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Osteoarthritis of the knee joint.

osteoarthritis of the knee joint on x-ray

Osteoarthritis of the knee joint is a specific disease that has a destructive effect on the cartilage of the knee joint.

When such a disease occurs, doctors observe serious disturbances in the blood circulation processes in the bone vessels, as a result of which deformation and destruction of cartilage tissue occurs, the person feels severe pain that limits any movement of the legs and knees, and observes swelling and changes in the appearance of the knees.

To prevent the development of serious consequences of gonarthrosis (deformation of the limb and ankylosis - immobilization of the joint), when only joint replacement surgery can help the patient, the disease should be identified and treated as early as possible.Also, do not treat it independently with folk methods and advertised remedies, but under the supervision of qualified doctors.

What are the reasons?

The mechanisms of osteoarthritis in medicine are usually divided into:

  • Primary- which occurs in old age due to the natural aging of body tissues and in the context of some factors that cause this disease, such as obesity (10% of cases), heredity and increased stress throughout life.
  • Secondary- accounts for 30% of all cases of osteoarthritis of the knee joint;It usually manifests itself after an injury, a fracture of the tibia, torn ligaments or damage to the meniscus.In addition, with such arthrosis of the knee joint, the symptoms of the disease in most cases appear after 3-4 years, but after a serious injury it is possible even after 2-3 months.

In 50-60% of cases, the cause of osteoarthritis of the knee joint is a spasm of the muscles of the anterior surface of the thigh.

What happens to the knee joint with osteoarthritis?

With excessive regular loads, genetic predisposition, metabolic disorders in the body, prolonged muscle spasms and injuries, the knee cartilage loses its softness and begins to thin.The smooth sliding of the articulated bones gives way to strong friction and the first degree of gonarthrosis develops, in which the cartilage loses its shock absorption properties.

The degradation process continues and poor shock absorption leads to flattening of bone surfaces with the formation of osteophytes in the form of bone growths.In this case, the disease already has a second degree and is accompanied by degeneration of the synovial membrane and the joint capsule.The lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the cartilage nutrition process is disturbed, which leads to even further deterioration of the patient's condition.

The thinning of the cartilage causes a reduction in the distance between the articulated bones by up to 80%.When walking, due to abnormal friction and the absence of a shock absorber, destructive processes in the joint increase rapidly, this quickly leads to the development of the third degree of osteoarthritis with pronounced symptoms:

  • Pain when moving, especially when going up or down stairs.
  • Pain both during exercise and at rest, morning stiffness.
  • The patient begins to limp, trying to save the painful joint.
  • Severe cases of the disease require the use of crutches or a cane.

The third degree of osteoarthritis of the knee joint is characterized by an almost complete absence of cartilaginous tissue, which leads to a decrease in joint mobility to a minimum.Therefore, no magic method, super medicine or ointment can restore the worn-out cartilage tissue, and given the degree of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.

Destruction of the knee joint due to osteoarthritis.

Stages of osteoarthritis

As osteoarthritis progresses, the following stages or degrees are distinguished:

  • The initial stage, or stage 1, is often called compensated, since there are no pronounced clinical signs of pathology yet.The patient may feel discomfort in the knees after physical activity, which disappears quickly after rest;The joints remain fully functional.
  • With grade 2, subcompensated osteoarthritis, the symptoms of the disease intensify.A pronounced pain syndrome is formed, which, however, is relieved by anesthetic ointments and gels used topically.Motor activity is altered and joint instability appears.In the vast majority of cases, patients go to doctors at this stage.
  • 3rd degree, decompensated, can also be called deforming.The knee joint is twisted, unstable, immobile and completely non-functional.The pain syndrome is constant and requires serious medical intervention.To unload the joint and move, a person needs a cane.

Symptoms and first signs.

Depending on the severity of the symptoms, the development of the disease is divided into 3 stages.Symptoms of early development of gonarthrosis vary greatly and are not specific.

At the first stage of pathology, the following signs are possible:

  1. knee pain when squatting or climbing stairs;
  2. joint pain after prolonged exercise or cooling down;
  3. the knee may hurt at the end of the day or in the morning;
  4. Stiffness and pain in the morning disappear after daily work.

