Arthritis of the knee joint

Osteoarthritis of the knee joint is a disease of the musculoskeletal system, which consists in the deformation and destruction of the cartilage tissue of the joint, as a result of which the structure and functions of the cartilage are disturbed. The disease has many names - gonoarthrosis, deforming osteoarthritis. The treatment of osteoarthritis of the knee joint does not have a clear scheme or a single drug that could help everyone who suffers from this problem in the same way. Since arthropathy is a disease with a progressive nature, it is more often observed in overweight women, venous disease and the elderly. The treatment is produced and prescribed individually for each patient.

Osteoarthritis of the knee joint can be unilateral or bilateral (depending on whether the disease develops in one or both legs). At the first symptoms, it is necessary to resort to adequate treatment, as ignoring this problem can lead to the final destruction of the cartilage and bone exposure and, therefore, to the disability of a person.

There are three stages of the disease:

1. The initial stage of the knee joint is characterized by the loss of shock-absorbing properties and, as a result, the cartilage rubs against each other during movement, causing severe discomfort to the patient. The cartilage becomes rough, deformed, dry, in the advanced stages of the disease - even covered with cracks.
2. Due to the decrease in depreciation, the deformation of the bones begins, which leads to the formation of osteophytes (growths on the surface of the bones) - this is the second stage of the disease. The synovial membrane of the joint and the capsule also undergo deformation, the knee joint gradually atrophies due to stiffness of movements. A change in the density of synovial fluid (becomes thicker, thicker), circulatory disorders, deterioration of the supply of nutrients to the knee joint is also observed. Thinning of the lining between the cartilaginous joints reduces the distance between the articulating bones.
3. The disease progresses rapidly and quickly passes into the third stage, when the patient is practically unable to move due to constant pain in the knee. Total and irreversible changes occur in cartilage tissue, leading to disability of a person.

Most often, arthropathy or gonathrosis develops after an injury or bruise, while a person feels constant severe pain in the knee, which significantly hinders his movements.

Reasons for the development of joints

Osteoarthritis of the knee joint, the treatment of which takes quite a long time, can occur due to such factors:

1. genetic predisposition.
2. Injuries: dislocations, bruises, fractures. When treating an injured knee, the joint is fixed and the person cannot bend and unbend the leg for a certain time. This leads to a deterioration of blood circulation, which most often causes the development of post-traumatic gonoarthrosis.
3. Meniscus removal.
4. Excessive physical activity that does not correspond to the person's age, leading to injuries or microtraumas, as well as hypothermia of the joints. For example, running on the asphalt or squats are not recommended for the elderly, as during these exercises significant pressure is placed on the knee joint, which wears out with age and cannot withstand such loads.
5. Overweight and obesity. This factor leads to damage to the menisci, injuries of which cause the development of knee joints.
6. Loose links or weak links.
7. Arthritis or other acquired joints. The inflammatory process can cause an accumulation of synovial fluid in the joint cavity or swelling. This causes the destruction of the cartilage tissue of the knee, leading to osteoarthritis of the knee joints.
8. Metabolic disorders in the human body. An insufficient amount of calcium significantly worsens the condition of bone and cartilage tissues in the human body.
9. Flatfeet. The wrong structure of the foot shifts the center of gravity and the load on the joint becomes greater.
10. Stress and nervous tension.

Symptoms of knee osteoarthritis

The clinical picture of the disease has the following symptoms:

1. Sensations of pain. The pain appears suddenly, depending on the physical load on the knee joint. Pain can be of a different nature. At the initial stage, these are weak backaches, to which a person usually does not pay much attention. Periodic mild pain can be experienced for months, and sometimes years, until the disease progresses to a more aggressive stage.
2. Visible deformity of the knee. This symptom appears in the later stages. At first, the knee looks swollen or swollen.
3. Accumulation of synovial fluid in the joint cavity or Baker's cyst. This is a dense formation on the back wall of the knee joint.
4. Joint cracking. Sharp crackles, accompanied by pain, are observed in patients in the second and third stages of the development of the disease.
5. Inflammatory reactions in the synovial synovium, due to which the cartilage swells and increases in volume.
6. Reduced joint mobility. observed in later stages. Bending the knee becomes almost impossible and is accompanied by severe pain. In the final stage, the knee may be completely immobilized. A person's movement becomes difficult or completely impossible (some patients move with bent legs).

