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, persistent 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 andoften 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 impaired, the joints of the knee knee narrow, the biomechanics of the joint changes. The synovial membrane, which lines the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant), is irritated, leading 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 comes out of the posterior wall of the joint capsule and Becker's cyst is formed (which, reaching large sizes, can cause pain in the popliteal fossa). The thin and delicate tissue of the joint capsule is replaced by coarse connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growths) form. The blood circulation in the periarticular tissues is disturbed, insufficiently oxidized metabolic products accumulate in them, which irritate the chemoreceptors, and a syndrome of constant pain develops. Against the background of changes in the anatomy of the joint, a violation of the surrounding muscles occurs, malnutrition and spasm occur, and gait is impaired. There is a constant limitation of the range of motion in the joint (contracture), sometimes so pronounced that only swaying movements (stiffness) or complete lack of movement (ankylosis) are possible.
We can say that osteoarthritis of the knee joint is a very common disease: it affects 10% of the entire population of the planet, and at 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).
- Disorders 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 causes, there are also adverse 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 (according to statistics, women get sick more often);
- increased sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases at rest.
- Difficulties in normal physiological movements in the joints.
- The characteristic "crunch" in the joints.
- Enlargement of the 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 "weight" in the knee, disturbing when walking long distances or increased physical activity. The X-ray will not have much information: only a slight narrowing of the joint space can be found, there will be no other changes. At the beginning of the defeat of the arthrosis 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,palpable pain, whose weight decreases at rest. Difficult movement in the joints occurs, a characteristic "squeak" is heard when walking (from the patient you can hear a common phrase in everyday life - "squeak of the knees"). Radiography revealed a distinct narrowing of the joint space and single osteophytes.
- With the transition of gonarthrosis to the next, third stage,the symptoms of pain will bother the patient constantly, including at rest, there is a violation of the configuration of the joints, ie, deformity aggravated by edema during the accession to the inflammation. Radiographs show moderate narrowing of the joint space and multiple osteophytes. In the third stage, many are already seeking medical help, because the quality of life is significantly affected by pain and difficulty walking normally.
- The fourth stage of osteoarthritis of the knee joint is accompanied byunbearable, exhausting pain. . . Minimal attempts to move become a difficult test for a person, deformity of the joints is noticeable visually, walking is extremely difficult. Radiography reveals significant changes: joint space is virtually undetectable in images, many gross osteophytes, "joint mice" (fragments of collapsing bone falling into the joint cavity) are revealed. This stage of gonarthrosis almost always leads to damage: often the outcome ofthe disease is a 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 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 a person can not 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 specialized orthopedic and trauma department.
How and how to treat osteoarthritis of the knee joint?
Currently known methods of treatment of patients with osteoarthritis of the knee are divided into non-drug conservative, medical and surgical.
Non-drug methods
Many patients ask themselves, "How to deal with osteoarthritis of the knee without pills? " In response, we must regret that gonarthrosis is a chronic disease that is impossible to eradicate forever. However, many of the currently existing non-pharmacological (ie non-drug) methods of dealing with this disease can significantly slow 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 the doctor and sufficient motivation of the patient to heal, sometimes it is enough to eliminate the negative factors. For example, weight loss has been shown to reduce the onset of the main symptoms of the disease.
Elimination of pathological physical activity and vice versa,therapeutic gymnasticswith the use of rational physical programs they reduce the intensity of pain. Exercises to strengthen the quadriceps muscle have been shown to be comparable in action to anti-inflammatory drugs.
If we are treating osteoarthritis of the knee joint, then it is necessary to strive forproper 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 passion will help to improve the elastic properties of articular cartilageto smoked meats, marinades, preservatives, sweet and salty foods, on the contrary, potentiates the disruption of metabolic processes in the body and the accumulation of excess weight to obesity.
Thinking about the most effective treatment for osteoarthritis of the knee, it is worth remembering such an effective treatment and prevention method asorthopedics: knee braces, orthoses, elastic bandages and orthopedic insoles reduce and properly distribute the load on the joint, thus reducing the intensity of pain in it. The use of a cane is also recommended as an effective relief for the knee joints. It should be in the arm 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. . . Widely used in various categories of patients suffering from osteoarthritis of any degree, it has proven its effectivenessmagnetic therapy: after several procedures the intensity of pain decreases, as a result of improved blood circulation, reduced swelling and elimination of muscle spasm, joint mobility increases. The effect of magnetic therapy is particularly pronounced with the development of active inflammation in the joint: the severity of edema is significantly reduced, the symptoms of synovitis regress. Not so popular, but no less effective in the treatment of knee joint for osteoarthritis, are physiotherapeutic methods such aslaser therapyandcryotherapy(exposure to cold), which have a pronounced analgesic effect.
Medication treatment
The following drugs are used in the schemes for effective treatment of osteoarthritis of the knee joint.
Non-steroidal anti-inflammatory drugs (NSAIDs), produced in forms for external (various gels, ointments) 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. In early manifestations of the disease is effective local use of these drugs in combination with non-drug methods (therapeutic exercises, magnetic therapy). But with advanced osteoarthritis of the knee joints, pills, and sometimes NSAID injections, are indispensable. It should be remembered that long-term systemic administration 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 taken NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor the laboratory parameters of the internal organs.
Glucocorticosteroids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when the previously prescribed NSAIDs of the patient do not cope with the elimination of the manifestations of inflammation. As a powerful anti-inflammatory agent, GCS in the treatment of osteoarthritis have 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 into the periarticular pain points are considered, 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 traumatologist. In 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. In accordance with national guidelines for the treatment of osteoarthritis, do not make 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 NSAIDs, corticosteroids, and non-drug methods, it is possible to prescribeopioid painkillers. . . These drugs are used only on prescription, which assesses 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 the ability to slow down the degenerative changes in cartilage and narrow the joint space. They are producedin the form of both 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. 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 comprehensive 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 drugs do not help with osteoarthritis of the knee? "" Is surgical treatment indicated for osteoarthritis of the knee? "In answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are an intractable pain syndrome and significant joint dysfunction that cannot be eliminated. with the help of 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 isendoprosthesis, ie removal of one's own joint with 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 the case of severe osteoporosis (significant reduction in bone mineral density), endoprosthesis is also notshown: "sugar" bone will not withstand the introduction of metal pins and rapid resorption (resorption) of bone tissue will begin at the site of their installation, pathological fractures may occur. Therefore, a timely decision on the need to install an endoprosthesis seems so important - it should be taken when the age and general condition of the human body still allows the operation. 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 people aged 45-75 years with 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 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 (replacement of the hip joint is much easier technically). This dictates the need to perform organ-preserving operations (preservation of the joint). 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 with the help of a shunt - a hollow metal tube. This allows the fatty 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 limb (but subject to a slight limitation of the range of motion), it is effectivecorrective osteotomy- cutting of the tibia with correction of its axis, followed by fixing with a plate and screws in the desired position. At the same time, two goals are achieved - normalization of biomechanics due to the restoration of the limb axis, as well as 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 attention and following the doctor's recommendations can stop its progression. .