Deforming osteoarthritis of the knee joints (also known as gonarthrosis or DOA for short)- degenerative-dystrophic disease of the knee joint, characterized by chronic, constantly progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and ligaments of the joints) and leads to joint deformity, reduced 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 its dystrophy (thinning) and resorption, while the bone tissue of the joint surfaces is exposed, slippage is disturbed, the knee joints are narrowed, the biomechanics of the joint changes. The synovial membrane that coats the joint and produces synovial fluid (which feeds the cartilage and plays the role of physiological lubricant) becomes 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 joint decreases, synovial fluid protrudes towards the posterior wall of the joint capsule and a Becker cyst is formed (which, reaching large sizes, can cause pain in the popliteal fossa). The thin and sensitive 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 disturbed, insufficiently oxidized metabolic products accumulate in them, which irritate the chemoreceptors, and a persistent pain syndrome develops. In the background of changes in the anatomy of the joint, there is a violation of the surrounding muscles, hypotrophy and spasm appear, and gait is disturbed. There is a constant limitation of the range of motion in the joint (contracture), sometimes so pronounced that only rocking movements (stiffness) or complete absence of movement (ankylosis) are possible.
About 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 people over the age of 60 affect 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, diseases of the parathyroid glands, hemochromatosis).
- Musculoskeletal disorders and neuropathy (Charcot's disease).
In addition to the main reasons, there are unfavorable background factors for the development of gonarthrosis, which include:
- overweight (literally puts pressure on the lower limbs);
- old age (mostly older people are susceptible to disease);
- female gender (according to statistics, women get sick more often);
- increased sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases when walking and decreases at rest.
- Difficulties in normal, physiological movements in the joints.
- Characteristic "creaking" in the joints.
- Enlargement of joints and visible deformation.
Stages of gonarthrosis
.png)
There are several stages of osteoarthritis:
- In the first stage, the person only feels symptoms such asmild discomfortor "weight" in the knee, disturbing when walking long distances, or increased physical exertion. The X-ray examination will not have much 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, the person does not turn to specialists, without attaching special importance to the symptoms that appear.
- For the second stage of osteoarthritis of the knee,palpable painwhose severity decreases at rest. Difficulty moving in the joints appears, a characteristic "squeak" is heard while walking (you can hear the usual phrase in everyday life from the patient - "knees squeak"). When performing radiography, there is a clearly noticeable narrowing of the joint space and individual osteophytes.
- With the transition of gonarthrosis to the next, third stage,the symptoms of pain will constantly disturb the patient, including at rest, there is a violation of the configuration of the joints, ie. deformity, exacerbated by edema at the time of joining the inflammation. Radiographs show moderate narrowing of the joint space and more osteophytes. In the third phase, many are already seeking medical help, because the quality of life is significantly affected by pain and difficulty in normal walking.
- The fourth stage of osteoarthritis of the knee joint followsinconsolable, exhausting pain. . . Minimal attempts to move become a difficult test for a person, deformity of the joints is visible, walking is extremely difficult. Radiography reveals significant changes: the joint space is practically undetectable in the images, more gross osteophytes, "joint mice" (fragments of collapsing bone falling into the joint cavity) are detected. This stage of gonarthrosis almost always involves disability: often the outcome of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who treats osteoarthritis of the knee?
Qualified medical care for gonarthrosis can be provided to the patient by a therapist, rheumatologist and general practitioner (family doctor), but these specialists treat the knee joint due to uncomplicated arthrosis.
When synovitis occurs or the treatment prescribed by a therapist does not give the desired effect, then it cannot be done without the help of an orthopedist. In situations where surgical care is required, a patient with osteoarthritis of the knee joint is referred to a specialized orthopedic and trauma department.
How and how to treat osteoarthritis of the knee?
Currently known methods of treatment of patients with osteoarthritis of the knee joint are divided into conservative, drug and surgical.
Drug-free methods
Many patients ask themselves the question: "How to get rid of osteoarthritis of the knee joint without pills? " In answering this, we must state with regret that gonarthrosis is a chronic disease, which is impossible to eliminate forever. However, many of the currently existing nonpharmacological (i. e. , drug-free) methods of coping with this disease can significantly slow its progression and improve a patient’s quality of life, especially if used in the early stages of the disease.
A timely visit to the doctor and sufficient motivation of the patient for healing is sometimes enough to eliminate the negative factors. For example, it has been proven that reducing excess weight reduces 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 be comparable in effect to anti-inflammatory drugs.
If we are treating osteoarthritis of the knee joint, then it is necessary to weighproper nutrition: products containing a large amount of animal collagen (dietary types of meat and fish) and cartilage components (shrimp, crabs, krill), fresh vegetables and fruits saturated with plant collagen and antioxidants, and a passion for smoked meat, marinades will help improve the elastic properties of articular cartilage, preservatives, sweet and salty foods, on the contrary, intensifies the disruption of metabolic processes in the body and the accumulation of excess weight to obesity.
