Knee arthrosis

Deforming osteoarthritis of the knee joint (also known as gonarthrosis or abbreviated DOA)- degenerative-dystrophic disease of the knee joint, characterized by a chronic, continuously progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structure, synovial membrane, capsule and articular ligament), and joint deformity leading to movement and often disability.

The disease begins with a change in the articular cartilage, which causes the joint surfaces of the bones to slip. Loss of malnutrition and elasticity leads to dystrophy (thinning) and resorption, while joint tissue bone tissue is exposed, slippage is disturbed, joint knee gaps are narrow, joint biomechanics change. The synovial membrane lining the joint and producing synovial fluid (which nourishes cartilage and plays a physiological lubricating role) is irritated, leading to an increase in the amount of joint (synovitis). Against the background of narrowing of the joint space, the volume of the joint decreases, the joint fluid protrudes from the posterior wall of the joint capsule, and a Becker cyst is formed (which can cause pain in the popliteal fossa when it reaches large sizes). The thin and fine tissue of the joint capsule is replaced by a coarse connective tissue, the shape of the joint changes. Periarticular bone tissue grows and osteophytes (abnormal bone growths) are formed. Blood circulation in the periarticular tissues is impaired, under-oxidized metabolites that irritate chemoreceptors accumulate in them, and persistent pain syndrome develops. Underlying changes in the anatomy of the joint are damage to the surrounding muscles, hypotrophy and cramps appear, and gait is disrupted. There is a permanent restriction on the range of motion of the joint (contracture), sometimes so pronounced that only rocking movements (stiffness) or complete absence of movements (ankylosis) are possible.

Arthrosis of the knee joint can be said to be a fairly common disease: it affects 10% of the total population of the planet and every third person over 60 years of age.

Causes of gonarthrosis

• Bone and joint injuries.
• Inflammatory diseases of the joints (rheumatic, chlamydial arthritis, gout).
• Violation of mineral metabolism in various endocrinopathies (diabetes mellitus, parathyroid diseases, hemochromatosis).
• Musculoskeletal Disorders and Neuropathy (Charcot Disease).

In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which are:

• overweight (literally puts pressure on the lower limbs);
• age (especially the elderly are susceptible to the disease);
• female gender (statistics show that women get sick more often);
• increased sport and professional physical activity.

Symptoms of osteoarthritis of the knee joints

• Pain that increases while walking and decreases at rest.
• Difficulties with normal physiological movements in the joints.
• The characteristic "crunch" in the joints.
• Joint enlargement and visible deformity.

Stages of gonarthrosis

Arthrosis has several stages:

1. In the first stage, one only experiences symptoms such as e. g.slight discomfortor "difficulty" in the knee, disturbing long distances when walking or increased physical exertion. X-ray examination provides little information: only a slight narrowing of the joint space can be detected, there will be no other change. At the beginning of the defeat of arthrosis of the knee joint, a person does not consult a specialist without attaching particular importance to the symptoms that appear.
2. In the second stage of arthrosis of the knee joint,tangible pain, the severity of which decreases at rest. The difficulty of moving the joints appears, a characteristic "squeaking" can be heard while walking (the patient may hear a phrase common in everyday life - "knee squeaking"). During radiography, a clear distinction can be made between the joint space and the individual osteophytes.
3. With the transition from gonarthrosis to the next, third stage,the symptoms of pain constantly bother the patient, including calm, violate joint configuration, azaformation exacerbated by edema upon association with inflammation. X-rays 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 normal gait.
4. It accompanies the fourth stage of arthrosis of the knee jointunquenchable, exhausting pain. . . Minimal attempts at movement become a difficult test for humans, deformation of joints is visually noticeable, walking is extremely difficult. Radiography reveals significant changes: the joint space is virtually undetectable in the images, multiple large osteophytes, "joint mice" (fragments of collapsing bone that fall into the joint cavity) are revealed. This stage of gonarthrosis is almost always accompanied by a disability: often the outcome of the disease is complete fusion, instability, and the formation of a "false joint. "

Who treats knee arthrosis?

Qualified medical care for gonarthrosis may be provided to the patient by a therapist, rheumatologist, and general practitioner (GP), but these specialists are engaged in the treatment of uncomplicated arthrosis of the knee joint.

When arthritis occurs or the treatment prescribed by a therapist does not give the desired effect, you cannot be without orthopedic help. In situations where surgical care is required, a patient with knee arthrosis is referred to a special orthopedic and traumatology department.

How and how to treat knee arthrosis?

Currently known methods of treating patients with knee arthrosis are divided into non-drug conservative, medical, and surgical interventions.

Non-pharmacological methods

Many patients ask themselves, "How to treat knee arthrosis without pills? " In response, we regret to state that gonarthrosis is a chronic disease that is impossible to eliminate forever. However, many of the currently available non-drug (i. e. , drug-free) methods have the potential to significantly slow its progression and improve a patient’s quality of life, especially when used in the early stages of the disease.

With timely doctor visits and proper patient motivation, it is sometimes enough to eliminate negative factors for recovery. For example, reducing overweight has been shown to reduce the onset of major symptoms of the disease.

Elimination of abnormal physical activity, and on the contrary,physiotherapyreduce the intensity of pain by using rational physical programs. Practices to strengthen the quadriceps femoris have been shown to be comparable in effect to anti-inflammatory drugs.

If treating arthrosis of the knee joint is to be pursuedproper nutritionImproving the elastic properties of articular cartilage helps products containing large amounts of animal collagen (dietary meat and fish) and cartilage components (shrimp, crab, krill), fresh vegetables and fruits that are saturated with plant collagen and antioxidants, and smoked meats, marinades, preservatives, sweets and savory foods on the contrary, increase the disruption of the body's metabolic processes and the accumulation of excess weight to obesity.

