Deformative osteoarthritis of the knee joint (aka gonarthrosis or abbreviated DOA)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic, steady progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsule and ligament) and leads to joint deformity, reduced range of motion and often disability.
The disease begins with changes in 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 on the joint surfaces is exposed, slippage is disturbed, the joints of the joint are narrowed, the biomechanics of the joint are altered. The synovial membrane that conducts the joint and produces synovial fluid (which nourishes cartilage and plays the role of physiological lubricant) becomes irritated, leading to an increase in its amount in the joint (synovitis). Due to narrowing of the joint space, the volume of the joint decreases, the synovial fluid protrudes from the posterior wall of the joint capsule, and a Becker cyst is formed (which when large sizes can cause pain in the popliteal fossa). The thin and delicate tissue in the joint capsule is replaced by coarse connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growths) form. Blood circulation in periarticular tissues is impaired, underoxidized metabolic products that irritate chemoreceptors accumulate in them, and persistent pain syndrome develops. Due to changes in the anatomy of the joint, a violation of the surrounding muscles occurs, hypotrophy and spasms appear, and gait disturbances occur. There is a persistent limitation of the range of motion of the joint (contracture), sometimes so pronounced that only rocking movements (stiffness) or complete absence of movements (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 over 60 years it affects every third person.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, arthritis).
- Violation of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the musculature and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which include:
- overweight (literally puts pressure on the lower extremities);
- age (mainly older people are susceptible to the disease);
- female gender (according to statistics, women get sick more often);
- increased sports and professional physical activity.
Symptoms of osteoarthritis of the knee joint
- Pain that increases with walking and falls at rest.
- Difficulty with normal, physiological movements in the joints.
- The characteristic "crunch" in the joints.
- Joint expansion and visible deformity.
Stages of gonarthrosis
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There are several stages of osteoarthritis:
- In the first phase, a person only experiences symptoms such asslight discomfortor "heaviness" in the knee, disturbing when walking long distances or increased physical exertion. X-ray examination will have some information: only a small narrowing of the joint space can be detected, there will be no other changes. At the beginning of the defeat of osteoarthritis 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 joint,palpable painwhose severity falls at rest. Difficulty moving in the joints appears when walking, a characteristic "squeak" is heard (from the patient one can hear a common phrase in everyday life - "knee squeak"). When performing radiography, there is a clear indistinguishable narrowing of the joint space and individual osteophytes.
- With the transition of gonarthrosis to the next, third stage,pain symptoms bother the patient constantly, including at rest, there is a violation of the joint configuration, ie. deformation, aggravated by edema at the time of joining of inflammation. On X-rays, a moderate narrowing of the joint space and more osteophytes is determined. In the third stage, many are already seeking medical attention, the quality of life is significantly affected by pain and difficulty walking normally.
- The fourth stage of osteoarthritis of the knee joint is accompanied byunquenchable, exhausting pain. . . Minimal movement attempts become a difficult test for a person, deformity of the joints is noticeably visual, it is extremely difficult to walk. Radiography reveals significant changes: the joint space is practically undetectable in the images, several coarse osteophytes, "joint mice" (fragments of collapsing bone falling into the joint cavity) are revealed. This stage of gonarthrosis almost always leads to disability: often the result of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who treats osteoarthritis of the knee joint?
Qualified medical care for gonarthrosis can be provided to the patient by a therapist, rheumatologist, and general practitioner (family physician), 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, one can not do without the help of an orthopedist. In situations where surgical treatment is required, a patient with osteoarthritis of the knee joint is referred to a specialized orthopedic and trauma department.
How and how is osteoarthritis of the knee joint treated?
The currently known methods of treating patients with osteoarthritis of the knee joint are divided into non-drug conservative, medical and surgical.
Non-medical methods
Many patients ask themselves the question: "How to deal with knee joint osteoarthritis without pills? " When we answer that, we have to state with regret that gonarthrosis is a chronic disease, it is impossible to remove it forever. However, many of the currently existing non-pharmacological (ie without the use of drugs) 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 a doctor and sufficient motivation for the patient to heal, it is sometimes enough to remove negative factors. For example, it has been proven that reducing obesity reduces the manifestation of the main symptoms of the disease.
Elimination of pathological physical activity and vice versatherapeutic gymnasticsby using rational physical programs, they reduce the intensity of pain. Exercises to strengthen the quadriceps femoris have been shown to be comparable in effect with anti-inflammatory drugs.
If we treat osteoarthritis of the knee joint, it is necessary to strive forproper nutrition: Improving the elastic properties of articular cartilage helps products that contain a large amount of animal collagen (diet types of meat and fish) and cartilage components (shrimp, crabs, krill), fresh vegetables and fruits saturated with vegetable collagen and antioxidants, and a passionfor smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, exacerbates the disruption of metabolic processes in the body and the accumulation of obesity up to obesity.
