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Osteoarthritis of the knee joint

Osteoarthritis of the knee joint on x-ray

Osteoarthritis of the knee joint is a specific disease that has a destructive effect on the cartilage of the knee joint.

When such a disease occurs, doctors observe serious disorders of blood circulation in the bone vessels, as a result of which deformation and destruction of cartilage tissue occurs, the person experiences severe pain that limits any movement of his legs and knees, and observes swelling and changes in the appearance of the knees.

In order to prevent the development of serious consequences of gonarthrosis (deformation of the limbs and ankylosis - immobilization of the joint), the disease must be identified and treated in a timely manner, when only joint replacement surgery can help the patient.In addition, do not treat alone with folk methods and advertised remedies, but under the supervision of qualified doctors.

What are the reasons?

The mechanisms of osteoarthritis are usually divided in medicine into:

  • Primary- which occurs in old age due to the natural aging of body tissues and against the background of some factors that trigger this disease, such as obesity (10% of cases), heredity and increased stress throughout life.
  • Secondary- it accounts for 30% of all cases of arthrosis of the knee joint;It usually manifests itself after an injury, a broken tibia, a torn ligament or a damaged meniscus.In addition, with such arthrosis of the knee joint, the symptoms of the disease appear in most cases after 3-4 years, although after a serious injury it is possible even after 2-3 months.

In 50-60% of cases, the cause of arthrosis of the knee joint is a spasm in the muscles of the front surface of the thigh.

What happens to the knee joint with osteoarthritis?

With excessive regular stress, genetic predisposition, metabolic disorders in the body, persistent muscle cramps and injuries, the knee cartilage loses its suppleness and begins to thin out.The gentle sliding of the joint bones is replaced by strong friction and first-degree gonarthrosis occurs, in which the cartilage loses its shock-absorbing properties.

The degradation process continues and poor shock absorption leads to flattening of the bone surfaces with the formation of osteophytes in the form of bone growths.In this case, the disease is already of a second degree and is accompanied by degeneration of the synovial membrane and the joint capsule.Lack of pumping and lack of exercise atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the nutritional process of the cartilage is disrupted, which leads to an even greater deterioration in the patient's condition.

The thinning of the cartilage reduces the distance between the joint bones by up to 80%.When walking, due to abnormal friction and the absence of a shock absorber, destructive processes in the joint quickly increase, which quickly leads to the development of third-degree arthrosis with pronounced symptoms:

  • Pain when moving, especially when climbing stairs.
  • Pain both with exertion and at rest, morning stiffness.
  • The patient begins to limp and tries to protect the painful joint.
  • In severe cases of the disease, the use of crutches or a walking stick is necessary.

The third degree of arthrosis of the knee joint is characterized by an almost complete absence of cartilage tissue, which leads to a limitation of joint mobility to a minimum.Therefore, no magical methods, super drugs or ointments can restore worn out cartilage tissue, and given the extent of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.

Destruction of the knee joint due to osteoarthritis

Stages of osteoarthritis

As osteoarthritis progresses, the following stages or degrees are distinguished:

  • The initial stage or stage 1 is often called compensated, since there are still no pronounced clinical signs of pathology.The patient may experience discomfort in the knees after physical activity, which quickly disappears after rest;The joints are still fully functional.
  • In grade 2 osteoarthritis, subcompensated, the symptoms of the disease worsen.A pronounced pain syndrome develops, but this is relieved by topically applied anesthetic ointments and gels.Motor activity is impaired and joint instability occurs.In the vast majority of cases, patients contact a doctor at this stage.
  • 3rd degree, decompensated, can also be called deforming.The knee joint is twisted, unstable, immobile and completely non-functional.The pain syndrome is constant and requires serious medical intervention.To relieve the joint and move, a person needs a stick.

Symptoms and first signs

Depending on the severity of the symptoms, the course of the disease is divided into 3 stages.The symptoms of the early development of gonarthrosis are very diverse and nonspecific.

At the first stage of pathology, the following signs are possible:

  1. Knee pain when squatting or climbing stairs;
  2. Joint pain after prolonged exercise or cooling down;
  3. the knee may hurt at the end of the day or in the morning;
  4. Stiffness and pain in the morning disappear after daily work.

The symptoms characteristic of stages 2 and 3 then appear (in ascending order):

  • the pain becomes acute and persistent;
  • swelling in the joint area;
  • Fluid may appear in the joint;
  • between the articular surfaces, pinching of cartilage, meniscus and synovial villi is possible, as a result of which severe immobility occurs (it can also pass abruptly);
  • it is difficult to step on the foot;
  • Immobility of the joints develops.

