One of the most common pathologies of the musculoskeletal system is osteoarthritis of the knee joint (also known as gonarthrosis) - a chronic disease accompanied by degeneration and destruction of the knee joint structures.
The result of destructive processes is a marked limitation or complete loss of joint mobility and, as a result - decreased performance, disability.
Adverse consequences can be avoided only with early diagnosis and timely therapy.
Arthrosis of the knee is of primary and secondary origin. The primary disease develops as an independent disease, is most frequently diagnosed in the elderly and, in this case, is due to age-related tissue changes. Secondary gonarthrosis becomes a consequence of other diseases and disorders of the body.
The development of gonarthrosis is promoted by:
- injuries (dislocations, fractures, meniscal injuries);
- diseases of the musculoskeletal system (congenital deformity of the legs, knee dysplasia, chondrocalcinosis, arthritis, osteoporosis);
- constant high loads on the joint caused by professional activity, professional sports;
- overweight, obesity;
- endocrine diseases, including diabetes mellitus, hypothyroidism, acromegaly;
- metabolic disorders;
- genetic predisposition.
Inflammation in knee arthrosis is accompanied by two main clinical manifestations - pain and edema. The intensity and frequency of the onset of the painful syndrome depend on the depth of damage to the joint structures. In the initial stage, the pain is felt only with the effort, it passes quickly at rest. With advanced gonarthrosis, acute pain is constantly present, intensifying during movement, when the weather changes.
Other signs of knee arthrosis:
- grinds when moving;
- joint stiffness, impaired motor function;
- knee deformity (with advanced gonarthrosis).
Gonarthrosis can be accompanied by synovitis (accumulation of fluid in the joint cavity) and the subsequent formation of a Baker's cyst (elastic formation at the back of the knee).
Degree of arthrosis
The symptoms of arthrosis of the knee joint vary depending on the depth of damage to the knee structures and therefore there are 3 stages of pathology.
- Arthrosis of the 1st degree knee jointmanifests itself in mild pain during exertion (passes immediately at rest), mild stiffness after sleep. The radiographic image shows an insignificant narrowing of the joint space (less than a third), the presence of single osteophytes (bony protuberances).
- Arthrosis of the 2nd degree knee jointis accompanied by pain syndrome and a characteristic crush during movements. The pain persists for a while at rest. Morning stiffness, limited range of motion is observed. Diagnostic procedures reveal a pronounced narrowing of the joint space (more than half) and multiple osteophytes.
- Grade 3 knee arthrosisis accompanied by constant painful pain, which increases with movement and at night. Morning stiffness persists for more than an hour with exacerbation of inflammation and at least half an hour during periods of remission. Joint mobility is severely limited or completely lost. The radiographic image shows several large osteophytes, cysts. The joint gap is reduced by more than two-thirds of the standard.
Depending on the degree of arthrosis of the knee joint, the patient is prescribed conservative or surgical treatment.
The diagnosis of knee arthrosis includes visual examination, analysis of the patient's complaints, results of laboratory tests (urinalysis, general and biochemical blood tests) and instrumental examination methods.
The following diagnostic procedures allow you to confirm or deny the diagnosis:
- ultrasound (ultrasound);
- MRI (magnetic resonance imaging);
- CT (computed tomography);
- arthroscopy and scintigraphy (if a tumor is suspected).
With these methods it is possible to identify the narrowing of the joint space, the degree of thinning and deformation of the cartilage, the presence of fluid in the joint cavity, structural changes in the synovium, proliferation of osteophytes and foci of ossification of the cartilage.
Conservative methods of treatment can reduce pain and inflammation, improve blood circulation and nutrition of periarticular tissues and strengthen the muscular system.
For this purpose, the following is done:
- drug therapy;
- physiotherapy and manual therapy;
- physiotherapy exercises.
Adherence to a therapeutic diet is also an important part of treating osteoarthritis.
The conservative treatment of osteoarthritis of the knee joint will be effective in the initial stage of the disease, when there are small degenerative changes in the cartilage, inflammation and dysfunction of the synovial membrane.
The medication includes a consultation:
- non-steroidal anti-inflammatory drugs (NSAIDs);
- hyaluronic acid.
Nonsteroidal anti-inflammatory drugs help to relieve inflammation and reduce its main symptoms - swelling and pain.
Preparations are prescribed in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration). NSAIDs knee joint osteoarthritis capsules and pills are taken in short courses, since the drugs have a strong irritating effect on the gastric mucosa and can cause the development of peptic ulcer, have many other side effects.
In addition, external medications (ointments, gels, creams) based on non-steroidal anti-inflammatory components are prescribed. Local therapy is allowed for a longer period.
NSAIDs have a pronounced anti-inflammatory effect, but with prolonged use, they contribute to further destruction of cartilage.
NSAIDs are symptomatic drugs. They help to eliminate the unpleasant symptoms of the disease, but do not affect the condition of the cartilage. In contrast to these agents, chondroprotectors and hyaluronic acid accelerate the regeneration of cartilage tissue and delay its destruction.
The preparations of the chondroprotective group contain chondroitin and glucosamine (structural elements of cartilage) and help to restore the knee in the event of arthrosis of the knee joint. They are available in the form of tablets, powder for oral administration, solution for injection.
