The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slip.Malnutrition and loss of elasticity lead to their degeneration and resorption, while the bone tissue of the joint surfaces is exposed, sliding is impaired, the joint space narrows and the biomechanics of the joints change.The synovial membrane that covers the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) becomes irritated, which leads to an increase in its quantity in the joint (synovitis).In the context of narrowing of the joint space, the volume of the joint decreases, synovial fluid protrudes from the posterior wall of the joint capsule and a Becker cyst is formed (which, when it reaches a large size, can cause pain in the popliteal fossa).
The thin, delicate tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.The periarticular bone tissue grows, osteophytes (pathological bone growths) are formed.Blood circulation in the periarticular tissues is disturbed, underoxidized metabolic products accumulate in them, irritating the chemoreceptors and a persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, there is a disruption in the functioning of the surrounding muscles, hypotrophy and spasms appear, gait is disturbed.A persistent limitation in the range of motion of the joint (contracture) appears, sometimes so pronounced that only rocking movements (stiffness) or a complete lack of movement (ankylosis) are possible.
Gonarthrosis is a very common disease: it affects 10% of the entire population of the planet and, over the age of 60, it affects one in every three people.
Causes of gonarthrosis
- Injuries to bones and joints.
- Inflammatory joint diseases (rheumatoid, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular system and neuropathy (Charcot disease).
In addition to the main reasons, there are also unfavorable background factors for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower limbs);
- age (mainly elderly people are affected by the disease);
- female sex (statistically, women get sick more often);
- increase in sports and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulty in the usual physiological movements in the joints.
- A characteristic “crisis” in the joints.
- Increase in the size of joints and their visible deformation.
Stages of gonarthrosis
Clinical stages of arthrosis of the knee joint.The disease goes through several stages.
- In the first stage, the person only feels a slight sensation of discomfort or “heaviness” in the knee, which is uncomfortable when walking long distances or when increasing physical activity.An X-ray examination will not be informative: only a slight narrowing of the joint space can be detected, there will be no other changes.At the beginning of the disease, the person does not turn to specialists, not giving much importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the severity of which decreases with rest.Difficulty in moving the joints appears and a characteristic “creaking” is heard when walking (from the patient you can hear a common phrase in everyday life: “creaking knees”).Radiographs reveal a clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis passes into the next third stage, the pain constantly bothers the patient, even at rest, and a disturbance occurs in the configuration of the joints, that is, deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate narrowing of the joint space and multiple osteophytes.In the third phase, many people already seek medical help, as... their quality of life suffers significantly due to the pain and difficulty in walking normally.
- The fourth stage is accompanied by unabated, debilitating pain.Minimal attempts at movement become a difficult ordeal for a person, deformation of the joints is visually noticeable, and walking is extremely difficult.The x-ray reveals significant changes: the joint space is practically not defined on the images, multiple coarse osteophytes, “articular rats” (deteriorating bone fragments that fall 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 doctor), but these specialists treat the knee joint with uncomplicated arthrosis.When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, you cannot do without the help of an orthopedist.In situations where there is a need for surgical care, the patient is referred to a specialized service in orthopedics and traumatology.
How and with what to treat osteoarthritis of the knee joint?
Currently known methods of treating arthrosis of the knee joint are divided into conservative non-medicinal, medicinal and surgical.
Non-drug methods
Many patients ask the question: “How to cure arthrosis of the knee joint without pills?”Answering this question, we regret to say that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many currently existing non-pharmacological methods of combating this disease can significantly slow down its progression and improve the patient's quality of life, especially when used in the early stages of the disease.If you consult a doctor in a timely manner and the patient is sufficiently motivated to heal, sometimes it is enough to eliminate negative factors.For example, it has been proven that losing excess weight reduces the manifestation of the main symptoms of the disease.
Eliminating pathological physical activity and, on the contrary, performing therapeutic exercises through rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have comparable effects to anti-inflammatory medications.
If we are treating arthrosis of the knee joint, we must strive for proper nutrition: products containing large amounts of animal collagen and chondroitin (shrimp, crab, krill), fresh vegetables and fruits rich in plant collagen and antioxidants will help improve the elastic properties of articular cartilage, and the passion for smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, enhances metabolic disorders in the body and the accumulation of excess weight to obesity.