Diagnosis of knee osteoarthritis

If obvious or minor symptoms of arthrosis of the knee joint appear, it is better to contact an orthopedic or rheumatologist immediately. Diagnosis usually consists of taking a patient's history and analyzing their general health. For a more accurate conclusion, they resort to X-ray or MRI of the knee. The patient also receives a referral for laboratory tests - general examination of blood and urine. Based on the data obtained, the doctor makes a conclusion and prescribes the necessary treatment.

Treatment of arthropathy of the knee joint

The treatment of arthrosis of the knee joint must be comprehensive. To date, there is no medical drug that relieves this disorder. One of the most important conditions for successful treatment is early diagnosis. The earlier the treatment of knee arthropathy begins, the more likely it is to prolong the remission period and prevent the destruction and deformation of the cartilage and bone tissues.

During the treatment, the doctor and the patient face several tasks:

1. Eliminate or reduce pain.
2. To establish the supply of nutrients to the knee joint and thus increase its restorative function.
3. Activation of blood circulation in the area of the knee joint.
4. Strengthening the muscles around the joint.
5. Increased joint mobility.
6. Try to increase the distance between the hinge bones.

The treatment of the disease, depending on the stage of its development, can be conservative and surgical.

Conservative treatment of arthrosis of the knee joint

Anti-inflammatory drugs that relieve pain

To relieve or reduce pain, the patient is usually prescribed a course of non-steroidal anti-inflammatory drugs (NSAIDs). It can be tablets, ointments and injections. The most common pain relievers can be used in two ways - internally or topically.

Usually, patients prefer local treatment in the form of gels, ointments, heating pads. The effect of these painkillers does not come immediately, but after a few days (about 3-4 days). The maximum effect is achieved after a week of regular use of the drug. Such drugs do not treat the disease as such, but only relieve the pain syndrome, since it is impossible to start treatment for the pain.

Painkillers should be taken strictly according to the doctor's prescription, they should be used only for severe pain, as their prolonged and frequent use can lead to side effects and even accelerate the destruction of the cartilage tissue of the joint. In addition, with prolonged use of these drugs, the risk of side effects increases, including ulcers of the stomach, duodenum, disruption of the normal function of the liver, kidneys, and allergic manifestations in the form of dermatitis are also possible.

Given their limited range of use, NSAIDs are prescribed with great caution, especially in elderly patients. The average duration of taking NSAIDs is about fourteen days. As an alternative to non-steroids, doctors sometimes offer selective drugs. They are usually prescribed for long-term use for a period of several weeks to several years. They do not cause complications and do not affect the structure of the cartilage tissue of the knee joint.

hormones

Sometimes, in the treatment of arthropathy of the knee joint, a course of taking hormonal drugs is prescribed. They are prescribed if NSAIDs are already ineffective and the disease itself begins to progress. Most often, hormonal drugs for the treatment of this disease are used in the form of injections.

The course of treatment with hormonal drugs is usually short and is prescribed during a severe flare-up, when inflammatory fluid accumulates in the joint. The hormone is injected into the joint about once every ten days.

Carboprotectors

To restore and nourish cartilage tissue in the early stages of the disease, a course of glucosamine and chondroitin sulfate, so-called chondroprotectants, is prescribed. It is by far the most effective treatment for osteoarthritis. They have almost no contraindications, while side effects occur in rare cases.