Consequences

If left untreated, knee osteoarthritis can cause the following complications:

  • joint deformity.In fact, joint deformity is rather not a complication, but the final stage of the disease.
  • Infection in a joint.Infection usually occurs due to microtrauma.They can be seen as small tears in the cartilage tissue.Pathogenic microorganisms are introduced into the joint from other areas through blood or lymph flow.This often occurs after infectious diseases.
  • Dislocations and fractures.These complications are explained by dysfunction of the knee joint.With osteoarthritis, the load from the thigh bone to the lower leg bones is not evenly distributed.The ligaments that normally strengthen the joint are also weakened.For this reason, at some point (even during normal walking), excessive stress may occur on the lower leg bones, resulting in a fracture or dislocation.To avoid this, people with severe structural and functional impairments in the knee joint should use a crutch or cane to get around.
  • Ankylosis.Ankylosis is the fusion of two bones where a joint once existed.This complication is perhaps the most serious, as the joint simply disappears.The tibia and femur gradually fuse and the tibia becomes fixed in one position.Movement is of course impossible.

diagnosis

To diagnose gonarthrosis use:

  • blood tests (general and biochemical);
  • radiography;
  • arthroscopy;
  • Ultrasonic;
  • MRI.

The most important diagnostic method for confirming the diagnosis of gonarthrosis is x-ray.Although it is not possible to examine the initial stages of the disease and the condition of the cartilage tissue on X-rays, bone changes of stages 2 and 3 are clearly visible.The:

  1. narrow joint space;
  2. marginal spines along the bone contour, the edges of the patella - osteophytes;
  3. changes in the periosteum;
  4. Change in the height of one of the condyles and others.

However, with the help of arthroscopy, changes can be examined in more detail.

Ultrasound and MRI help detect changes in the soft tissue of the knee joint in the early stages of osteoarthritis.These methods also provide a good indication of the condition of cartilage tissue, synovium and fluid.

How do you treat osteoarthritis?

The treatment of osteoarthritis of the knee joint is lengthy and sometimes painful.The duration is due to the fact that once the disease manifests itself, it is constantly remembered throughout life.

Therefore, in order to properly treat gonarthrosis, a fairly strong financial foundation and discipline are required.An important role is played by how seriously the patient takes the treatment, because in order to reduce the frequency of exacerbations of the disease, the patient is often forced to change his daily activity and favorite profession, engage in joint development, quit smoking and drink alcoholic beverages.

There are three main stages in the treatment of deforming arthrosis of the knee joint.

The first stage of treatment includes:

  • communicate to patients the nature of their disease, risk factors and secondary prevention measures;
  • daily gymnastics with stretching elements;
  • contrast shower;
  • swim in the pool 2 – 3 times a week;
  • weight loss.

The second stage of treatment includes:

  • External fixation of the joint using forceps, bandages, elastic bandages and orthoses;
  • the use of ointments and creams based on nonsteroidal anti-inflammatory drugs to relieve inflammation and pain;
  • the use of drugs from the group of chondroprotectors to reduce the rate of cartilage destruction.

The third stage of treatment includes:

  • natural oral use of NSAIDs;
  • intra-articular injections with hormonal anti-inflammatory drugs;
  • additional use of drugs with a pronounced analgesic effect;
  • surgical replacement of a diseased joint with an implant.

In addition to drug treatment, modern medicine uses methods such as:

  1. Kinesitherapy.In this case, treatment of arthrosis of the knee joint occurs with special exercises.The load is selected individually depending on the course of the disease and the patient's physical fitness.
  2. Ozone therapy.This is an effect on a painful knee joint with ozone.In this physiotherapeutic treatment method, the substance can be administered by injection or applied externally.
  3. Dietary supplements.Biologically active dietary supplements are a worthy alternative to other medications.
  4. homeopathy.Medicines are taken in small doses.The course of treatment lasts only a few weeks, but during this time, with the correct selection of drugs, blood circulation and normal nutrition of cartilage tissue cells are completely restored.
  5. Exercisesallow you to improve blood circulation in the knee joint, restore the elasticity of the ligaments, improve the nutrition of cartilage tissue cells and promote their recovery.

Drug treatment

All drugs used in the treatment of gonarthrosis can be divided into those that help eliminate the main symptoms of the disease and those that restore the function of the knee joint and prevent the progression of the pathology.The first type of drugs includes non-steroidal anti-inflammatory drugs and hormonal drugs.The second group includes chondroprotectors and hyaluronic acid.

Nonsteroidal anti-inflammatory drugs

Drug treatment for osteoarthritis begins with pain relief.They are the ones who cause the greatest moral and physical suffering to patients and lead to the loss of the ability to work.Non-steroidal anti-inflammatory drugs (NSAIDs) have proven to be effective among painkillers.