When thinking about what is the most effective treatment for knee osteoarthritis, it is worth remembering a treatment and preventive method that is as effective as bracing: fixing knee braces, orthoses, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thus reducing the intensity of pain in it.
Comprehensive treatment of osteoarthritis of the knee joint also involves the appointment of very effective physical procedures, even in advanced forms of the disease.When widely used in different categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after just a few procedures, the intensity of pain decreases, as a result of which blood circulation is improved, swelling is reduced and muscle spasm is eliminated, joint mobility is increased.The effect of magnetic therapy is especially pronounced when active inflammation develops in the joint: the severity of the edema decreases significantly and the symptoms of synovitis regress.Not so popular, but no less effective in treating the knee joint with arthrosis, are such physiotherapy methods as laser therapy and cryotherapy (exposure to cold), which have a pronounced analgesic effect.
Drug treatment
Non-steroidal anti-inflammatory drugs (NSAIDs), available in forms for external use (various gels, ointments) and systemic (tablets, suppositories, solutions), have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By blocking inflammation at an enzymatic level, they eliminate joint pain and swelling and slow the progression of the disease.At the first manifestations of the disease, the local use of these drugs in combination with non-medicinal methods is effective.But with advanced osteoarthritis of the knee joints, you cannot do without pills.It should be remembered that prolonged systemic use of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, negatively affect kidney and liver function.Therefore, patients taking NSAIDs for a long time should also be prescribed medications that protect the gastric mucosa and regularly monitor laboratory parameters of the functioning of internal organs.
In the case of advanced, “advanced” osteoarthritis, when a person feels unbearable pain that does not subside even at rest, disturbs normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, it is possible to prescribe opioid analgesics.These medications are only used with a medical prescription, which considers the convenience of prescribing them in each specific case.
Chondroprotectors (literally translated as “protect cartilage”).This name refers to several drugs, united by one property - a structure-modifying effect, that is, the ability to slow down degenerative changes in cartilage and narrowing of the joint space.They are produced in forms both for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these medications do not work miracles and do not “grow” new cartilage, but they can prevent its destruction.To obtain a lasting effect, they must be used for a long time, in regular courses, several times a year.
Surgical treatment of arthrosis of the knee joints
There are often cases when, despite comprehensive and adequate treatment, the disease progresses, progressively reducing a person's quality of life.In these situations, the patient begins to ask questions: “What to do if the prescribed medications do not help with osteoarthritis of the knee joint?”, “Is surgical treatment indicated for osteoarthritis of the knee?”, “How is osteoarthritis of the knee joint treated surgically?”When answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are intractable pain syndrome and significant dysfunction of the joint, which cannot be eliminated with the use of complex conservative therapy.
The most popular type of surgical treatment for gonarthrosis is endoprosthesis, that is, removal of the joint itself with immediate installation of a metal prosthesis that replaces it, whose design is similar to the anatomy of the human knee joint.At the same time, a prerequisite for carrying out this type of surgical treatment is the absence of gross deformities of the joint, the formation of “false joints”, muscle contractures and pronounced muscle atrophy.
In case of severe osteoporosis (significant decrease in bone mineral density), the endoprosthesis is also not recommended: the “sugar” bone will not resist the introduction of metal pins and rapid resorption of bone tissue will begin at the site of its installation, pathological fractures may occur.Therefore, the timely decision on the need to install an endoprosthesis seems so important - it must 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 the endoprosthesis, that is, 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 from surgical treatment are observed in people aged 45 to 75 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 these operations 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 arthroplasty is much simpler in technical terms).These include arthromedullary bypass surgery and corrective osteotomy.The arthromedullary shunt is a connection of the medullary canal of the femur with the cavity of the knee joint using a shunt - a hollow metal tube.Thanks to this, the fatty bone marrow from the lower third of the femur enters the knee joint, nourishing and lubricating the cartilage, thus achieving a significant reduction in pain.
When the axis of the lower limb changes (but with a condition of slight limitation of range of motion), corrective osteotomy is effective - intersection of the tibia with correction of its axis, followed by fixation with a plate and screws in the desired position.In this case, 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.And although today medicine is not able to offer a medicine that will eliminate it forever, or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can prevent its progression.