replaced with thick connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes are formed (pathological bone growth). Blood circulation to the periarticular tissues is impaired, under-oxidized metabolic products that irritate the 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 spasms appear, and gait is disturbed. There is a constant limitation of the range of motion in the joints (contractures), sometimes so pronounced that only oscillating movements (stiffness) or complete absence of movements (ankylosis) are possible.
For osteoarthritis of the knee joint, we can say that this is a fairly common disease: it affects 10% of the entire 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, parathyroid gland disease, hemochromatosis).
- Muscular apparatus diseases and neuropathy (Charcot 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 (mostly the elderly are susceptible to the disease);
- female sex (according to statistics, women get sick more often);
- increase of physical sports and professional activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases at rest.
- Difficulty of normal, physiological movements in the joints.
- Characteristics of "chewing" in the joints.
- Expansion of joints and visible deformation.
Stages of gonarthrosis
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There are several stages of osteoarthritis:
- In the first stage, a person experiences only symptoms such asslight discomfortor "aggravation" in the knee, disturbing when walking long distances or increasing physical exertion. X-ray examination will have little information: only a slight narrowing of the joint space can be detected, there will be no other changes. At the beginning of the loss of osteoarthritis of the knee joint, a person does not turn to specialists, without paying special attention to the symptoms that have appeared.
- For the second stage of osteoarthritis of the knee joint,tactile pain, the severity of which decreases at rest. Difficulty of movements in the joints appears, when you walk, a characteristic "crack" is heard (from the patient you can hear a common phrase in everyday life - "knees crack"). During radiography, a distinct narrowing of the joint space and single osteophytes is found.
- With the passage of gonarthrosis to the next stage, the third,pain symptoms will bother the patient constantly, including at rest, there is a violation of the configuration of the joints, d. m. th. deformation, aggravated by edema at the time of joining inflammation. On radiography, a moderate narrowing of the joint space and multiple osteophytes are determined. In the third stage, many already seek medical help because quality of life is significantly affected by pain and difficulty walking normally.
- The fourth stage of osteoarthritis of the knee joint is associated withunquenchable, exhausting pain. . . Minimal effort to move becomes a difficult test for a person, joint deformity is visually visible, walking is extremely difficult. Radiography reveals significant changes: joint space is virtually undetectable in images, multiple gross osteophytes are detected, "articular mice" (fragments of collapsing bones falling into the joint cavity). This stage of gonarthrosis almost always involves disability: often the result of the disease is complete melting of the joint, its instability and the formation of a "fake joint".
Who treats osteoarthritis of the knee joint?
Qualified medical care for gonarthrosis can be offered 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 osteoarthritis.
When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, then you can not do without the help of an orthopedist. In situations where surgical care is required, a patient with osteoarthritis of the knee is referred to a specialized orthopedic and trauma department.
How and how to treat osteoarthritis of the knee joint?
Currently known methods of treating patients with osteoarthritis of the knee are divided into non-conservative, medical and surgical.
Non-drug methods
Many patients ask themselves the question: "How to deal with osteoarthritis of the knee joint without pills? " In response to it, we must declare with regret that gonarthrosis is a chronic disease, it is impossible to eliminate it forever. However, many of the existing non-pharmacological methods (i. e. , without the use of drugs) to deal with this disease can significantly slow its progression and improve the patient's quality of life, especially when used in the early stagesof the disease.
With a timely visit to a doctor and sufficient motivation of the patient to heal, sometimes it is enough to eliminate the negative factors. For example, it has been proven that reducing excess weight reduces the onset of the main symptoms of the disease.
Elimination of pathological physical activity and, conversely,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 osteoarthritis of the knee joint, then it is necessary to strive for itproper nutrition: to improve the elastic properties of articular cartilage will help products that contain a large amount of animal collagen (dietary types of meat and fish) and cartilage components (shrimp, crab, krill), fresh saturated vegetables and fruitswith vegetable collagen and antioxidants, and a passion for smoked meats, marinades, preservatives, sweet and salty dishes, on the contrary, emphasizes the disturbance of metabolic processes in the body and the accumulation of excess weight until obesity.
Reflecting on the most effective treatment for knee osteoarthritis, it is worth remembering such an effective treatment and prophylactic method asorthotics: fixation of knee pads, orthoses, elastic bandages and orthopedic insoles reduce and accurately distribute the load on the joints, thus 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 in front of the affected limbs.