Glucosamine stimulates the restoration of cartilage, improves metabolism, protecting cartilage tissue from further destruction, providing it with normal nutrition. Chondroitin sulfate neutralizes the enzymes that destroy the cartilage tissue, stimulates the production of collagen protein, helps to saturate the cartilage with water and also helps to keep it inside. The effectiveness of chondroprotectors is absent in the last stages of the disease, since the cartilage tissue is practically destroyed and cannot be restored. The daily dose of glucosamine is 1500 milligrams, chondroitin sulfate is 1000 milligrams. Taking these drugs must be strictly systematic to achieve the desired effect. The course of treatment must be repeated 2-3 times a year. Both tools should be used in conjunction.

In pharmacies, glucosamine is presented in the form of injections, powder, capsules, gel. chondroitin - in ampoules, tablets, ointments, gels. There are also combined formulations that include both chondroprotectants. There are also so-called third-generation chondroprotectors, which combine a chondroprotector and one of the NSAIDs.

Vasodilator drugs

To relieve spasm of small vessels, improve blood circulation and supply nutrients to the knee joint area, as well as eliminate vascular pain, vasodilators are prescribed. They are used together with chondroprotectants. If knee arthrosis is not accompanied by fluid accumulation, it is also recommended to use heating ointments, gels, liquids.

Hyaluronic Acid

The second name of this drug is an intra-articular fluid supplement. The composition of hyaluronic acid is very similar to the composition of intra-articular fluid. When the drug is injected into the joint, it forms a film that prevents the cartilage from rubbing together during movement. The course of treatment with hyaluronic acid is prescribed only after the removal of pain and elimination of the flare-up.

Physiotherapy

A course of exercise therapy can be very useful and bring good results only when prescribed by a doctor and carried out under supervision, according to the recommendations of a specialist or trainer. Self-medication is dangerous for health. Exercise therapy is used to further prevent the destruction of cartilage tissue, slowing the development of stiffness, relaxing the muscle spasm that causes pain. During peak exercise treatment is contraindicated. A course of special individual exercises that take into account not only the stage of the disease and the condition of the cartilage, but also the age of the patient, should be developed by an expert in this field.

Physiotherapy

As one of the methods of conservative treatment, physiotherapy is used - electrophoresis, laser therapy, acupuncture, transpotential currents, UHF. A program of local massage also gives positive results. Compresses based on dimethylsulfoxide or dischofit, medical bile are widely used. Physiotherapy methods act in several directions - they relieve pain, reduce inflammation, normalize the metabolism inside the joint and restore its normal functions. The method and duration of the course of physiotherapy is determined by the patient's history and is prescribed only after a thorough diagnosis and study of the condition of the joints.

The patient must strictly control his diet, as excess weight puts additional pressure on the knee joint and accelerates the progression of the disease. Excessive physical activity is dangerous, it should be avoided, but at the same time, doing exercises is simply necessary. Orthopedists recommend wearing comfortable shoes with special soles, using a cane to facilitate movement. There are many techniques developed by experts in the field of rheumatology and orthopedics to treat osteoarthritis of the knee.

Physical therapy for pain relief includes:

1. Medium wave UV radiation (SUV radiation). The contact of ultraviolet radiation with the skin of the knee continues until a slight redness appears. Substances are formed in the tissues that soften the sensitivity of nerve fibers, due to which an analgesic effect is achieved. The duration of the course of treatment is prescribed by the doctor depending on the symptoms, frequency and intensity of the pain. On average, the course of treatment is about 7-8 sessions.
2. Local magnetotherapy aimed at the general rehabilitation of the patient's body. This process relieves inflammation, eliminates pain, neutralizes muscle spasms. It is effectively used for arthropathy of the knee joint in the initial stages. The course of treatment is usually limited to 20-25 procedures, each of which takes about half an hour.
3. Infrared laser therapy, low intensity UHF therapy, centimeter wave therapy (CMW therapy).
4. Ultrasound, darsonvalization, therapeutic baths, interference therapy, which is prescribed to improve blood circulation in the joint.

Equally important is the spa health treatment. Such treatment is prescribed for deforming and dystrophic osteoarthritis. This treatment, like those mentioned earlier, has its own contraindications, so the attending physician carefully studies the patient's history before recommending him a sanitizing-resort method.

