Deforming osteoarthritis of the knee joints (also known as gonarthrosis or DOA for short)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic, constantly progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and joint ligaments) and leads to joint deformity, reduced range of motion and often disability.
The disease begins with changes in the articular cartilage, as a result of 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 joint surfaces is exposed, the sliding is disturbed, the joint gaps in the knee are narrowed, 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 a physiological lubricant) becomes irritated, which leads to an increase in its amount in the joint (synovitis). Against the background of the 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's cyst is formed (which, reaching large sizes, can cause pain in the popliteal fossa). The thin, delicate tissue of the joint capsule is replaced by coarse connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes are formed (pathological bone growths). Blood circulation in 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 spasm appear, and the gait is disturbed. There is persistent limitation of the range of motion of the joint (contracture), sometimes so pronounced that only swinging movements (stiffness) or complete absence of movement (ankylosis) are possible.
As 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, affects one in three people.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid arthritis, chlamydia, gout).
- Violation 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 unfavorable underlying factors for the development of gonarthrosis, which include:
- overweight (literally puts pressure on the lower limbs);
- age (especially older people are susceptible to the disease);
- female sex (according to statistics, women get sick more often);
- increased sport and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases when walking and decreases at rest.
- Difficulty of habitual and physiological movements of the joints.
- The characteristic "crunch" of the joints.
- Joint enlargement and visible deformity.
Stages of gonarthrosis
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There are several stages of osteoarthritis:
- In the first stage, a person only experiences symptoms such asslight discomfortor "heaviness" in the knee, which disturbs when walking long distances or an increase in 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 particular importance to the symptoms that have appeared.
- For the second stage of osteoarthritis of the knee joint,tangible pain, the severity of which decreases at rest. Difficulty in movement appears in the joints, when walking a characteristic "creak" is heard (from the patient you can hear a common phrase in everyday life - "creak of the knees"). When X-ray is performed, a clearly distinguishable narrowing of the joint space and individual osteophytes are found.
- With the passage of gonarthrosis to the next, third stage,pain symptoms will constantly disturb the patient, even at rest, there is a violation of the configuration of the joints, i. e. deformation, aggravated by edema at the time of accession to inflammation. On radiographs, moderate joint space narrowing and more osteophytes are determined. In the third stage, many are already seeking medical attention, because the 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, deformity of the joints is noticeable visually, walking is extremely difficult. X-ray reveals significant changes: the joint space is practically undetectable in the images, more coarse osteophytes, "joint mice" (collapsed bone fragments falling into the joint cavity) are revealed. This stage of gonarthrosis almost always involves disability: often the outcome of the disease is the complete fusion of the joint, its instability and the formation of a "false joint".
Who treats osteoarthritis 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 osteoarthritis.
When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, one cannot do without the help of an orthopedist. In situations where surgical assistance is required, a patient with osteoarthritis of the knee joint is referred to a department that specializes in orthopedics and trauma.
How and how to treat osteoarthritis of the knee joint?
Currently known methods for treating patients with osteoarthritis of the knee joint are divided into non-pharmacological, medical and surgical conservatives.
Non-pharmacological methods
Many patients ask themselves the question: "How to deal with osteoarthritis of the knee joint without pills? " In response, we must regretfully affirm that gonarthrosis is a chronic disease, impossible to eliminate it forever. However, many of the currently existing non-pharmacological methods (i. e. without the use of drugs) to treat this disease 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, it is sometimes enough to eliminate the negative factors. For example, reducing excess weight has been shown to reduce the manifestation 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 have an effect comparable to anti-inflammatory drugs.
If we treat osteoarthritis of the knee joint, then it is necessary to strive forappropriate nutrition: improving the elastic properties of joint cartilage will help products containing a large amount of animal collagen (dietary types of meat and fish) and cartilage components (shrimp, crab, krill), fresh vegetables and fruits saturated with vegetable collagen and antioxidants, and the passion for smoked products, marinades, preservatives, sweet and savory dishes, on the contrary, enhances the disturbance of metabolic processes in the body and the accumulation of excess weight up to obesity.
Reflecting on the most effective treatment for osteoarthritis of the knee, it is worth remembering such an effective treatment and prophylactic method asorthotics: The attachment of knee pads, orthoses, elastic bandages and orthopedic insoles reduces and correctly distributes the load on the joint, 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 opposite the affected limb.
Comprehensive treatment of arthrosis of the knee joint also implies the appointment of very effective treatment, even with advanced forms of the diseasePhysiotherapy. . . With widespread use in different categories of osteoarthritis patients of any degree, it has proven its effectivenessmagnetotherapy: after several procedures, the intensity of pain decreases, due to the improvement of blood circulation, the reduction of edema and the elimination of 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 subside. Not so popular, but no less effective in treating the knee joint for osteoarthritis, are such physiotherapy methods aslaser therapyAndcryotherapy(exposure to cold), which have a pronounced analgesic effect.
Pharmacological 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 use (various gels, ointments) and systemic (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 pain and swelling in the joints and slow down the progression of the disease. With the first 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 should be remembered that prolonged systemic intake of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract, and, in addition, adversely 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 the laboratory performance of internal organs.
Glucocorticosteroids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when 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 have some 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 arthrosis, injections of GCS into the painful periarticular points are meant, which increase the intensity of the fight against inflammation and minimize the risk of unwanted side effects of the drug. This manipulation can be performed by a rheumatologist or a traumatology 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 "neglected" advanced osteoarthritis, when a person experiences unbearable 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 prescribeopioid pain relievers. . . These drugs are used only with the doctor's prescription, who considers the adequacy of their appointment in each case.
Chondroprotector(literally translated as "cartilage protection"). This name is understood as various medicines, united by one property: a structural modifying action, eg. 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 don't work wonders and don't "grow" new cartilage, but they can stop its destruction. To achieve a lasting effect, they need to 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, constantly reducing the quality of human 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? " Answering these questions, it should be clarified that the indications for the 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 treatment for third and fourth degree osteoarthritis isendoprosthesis, that is. removal of one's 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 is: 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), endoprosthesis is also not indicated: the "sugar" bone will not resist the introduction of metal pins and the rapid resorption (resorption) of the bone tissue will begin at the site of installation, pathological fractures may occur. Therefore, a timely decision on the need to install an endoprosthesis seems to be so significant - it should be made when the age and general condition of the human body still allows the operation to be performed. According to the results of long-term studies, the duration of the endoprosthesis effect in patients with advanced osteoarthritis, i. e. 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 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 these operations are often unsatisfactory and the complication rate is high. This is due to the design features of endoprostheses and the complexity of the surgery itself (hip joint replacement is much simpler in technical terms). This dictates the need to perform organ preservation operations (joint preservation). 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 by means of a shunt - a hollow metal tube. This allows the fatty bone marrow of 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- resection of the tibia with correction of its axis, followed by fixing with 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 axis of the limb, as well as the activation of blood circulation and metabolism during bone fusion.
Summarizing the above, I would like to emphasize that the treatment of gonarthrosis is a complex social task. And although today medicine is not able to offer a drug that will free him 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.