The minimum course for taking pills and powder is 3 months. After an interval, the course is repeated an additional 2-3 times. The course of treatment with the solution includes 12-15 injections, repeated 2-3 times a year.
The first positive results of treatment with chondroprotectors are noticeable only a few months after the start of therapy.
Hyaluronic acid is injected into the affected joint. The knee osteoarthritis medication acts as a lubricant - it involves the joint surfaces, thus reducing friction between them.
Therapy with hyaluronic acid preparations increases the elasticity of cartilaginous tissue, prevents further destruction of joint structures, thus improving joint mobility, reducing symptoms of inflammation. The drugs are well tolerated and have no side effects. Its only disadvantage is the high cost.
The course of treatment with hyaluronic acid usually includes 3-4 injections, which are administered at intervals of 10-14 days.
If non-steroidal anti-inflammatory drugs fail to relieve knee pain in arthrosis, blockage is performed - a treatment method in which drugs are injected directly into the affected tissues to relieve pain and inflammation. In the treatment of arthrosis, joint block (injections in the joint cavity) and periarticular block (in the periarticular cavity) are used.
The main advantage of the method is instantaneous targeted action, since with this introduction the maximum concentration of the active substance is created precisely in the inflammation zone. In addition, the drugs do not enter the systemic circulation, which significantly reduces the risk of adverse reactions.
In the final stages of gonarthrosis, the joint space narrows, osteophytes grow, joint surfaces are deformed, so only periarticular blocks are allowed.
Knee block in osteoarthritis can be performed with anesthetics and corticosteroids.
Anesthetics are generally administered in combination with steroid hormones to reduce the pain of the procedure.
Hyaluronic acid and chondroprotectors can also be injected directly into the joint. But, in this case, we are not talking about blocking, but about intra-articular injection, since these drugs do not block pain impulses, but initiate the processes of regeneration of cartilaginous tissue.
Physiotherapy and manual therapy
The main physiotherapy methods used to treat osteoarthritis include:
- laser treatment
- ultrasound therapy; cryotherapy;
- paraffin and ozokerite therapy;
- mud therapy.
The main task of all physiotherapeutic procedures is to stimulate blood circulation in nearby tissues, to improve cartilage nutrition.
Pain syndrome forces a patient with gonarthrosis to limit motor activity, resulting in atrophy of nearby ligaments and muscles. This condition negatively affects the joint tissues, as it is during movement that nutrients penetrate the synovial fluid into the cartilage. If the joint is constantly at rest, the dystrophic processes are aggravated.
That is why physiotherapy exercises are an integral part of conservative therapy. Moderate physical activity makes it possible to strengthen the muscular system, increase the nutrition of joint structures, eliminate stiffness and improve knee motor function.
The corrective gymnastics exercises are developed by the doctor individually for each patient, taking into account the depth of the injury and the functional state of the joint structures.
General recommendations for exercise therapy for knee joint arthrosis:
- start training only after alleviating signs of acute inflammation;
- perform all exercises smoothly, without sudden movements;
- increases the load gradually;
- excludes high loads on the joint (increased knee flexion / extension);
- Stop training if pain or discomfort occurs.
For gonarthrosis, the patient's diet should include foods that contain:
- amino acids (dairy products, lean meats);
- collagen (dishes with added gelatin);
- essential fatty acids (vegetable oils, fish);
- sulfur and selenium (vegetables, cereals, cabbage and apples, beef, chicken, eggs).
- excludes the use of smoked meats, pickles, marinades;
- limit salt intake;
- follow a diet 5 times;
- observe the drink regime.
Excess weight is one of the main factors that cause the development of arthrosis of the knee joint. Therefore, the task of overweight patients is to reduce body weight. In this case, the result can only be achieved with the help of a diet, as intense sports are harmful to the inflamed joint.
To reduce body weight, it is recommended to exclude from the menu:
- fatty fish and meat;
- cream, homemade sour cream and other dairy products with a high percentage of fat;
- margarine, mayonnaise, various sauces; confectionery
- fast food;
- sugary drinks.
Grade 3 knee joint arthrosis does not lend itself to conservative therapy, so the only way out for the patient is surgery.
There are two surgical options:
- Corrective osteotomy- performed in the initial stage of development of stage 3 of gonarthrosis, if the cartilage tissue is partially destroyed, it is possible to remove the osteophytes;
- endoprosthesis- the replacement of a joint or its destroyed parts is carried out with complete destruction of the cartilage.
Pathological changes in joint structures are progressive and irreversible. However, with early diagnosis and adequate treatment, it is possible to completely stop the inflammation and stop the dystrophic changes in the cartilage tissue - 1st degree knee joint arthrosis lends itself well to conservative therapy.
In the case of 2nd degree arthrosis, which is accompanied by destruction of the cartilage and formation of osteophytes, conservative techniques allow to slow or suspend the deformation of the cartilage, stop the inflammation and improve motor activity. However, doctors are often forced to resort to blockages, arthroscopy.
It is impossible to cure grade 3 knee arthrosis conservatively. Surgery is the only way to restore knee mobility.