Comprehensive treatment of osteoarthritis of the knee also means the appointment of very effective, even with advanced forms of the diseasephysiotherapy. . . With wide use in different categories of patients suffering from osteoarthritis of any degree, it has proven its effectivenessmagnetotherapy: after some procedures, the intensity of pain decreases, as a result of improved blood circulation, reduction of edema and elimination of muscle spasm, joint mobility increases. The effect of magnetotherapy is especially pronounced with the development of active inflammation in the joints: the severity of edema is significantly reduced, the symptoms of synovitis regress. Not so popular, but no less effective in treating knee joint for osteoarthritis, are physiotherapy methods like p. shlaser therapyANDcryotherapy(exposure to cold), which have a pronounced analgesic effect.
Drug treatment
The following drugs are used in the treatment schemes of knee arthrosis.
Non-steroidal anti-inflammatory drugs (NSAIDs), produced in forms for external use (various gels, oils) 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. With early manifestations of the disease, topical use of these drugs in combination with non-medicinal methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills, and sometimes NSAID injections, are a must. It should be remembered that prolonged systemic intake of NSAIDs can cause the development and worsening of ulcerative processes in the gastrointestinal tract, and, in addition, adversely affect kidney and liver function. Therefore, patients who have been taking NSAIDs for a long time should also be prescribed medications that protect the gastric mucosa and regularly monitor the laboratory performance of internal organs.
Glucocorticosteroids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when the NSAIDs previously prescribed 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 osteoarthritis has certain contraindications, as 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 osteoarthritis, GCS injections are meant at the points of periarticular pain, 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 joints. 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 make more than three injections of the drug per year into the same joint.
With advanced, "neglected" osteoarthritis, when a person experiences excruciating pain that does not subside even at rest, disrupts normal sleep, and is not removed by NSAIDs, GCS, and non-drug methods, it is possible to describeopioid pain relievers. . . These drugs are used only with a doctor's prescription, which takes into account the appropriateness of their appointment in each case.
Chondroprotectors(literally translates as "cartilage protection"). This name is understood as different medicines, united by one property - a structural modifying action, d. m. th. the ability to slow down degenerative changes in cartilage and narrow joint space. They are produced in forms for both oral administration and insertion into the joint cavity. Of course, these drugs do not work wonders and do not "grow" the new cartilage, but they can stop its destruction. To achieve a lasting effect, they should be applied for a long time, with regular courses several times a year.
Surgical treatment of osteoarthritis 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 the prescribed medication does not help with osteoarthritis of the knee? " "Is surgical treatment for osteoarthritis indicated? " In answering these questions, it should be clarified that the indicationsfor the surgical treatment of osteoarthritis of the knee joints are insoluble pain syndrome and significant joint dysfunction, which can not be eliminated with the use of complex conservative therapy, which is possible with the latter, the fourth degree of the disease.
The most popular type of surgical care for third- and fourth-degree osteoarthritis isendoprosthetics, d. m. th. removal of your joint with the simultaneous installation of a replacement metal prosthesis, the pattern of which is similar to the anatomy of the human knee joint. In this case, a prerequisite for this type of surgical treatment is: the absence of gross deformities of the joint, formed "false joints", muscle contractures and severe muscle atrophy. In the case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics are also not indicated: the "sugar" bone will not withstand the insertion of metal pins, and rapid resorption (resorption) of bone tissue will begin. at their place of installation, pathological fractures may occur. Therefore, a timely decision on the need to install an endoprosthesis seems to be so significant - it must 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 endoprosthetics in patients with advanced osteoarthritis, d. m. th. the temporary duration of the absence of significant motor limitations and the maintenance of a good 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 surgeries 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 joint replacement is much easier technically). This dictates the need to perform organ preservation operations (node preservation). These include arthromedular bypass surgery and corrective osteotomy.
Artromedullary bypass- connecting the medullary canal of the femur to the cavity of the knee joint using a shunt - a hollow metal tube. This allows fatty bone marrow from the lower third of the femur to enter the knee joint, nourishing and lubricating the cartilage, significantly reducing pain.
When changing the axis of the lower limbs (but with the condition of a small limitation of the range of motion), it is effectivecorrective osteotomy- passing the tibia with the correction of its axis, followed by fixing 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.
Summarizing 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 medicine that will remove it forever, or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor’s recommendations canstop his progress.