The drugs can be used in two ways - topically or orally (in tablet form).Topical treatments (preferred) often include patches, ointments or gels.The analgesic effect usually occurs on days 3 to 4 and reaches its maximum on days 7 to 10.

The course of treatment with non-steroidal drugs should be limited to 10-14 days.NSAIDs have a limited scope and are used with great caution in the treatment of elderly patients.

Hormonal medications

In cases where treatment with NSAIDs is not enough and the disease continues to progress, the doctor may prescribe hormone injections.They belong to the means of “heavy artillery” and help to quickly eliminate pain, relieve inflammation and swelling of the surrounding tissues.

Due to the large number of side effects, hormonal drugs are prescribed in short courses only during the acute phase of the disease, when inflammatory fluid accumulates in the joint cavity.The drug is administered into the joint space no more than once every 10 days.

Chondroprotectors

To prevent further destruction of the cartilage surfaces of the joint, chondroprotectors are prescribed.

These medications also help relieve pain and reduce signs of inflammation in the surrounding soft tissue.In addition, chondroprotectors slow down the destruction of joint tissue and stabilize the disease due to their shock-absorbing and lubricating functions.Chondroprotectors improve cartilage nutrition, normalize the composition and properties of intra-articular fluid, and protect pain receptors from excessive irritation.

Hyaluronic acid

Hyaluronic acid is called a fluid prosthesis made from intra-articular fluid.In its properties, it is similar to the natural synovial fluid (intra-articular fluid), which nourishes the cartilage tissue and cushions the knee joint during movements.

By injecting hyaluronic acid preparations into the joint, a thin protective film is created that prevents the cartilage surfaces from rubbing against each other.Injections are only carried out after the acute phase of the disease has passed.

Movement therapy and exercises for osteoarthritis

Physical exercise helps restore and strengthen joint function.They should be performed slowly and carefully so as not to cause sprains and not to exceed the permissible load.

The following exercises are considered the most effective:

  1. Slowly lift your straight legs one at a time while lying on your stomach.This exercise works the thigh and calf muscles.The load must not be shifted backwards.You shouldn't lift your legs too high either.The main thing is to tense the muscles at the top point;
  2. This exercise is similar to the first, except now you should raise your leg with your knee bent.At the top point, the thigh muscles should be further tensed.The exercise must be performed the same number of times on each leg;
  3. Lie on the floor (on your stomach), raise your straight legs, then spread them apart and bring them together.This exercise requires strong, trained abdominal muscles and is therefore not suitable for all patients.In addition, carrying it out can lead to an increase in blood pressure.It is better to avoid it for patients suffering from hypertension or other diseases of the cardiovascular system;
  4. To perform the next exercise, you need to lie on your side, bend the leg lying on the floor at the knee and slowly raise the other leg, holding it at the top point.It is important that the angle when performing it is the same on each leg;
  5. You will need a chair for this exercise.Sitting on it, the legs are stretched one after the other, lifted and held in a stretched position for as long as possible;
  6. It makes sense to stand on your tiptoes while holding onto the back of a chair or bed.As with other exercises, you need to stay at the highest point for a few seconds and also use your leg muscles.
  7. By gently moving from toe to heel, you can activate blood circulation in the lower extremities.Such movements should be performed alternately: while one leg rests on the toe, the other on the heel and vice versa.All movements must be smooth;
  8. Lean on the back of a chair or bed, stand on your heels and lift your toes for a minute.If you cannot hold this position for the specified time, you should start with less and increase it gradually.
  9. A massage that is performed while standing.The legs should be rubbed with vigorous movements from the knee to the thigh.It is necessary to complete the massage by stroking the skin.

The doctor conducts several sessions in the office and shows basic techniques so that the patient can massage the problematic knee independently.Competent measures will improve the condition of the damaged area.

Massage and self-massage

Perform self-massage with your palm, palm edge, fingertips, or fist.Gently approach the painful knee and apply strong pressure to the affected area: strong tapping, blows and active kneading of the tissue often worsen the condition.

Basic techniques:

  • The first stage consists of light stroking movements in a clockwise direction, the second stage consists of circular movements counterclockwise.
  • Press one palm onto the sore knee and tap it lightly with the fingertips of the other hand.
  • Maintain the starting position of the palm and tap not with your fingers, but with the edge of your palm.
  • Gently stroke the knee in circles, gradually increasing the pressure (but moderately).
  • During therapy, massage the affected area twice a day for 10-15 minutes.For prevention, it is enough to carry out a light massage every 7 days.

Before the procedure, apply an ointment or gel with an anti-inflammatory effect to the painful knee.

Physiotherapeutic treatment

All methods of physiotherapy can be divided into several groups:

  1. pain relief;
  2. Reduces inflammation;
  3. Restoring the nutrient supply to the joint and accelerating the recovery of joint function.