When we reflect on the most effective treatment for knee osteoarthritis, it is worth remembering such an effective treatment and prophylactic method asorthotics: attachment of knee pads, orthoses, elastic bandages and orthopedic insoles reduces and distributes the load on the joint correctly, thereby reducing the intensity of pain in it. The use of a cane is also recommended as an effective relief of the knee joint. It should be in the hand opposite the affected limb.
Comprehensive treatment of osteoarthritis of the knee joint also involves the appointment of very effective, even with advanced forms of the diseasephysiotherapy. . . With widespread use in various categories of patients suffering from osteoarthritis to any degree, it has proven its effectivenessmagnetotherapy: after several procedures, the pain intensity decreases, due to improved blood circulation, reduction of edema and elimination of muscle spasms, joint mobility increases. The effect of magnetotherapy is particularly pronounced with the development of active inflammation of the joint: the severity of edema is significantly reduced, the symptoms of synovitis regress. Not as popular but no less effective in treating the knee joint for osteoarthritis are physiotherapy methods such aslaser therapyandcryotherapy(exposure to cold), which has a pronounced analgesic effect.
Drug treatment
The following drugs are used in the schemes for the 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 largely prescribed by doctors. By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling and slow down the course of the disease. With early manifestations of the disease, the local use of these drugs in combination with non-medical methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joint, pills and sometimes injections of NSAIDs are indispensable. It should be remembered that prolonged systemic ingestion of NSAIDs can cause the development and worsening of ulcerative processes in the gastrointestinal tract and in addition adversely affect the function of the kidneys and liver. Therefore, patients who have been taking NSAIDs for a long time should also 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 previously prescribed NSAIDs for the patient are unable to cope with the elimination of the manifestations of inflammation. As a strong anti-inflammatory drug, GCS for the treatment of osteoarthritis has certain contraindications, as they can cause a number of significant side effects. In systemic forms with gonarthrosis, they are practically not prescribed. For effective treatment of osteoarthritis is usually meant GCS injections into the periarticular pain 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 performed by a rheumatologist or trauma specialist. In case of concomitant synovitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single administration of GCS, the effect of such treatment lasts up to 1 month. In accordance with national guidelines for the treatment of osteoarthritis, do not perform more than three injections of the drug per year in the same joint.
With advanced, "neglected" osteoarthritis, when a person experiences excruciating pain that does not subside even at rest, disrupts normal sleep and is not removed by NSAIDs, GCS and non-medical methods, it is possible to prescribeopioid analgesics. . . These medicines are used only on prescription from a doctor, who in each case assesses whether their appointment is appropriate.
Chondro protectors(literally translated as "cartilage protection"). This name is understood as various drugs, united by a property - a structure-modifying action, ie. the ability to slow down degenerative changes in cartilage and narrowing of the joint space. They are produced in forms both for oral administration and for introduction into the joint cavity. Of course, these substances do not work miracles and do not "cultivate" new cartilage, but they can stop its destruction. To achieve a lasting effect, they must be used for a long time, with regular courses several times a year.
Surgical treatment of osteoarthritis of the knee joint
There are frequent cases where the disease progresses despite sufficiently complex treatment, which constantly reduces the quality of life. In such situations, the patient begins to ask questions: "what to do if prescribed medication does not help the knee joint? " "Is surgical treatment indicated for osteoarthritis? " In response to these questions, it should be clarified that the indications for surgical treatment of osteoarthritis inThe knee joint is a tireless pain syndrome and significant dysfunction of the joint that cannot be eliminated with the use of complex conservative therapy, which is possible with the last, fourth degree of the disease.
The most popular type of surgical treatment for third and fourth degree osteoarthritis isendoprosthetics, i. e. removal of your own joint with simultaneous installation of a replacement metal prosthesis whose design resembles 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 case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics are also not indicated: "sugar" bones will not resist the insertion of metal needles, and rapid resorption (resorption) of bone tissue will begin at their site of installation, pathological fractures may occur. That is why a timely decision on the need to install an endoprosthesis seems to be so important - it should be taken when the age and general condition of the human body still allows 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 people 45-75 years with a 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 surgeries are often unsatisfactory and the percentage of complications is high. This is due to the design features of endoprostheses and the complexity of the surgical procedure itself (replacement of the hip joint is much easier in technical terms). This dictates the need to perform organ-preserving operations (preservation of the joint). These include arthromedullary bypass surgery and corrective osteotomy.
Arthromedullary bypassconnection of the medullary canal of the femur to the knee joint hole by means of a shunt - a hollow metal tube. This allows the oily bone marrow from the lower third of the femur to enter the knee joint, which nourishes and lubricates cartilage, thereby significantly reducing pain.
When you change the axis of the lower extremity (but subject to a slight limitation of the range of motion), it is effectivecorrective osteotomytransection of the tibia 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 - normalization of biomechanics due to the restoration of the lemax, as well as activation of blood circulation and metabolism during bone fusion.
In summary, I would like to note that the treatment of gonarthrosis is a complex social task. And although medicine today is unable to offer a drug that will get rid of it forever, or other ways to cure this disorder completely, a healthy lifestyle, timely seeking medical attention and following the doctor's recommendations can stop its development.