When considering the most effective treatment for osteoarthritis of the knee, it is worth remembering such effective methods of treatment and prevention asorthotics: fixing knee pads, orthoses, elastic bandages and orthopedic insoles reduces and properly distributes the load on the joint, thus reducing the intensity of pain in it. The use of walking sticks is also recommended as an effective relief of the knee joints. It should be in the hand opposite the affected limb.
Comprehensive treatment of osteoarthritis of the knee also involves the appointment of very effective, even in advanced forms of the diseasephysiotherapy. . . With widespread use in various categories of patients suffering from osteoarthritis of any degree, it has proven its effectivenessmagnetotherapy: after several procedures, the intensity of pain decreases, which is due to improved blood circulation, reduced edema and elimination of muscle spasm, joint mobility increases. The effect of magnetotherapy is particularly pronounced with the development of active inflammation in the joint: the severity of edema is significantly reduced, the symptoms of synovitis decline. Not so popular, but no less effective in the treatment of knee joint due to osteoarthritis, are not physiotherapeutic methods such aslaser therapyicryotherapy(exposure to cold), which have a pronounced analgesic effect.
Drug treatment
The following drugs are used in schemes for the effective treatment of osteoarthritis of the knee joint.
Nonsteroidal anti-inflammatory drugs (NSAIDs), produced in forms for external use (various gels, ointments) and for 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 down the progression of the disease. With early manifestations of the disease, topical use of these drugs in combination with drug-free methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills, and sometimes NSAID injections, are necessary. It must be remembered that prolonged systemic intake of NSAIDs can cause the development and worsening of ulcerative processes in the gastrointestinal tract, and in addition, negatively affect the function of the kidneys and liver. Therefore, patients who take non-steroidal anti-inflammatory drugs for a long time should 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 the patient has not been prescribed previously prescribed nonsteroidal anti-inflammatory drugs to eliminate the manifestations of inflammation. Because they are powerful anti-inflammatory agents, GCS has certain contraindications in the treatment of osteoarthritis, as it can cause a number of significant side effects. In systemic forms with gonarthrosis, they are practically not prescribed. As a rule, effective treatment of osteoarthritis refers to injections of GCS into periarticular painful points, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted side effects of the drug. This manipulation can be reported by a rheumatologist or traumatologist. With concomitant synovitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single application of GCS, the effect of such treatment lasts up to 1 month. According to national guidelines for the treatment of osteoarthritis, do not do more than three injections of the drug per year in the same joint.
In advanced, "neglected" osteoarthritis, when a person experiences unbearable pain that does not subside even at rest, disrupts normal sleep, and is not removed by nonsteroidal anti-inflammatory drugs, GCS, and drug-free methods, it is possible to prescribeopioid painkillers. . . These drugs are used only on prescription, which considers the appropriateness of their appointment in each case.
Chondroprotectors(literally translated as "cartilage protection"). This name is understood as different drugs, united by one property - structural-modifying action, ie. ability to slow degenerative changes in cartilage and narrow joint space. They are produced in forms for oral administration and for introduction into the joint cavity. Of course, these drugs do not work wonders and do not "grow" new cartilage, but they can stop its destruction. In order to achieve a lasting effect, they must 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 medication does not help with osteoarthritis of the knee? " "Is surgical treatment of osteoarthritis of the knee indicated? " In answering these questions, it should be clarified thatpain and significant joint dysfunction, which cannot be eliminated by applying complex conservative therapy, which is possible with the last, fourth degree of the disease.
The most popular type of surgical care for third and fourth degree osteoarthritis isendoprosthetics, ie. removal of one's own joint with the simultaneous installation of a replacement metal prosthesis whose design is similar to the anatomy of a human knee joint. In this case, the prerequisite for this type of surgical treatment is: the absence of large joint deformities, formed "false joints", muscle contractures and severe muscle atrophy. In the case of severe osteoporosis (significant reduction in bone mineral density), endoprosthetics are also not indicated: "sugar" bone will not withstand the introduction of metal needles, and rapid resorption (resorption) of bone tissue will begin at their site of installation, pathological fractures may occur. Therefore, it seems that a timely decision on the need to install an endoprosthesis is so important - it should 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, ie. 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 persons aged 45 to 75 years with low body weight (below 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 endoprostheses and the complexity of the surgical intervention itself (hip joint replacement is technically much easier). This dictates the need to perform organ preservation operations (joint preservation). These include arthromedullary bypass surgery and corrective osteotomy.
Arthromedullary bypass- connecting the medullary canal of the femur with 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, thus significantly reducing pain.
When changing the axis of the lower extremity (but with the condition of a slight limitation of the range of motion), this is effectivecorrective osteotomy- cross-section of the lower leg with correction of its axis, followed by fixation 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 axis of the limbs, 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 cure that will get rid of it forever, or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following a doctor’s recommendations can stop its progression.