When considering the most effective treatment for knee inflammation, it is worth remembering an effective treatment and prevention method such asorthoses: fixative knee pads, orthoses, elastic bandages and orthopedic insoles reduce and distribute the load on the joint correctly, thereby reducing the intensity of pain. The use of a walking stick is also recommended for effective relief of the knee joints. It should be in your hand against the affected limb.

Comprehensive treatment of knee arthrosis involves the appointment of highly effective, even in advanced forms of the diseasephysiotherapy. . . Widespread in different categories of patients with any degree of arthrosis, proven its effectivenessmagnetotherapy: after several procedures, the intensity of the pain decreases, the mobility of the joint increases due to the improved blood circulation, the reduction of edema and the cessation of muscle cramps. The effect of magnetic therapy is particularly pronounced with the development of active inflammation of the joint: the severity of the edema is significantly reduced, and the symptoms of synovitis regress. Physiotherapeutic methods such as e. g.laser therapyandcryotherapy(cold exposure), which have a pronounced analgesic effect.

Drug treatment

The following medications are used to effectively treat arthrosis of the knee joint.

Non-steroidal anti-inflammatory drugs (NSAIDs), in external (various gels, ointments) and systemic forms (tablets, suppositories, solutions), have long been shown to be effective in the treatment of osteoarthritis and are widely prescribed by physicians. By enzymatically inhibiting inflammation, they eliminate joint pain and swelling and slow the progression of the disease. In the early manifestations of the disease, topical application of these drugs in combination with non-pharmacological methods (therapeutic practices, magnetotherapy) is effective. But in advanced osteoarthritis of the knee joints, injections of tablets and sometimes NSAIDs are essential. It should be recalled that long-term systemic administration of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract, as well as adversely affect renal and hepatic function. Therefore, patients who regularly monitor laboratory performance of internal organs should also be prescribed medication to protect the gastric mucosa.

Glucocorticosteroids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. These are recommended if NSAIDs previously prescribed to the patient are unable to cope with the manifestations of inflammation. As a potent anti-inflammatory agent, GCS has certain contraindications in the treatment of arthrosis as they can cause a number of significant side effects. It is practically not prescribed for systemic forms with gonarthrosis. In general, effective treatment of arthrosis requires GCS injections into the periarticular pain points, which increase the intensity of the fight against inflammation and minimize the risk of unwanted side effects of the drug. This manipulation can be performed by a rheumatologist or traumatologist. 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 for up to 1 month. In accordance with national guidelines for the treatment of osteoarthritis, do not inject more than three times a year into 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, GCS, and non-medicated methods, it can be prescribedopioid analgesics. . . These drugs are used only on prescription, who always consider the correctness of their appointment.

Chondroprotectors(literally translated as "cartilage protector"). This name is considered to be a variety of drugs that are united by one property - a structure-modifying effect, i. e. the ability to slow down degenerative changes in cartilage and narrowing of the joint space. It is formulated for oral administration and delivery to a joint cavity. Of course, these drugs don’t work wonders and don’t "grow" new cartilage, but they can stop it from dying. In order to achieve a lasting effect, they should be used for a long time, with regular courses several times a year.

Surgical treatment of arthrosis of the knee joints

There are often cases where, despite appropriate complex treatment, the disease progresses and continuously reduces the quality of human life. In such situations, the patient begins to ask questions, "what to do if the prescribed medications do not help with knee arthrosis? " "Is surgical treatment indicated for knee inflammation? " In answering these questions, it should be clarified that surgical treatment of osteoarthritis of the kneepain syndrome and significant joint dysfunction that cannot be eliminated with complex conservative therapy, which is the last, fourth degree of the disease.

The most popular type of surgical care for third and fourth degree arthrosisendoprosthetics, i. e. , removing its own joint by simultaneously installing a replacement metal prosthesis that is similar in design to the anatomy of a human knee joint. In this case, the prerequisites for this type of surgical treatment are the lack of gross deformity of the joint, the formation of "false joints", muscle contractions and severe muscle atrophy. In case of severe osteoporosis (significant decrease in bone mineral density), endoprosthetics are also not indicated: "sugar" bone will not resist the introduction of metal pins and rapid absorption (absorption) of bone tissue begins at the site of installation, pathological fractures may occur. Therefore, a timely decision on the need to install an endoprosthesis seems so important - this should be made when the age and general condition of the human body still allows the operation to be performed. Long-term studies have shown that the duration of action of endoprosthetics in patients with advanced arthrosis, i. e. , the temporary duration of lack of significant motor limitations and maintenance of a decent quality of life, is approximately 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 surgery, the results of such surgeries are often unsatisfactory and the rate of complications is high. This is due to the design characteristics of the endoprostheses and the complexity of the surgical procedure itself (replacement of the hip joint is much easier from a technical point of view). This dictates the need for organ preservation operations (joint preservation). These include arthromedullary bypass surgery and corrective osteotomy.

Arthromedullaris bypass- connection of the medullary canal of the femur to the cavity of the knee joint by means of a shunt - hollow metal tube. This allows the fatty bone marrow from the lower third of the femur to enter the knee joint, nourish and lubricate the cartilage, thereby significantly reducing pain.

It is effective when changing the axis of the lower limb (but with a slight limitation of the range of motion)corrective osteotomy- by correcting the axis of the incision of the tibia and then fixing it with the plate and the screws in the desired position. At the same time, they achieve two goals - the normalization of biomechanics due to the restoration of the limb axis, and the 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 while medicine today can’t recommend a drug that gets rid of it forever, or other methods that can completely cure this disease, a healthy lifestyle, seeking medical help in a timely manner, and following a doctor’s recommendation can stop its progression.