Surgical treatment of arthrosis of the knee joint

This is a radical method of treating arthropathy of the knee joint, which partially or completely restores the function of the joint. The methods and forms of surgery depend on the degree of joint damage, as well as on the patient's history.

Late arthropathy of the knee joint is treated only surgically - the knee joint is completely or partially replaced with an endoprosthesis. Surgical treatment allows not only to improve well-being, but also to restore the patient's ability to work in the last stages of knee arthropathy. A significant disadvantage of the operation, many consider a long recovery period using exercise therapy, mechanical therapy and other means.

There are several types of surgery for osteoarthritis of the knee joint:

1. Arthroplasty of the joint. The principle of the operation is to fix the lower limb in the most functional position for it and immobilize it in the area of the knee joint. The damaged cartilage is completely removed. This is a radical method, used in extreme cases. The result is the elimination of pain, but the patient remains disabled for life.
2. Arthroscopic cleaning. This method of surgery has a temporary but lasting effect. It is mainly used in the second stage of the development of the disease. During the operation, damaged parts of the cartilage tissue are removed, thus eliminating pain. Effectiveness after surgery is maintained for two to three years.
3. Endoprosthetic. The most popular treatment for this disease. The knee joint is removed completely or partially. And in its place is an endoprosthesis made of ceramic, metal or plastic. As a result, the patient restores motor activity, eliminates pain. The effectiveness of the operation is maintained for more than fifteen to twenty years.

Recovery period

The recovery period after such an operation lasts about three months. The purpose of the restoration is:

1. Recovery of motor activity.
2. Improvement of muscle and joint function.
3. Providing protection to the prosthesis.

The drain is removed on the second or third day after surgery. To eliminate pain, special preparations with a cooling effect are used. Physical activity is recommended to begin immediately after drain removal. A week later, the patient is transferred to a rehabilitation center. The physiotherapist monitors the patient's condition.

For some time after the operation (about a year), the patient still feels pain, this is due to the implantation of the prosthesis. The older the patient, the longer the process of implanting the prosthesis. NSAIDs are prescribed to relieve inflammation and reduce pain. Sometimes doctors prescribe hormonal drugs that guarantee a stable result.

A mandatory component is the exercise therapy course. Classes must be planned individually for each patient and strictly performed every day. Physical activity is gradually increased to prevent injury.

After leaving the clinic, the patient must comply with certain instructions regarding further lifestyle. Physical activities such as dancing or yoga are allowed six months after surgery. Loads that can damage the intention (fast running, jumping, power sports) are strictly prohibited. After the operation, it is not recommended to lift weights of more than twenty five kilograms. In the house where the patient will live, it is necessary to strengthen all the handrails of the stairs, equip the shower with a handrail, carefully check all the chairs and other furniture for maintainability. By following these simple recommendations, the intention will last a long time.

Despite compliance with recommendations and prescriptions, postoperative arthropathy of the knee joint is more often observed after such surgeries (after about 2-3 years).

Prevention of knee joints

In order to avoid this disease, people at risk (athletes, the elderly, overweight people, business workers) must comply with certain requirements:

1. Proper nutrition and weight loss. It is necessary to exclude harmful foods from your diet - fatty, fried, alcohol, but it is better to consult a nutritionist who will help you individually choose the right diet.
2. When playing sports, monitor the load on the joints, if necessary, reduce it.
3. Monitor your health and treat infectious diseases in time, preventing them from becoming chronic.
4. Timely and adequate treatment of spinal diseases, if any, development of correct body posture.
5. Sports activities (cycling, swimming, walking, special gymnastics exercises for the joints).
6. No self-medication! At the first symptoms of arthrosis of the knee joint, contact the clinic.
7. Avoid stress, have a good sleep.
8. Systematically increase your immunity (harden up or at least take a series of vitamins 2-3 times a year).
9. Avoid hypothermia of the body, especially the lower extremities.

A healthy lifestyle and early treatment are the best means of preventing arthrosis of the knee joints.