The doctor can determine what type of treatment the patient needs based on the existing symptoms and comorbidities.

Surgery for osteoarthritis

Surgical treatment refers to radical methods that partially or completely restore the function of the knee joint.Surgical treatment methods differ in the degree of intervention in the affected joint.

  1. Arthroscopyrefers to the most gentle method of surgical treatment.This technique is less traumatic and can be used as a therapeutic measure in the early stages of osteoarthritis.Its main goal is to extend the life of the damaged joint.Arthroscopy is performed using an endoscope - a flexible probe with a camera on the end.Small punctures are made in the knee joint through which an endoscope and auxiliary instruments are inserted.The operation involves removing damaged areas of tissue that are causing pain.The operation is best suited for young people and can be repeated several times if necessary.
  2. Endoprostheticsrefers to the most radical surgical techniques.In this case, complete restoration of joint function occurs by replacing the entire knee joint or part of it with an implant.This method is the best alternative to the existing arthrodesis technique (complete immobilization of the damaged joint).Currently, endoprosthesis replacement delivers up to 90% positive results and significantly improves patients' quality of life.
  3. OsteotomyIt is used when significant deformations have occurred in the joint and the function of the joint is noticeably impaired.During an osteotomy, an artificial bone fracture is created at a previously planned location.The bone parts are then brought into the correct, physiological position and allowed to grow together.Sometimes during surgery, artificial fixators of bone fragments can be used, which contribute to a more stable position of the bone.

Folk remedies

Traditional medicine will also help you.The use of various lotions to relieve swelling and pain has long been practiced by many patients.Here are some useful recipes:

  1. Burdock leaves.Take 5 burdock leaves and hold them over boiling water to steam them.Lubricate the sore knee with vegetable oil and apply steamed leaves.Wrap your leg in cling film and a warm scarf.Leave the lotion on for a few hours.
  2. Cabbage leaf lotion.It is made from fresh cabbage leaves that are soaked in May honey and applied to the leg.The therapeutic effect is enhanced by insulation made of woolen fabric or plastic film.This product is suitable for people of all ages.
  3. Eggshells, kefir.Grind the shells of 2 eggs and mix with 1 spoon of kefir.Apply the mixture to your knee, wrap it with a cloth and cling film and lie under a blanket.Leave it like this for a few hours and then rinse off the composition with water.This treatment can be used daily.
  4. Horseradish compress.According to this folk recipe, to enhance the medicinal properties of horseradish, it is recommended to first chop and boil it.It must then be applied to the affected area.
  5. turpentine– an excellent warming agent for painful joints.Before going to bed, the knee is rubbed with turpentine and tied with a woolen scarf.The patient feels significant relief after the first procedure.The course of treatment is selected individually for each person.

diet

The therapeutic diet involves avoiding or consuming minimally (to suppress appetite) preserved, smoked and fried foods.To restore damaged cartilage, it is necessary to provide the body with complex carbohydrates (porridges, whole grain products).Juices (carrot, beetroot, apple) should also be included in the diet.They remove toxins from the body and reduce the effects of inflammatory processes.

The diet should contain fish and aspic, which act as a kind of chondroprotector and contribute to the formation of new cartilage.Remember that you cannot prescribe a diet - only a nutritionist (dietitian) can choose the best option.

Example menu:

  • Breakfast: oatmeal with water without butter or sugar, fruit juice, boiled egg;
  • Second breakfast: a glass of low-fat natural yogurt;
  • Lunch: stewed meat or fish, stewed vegetables, tea without sugar;
  • Afternoon snack: cottage cheese casserole with nuts, a glass of fruit juice;
  • Dinner: vegetable salad, apple, tea without sugar;
  • Second dinner: a glass of low-fat kefir.

prevention

Prevent joint diseases:

  • dose the load on your legs during active sports;
  • Create a diet that includes foods and dishes that contain calcium, magnesium and gelatin.
  • If the work involves lifting or moving heavy objects, follow safety regulations and do not carry loads that exceed a certain limit.
  • Regularly perform self-massage to prevent arthrosis, especially with constant stress on your legs;
  • eat right, limit “harmful” foods;
  • Control of body weight (excess weight means additional stress on the joints);
  • Get regular checkups and treat acute and chronic illnesses.

forecast

If arthrosis of the knee joint is diagnosed in the early stages, the cause of the pathological process is eliminated and adequate treatment is carried out, the prognosis is favorable.The therapy offered allows for long-term remission, but treatment is usually lifelong.

Without the necessary treatment, as well as if the patient does not follow the doctor's instructions, arthrosis of the knee joint becomes a cause of disability.