Subsequently, the characteristic symptoms of stages 2 and 3 appear (in increasing order):

  • the pain becomes sharp and prolonged;
  • swelling in the joint area;
  • fluid may appear in the joint;
  • between the articular surfaces, it is possible to pinch particles of cartilage, menisci and synovial villi, as a result of which acute immobility occurs (it can also happen abruptly);
  • it is difficult to step on the foot;
  • Joint immobility develops.

Consequences

If left untreated, the following complications of knee osteoarthritis may develop:

  • Joint deformity.In fact, most likely, joint deformation is not a complication, but the last stage of the disease.
  • Infection in a joint.Infection usually occurs due to microtrauma.They can be considered small cracks in the cartilage tissue.Pathogenic microorganisms enter the joint through the flow of blood or lymph from other areas.This often occurs after infectious diseases.
  • Dislocations and fractures..These complications are explained by dysfunction of the knee joint.With osteoarthritis, there is no uniform distribution of the load from the femur to the bones of the lower leg.The ligaments that normally strengthen the joint also become weak.Because of this, at any given time (even during normal walking), the bones of the lower leg may be subject to excessive stress, resulting in a fracture or dislocation.To avoid this, people with severe structural and functional deficiencies in the knee joint must move with the help of a crutch or a cane.
  • Ankylosis.Ankylosis is the fusion of two bones where a joint once existed.This complication is perhaps the most serious, as the joint simply disappears.The tibia and femur gradually fuse and the tibia is fixed in one position.Of course, movement is impossible.

Diagnosis

To diagnose gonarthrosis use:

  • blood tests (general and biochemical);
  • radiography;
  • arthroscopy;
  • Ultrasound;
  • MRI.

The most important diagnostic method to confirm the diagnosis of gonarthrosis is x-ray.Although it is not possible to examine the initial stages of the disease and the state of the cartilage tissue using x-rays, the bone changes of stages 2 and 3 are clearly visible.This:

  1. narrow joint space;
  2. marginal spines located along the contour of the bones, the edges of the patella - osteophytes;
  3. changes in the periosteum;
  4. change in the height of one of the condyles and others.

However, the changes can be examined in more detail using arthroscopy.

Ultrasound and MRI help detect changes in the soft tissues of the knee joint during early osteoarthritis.These methods also provide a good indication of the status of the cartilage tissue, synovial membrane and fluid.

How to treat osteoarthritis?

Treatment for osteoarthritis of the knee joint is long and sometimes painful.The duration is because once the disease has manifested, it will be constantly remembered as long as the person lives.

Therefore, to properly treat gonarthrosis, discipline and a fairly solid financial foundation are required.An important role is played by the seriousness with which the patient takes the treatment, since often, in order to reduce the frequency of exacerbations of the disease, the patient is forced to change his daily activity, his favorite profession, develop his joints, give up smoking and drinking alcoholic beverages.

There are three main stages in the treatment of deforming osteoarthritis of the knee joint.

The first stage of treatment includes:

  • communicate to patients the essence of their disease, risk factors and secondary prevention measures;
  • daily gymnastics with stretching elements;
  • contrast shower;
  • swim in the pool 2 or 3 times a week;
  • weight loss.

The second stage of treatment includes:

  • external fixation of the joint using clamps, bandages, elastic bandages and orthoses;
  • the use of ointments and creams based on non-steroidal anti-inflammatory drugs to relieve inflammation and pain;
  • the use of drugs from the group of chondroprotectors to reduce the rate of cartilage destruction.

The third stage of treatment includes:

  • use of oral NSAID course;
  • intra-articular injections with hormonal anti-inflammatory drugs;
  • additional use of drugs with a pronounced analgesic effect;
  • Surgical replacement of a diseased joint with an implant.

Along with drug treatment, modern medicine uses methods such as:

  1. Kinesitherapy.In this case, the treatment of osteoarthritis of the knee joint is carried out using special exercises.The load is selected according to the degree of development of the disease and the physical condition of the patient individually.
  2. Ozone therapy.This is an effect on a sore knee joint using ozone.With this method of physiotherapy treatment, the substance can be administered by injection or used topically.
  3. dietary supplement.Biologically active supplements are a valuable alternative to other medications.
  4. Homeopathy.It involves taking medications in small doses.The course of treatment lasts only a few weeks, but during this time, provided the drugs are correctly selected, blood circulation and normal nutrition of the cells of cartilage tissue are completely restored.
  5. Ceremoniesallows you to improve blood circulation in the knee joint, restore the elasticity of the ligaments, improve the nutrition of cartilage tissue cells and promote their restoration.

Pharmacological treatment

All drugs used in the treatment of gonarthrosis can be divided into those that help eliminate the main symptoms of the disease and those that restore the function of the knee joint and prevent the progression of the pathology.The first type of drugs includes non-steroidal anti-inflammatory drugs and hormonal drugs.The second group includes chondroprotectors and hyaluronic acid.

Non-steroidal anti-inflammatory drugs

Pharmacological treatment of osteoarthritis begins with the elimination of pain.It is they who cause the greatest moral and physical suffering to patients and cause the loss of the ability to work.Nonsteroidal anti-inflammatory drugs (NSAIDs) have performed well among pain relievers.

Medications can be used in two ways: topically or orally (in tablets).Local treatments (preferred) usually include patches, ointments, or gels.The analgesic effect, as a rule, occurs between days 3 and 4, and its maximum develops between days 7 and 10.

The course of treatment with nonsteroidal medications should be limited to 10 to 14 days.NSAIDs have a limited range of use and are used with great caution in the treatment of elderly patients.

Hormonal drugs

In cases where NSAID treatment is not sufficient and the disease continues to progress, the doctor may prescribe hormonal injections.They belong to the "heavy artillery" means and help to quickly eliminate pain, relieve inflammation and swelling of the surrounding tissues.

Due to the large number of side effects, hormonal drugs are prescribed in short courses, only during the acute period of the disease, when inflammatory fluid accumulates in the joint cavity.The drug is administered into the joint space no more than once every 10 days.

Chondroprotectors

To prevent further destruction of the cartilaginous surfaces of the joint, chondroprotectors are prescribed.

These medications also help reduce pain and signs of inflammation in the surrounding soft tissues.In addition, chondroprotectors slow down the destruction of joint tissues and stabilize the disease thanks to their cushioning and lubricating functions.Chondroprotectors improve cartilage nutrition, normalize the composition and properties of intra-articular fluid, and protect pain receptors from excessive irritation.

hyaluronic acid

Hyaluronic acid is called intra-articular fluid fluid prosthesis.In its properties, it is similar to natural synovial (intra-articular) fluid, which nourishes cartilage tissue and cushions the knee joint during movements.

Hyaluronic acid preparations are injected into the joint, thereby creating a thin protective film that prevents the cartilage surfaces from rubbing against each other.Injections are performed only after the acute phase of the disease has passed.

Exercise therapy and exercises for osteoarthritis.

Physical exercise helps restore joint function and strengthen it.They must be performed slowly and carefully so as not to cause sprains and not exceed the allowable load.

The following exercises are considered the most effective:

  1. Slowly raise your straight legs one at a time while lying on your stomach.This exercise uses the thigh and calf muscles.The load must not be allowed to transfer rearwards.You should also not raise your legs too much.The main thing is to tense the muscles at the top point;
  2. This exercise is similar to the first, only now you must raise your leg with your knee bent.At the top point, the thigh muscles should be tightened even more.The exercise should be performed the same number of times on each leg;
  3. Lying on the floor (face down), raise your straight legs, then spread them apart and bring them together.This exercise requires strong, trained abdominal muscles, so it is not suitable for all patients.Additionally, doing so can increase blood pressure.For patients suffering from hypertension or other diseases of the cardiovascular system, it is better to avoid it;
  4. To perform the following exercise, you need to lie on your side, bend the leg that is on the floor at the knee, and slowly raise the other leg and hold it at the top point.It is important that the angle when performing the execution on each leg is the same;
  5. You will need a chair for this exercise.Sitting on it, the legs are straightened one by one, raised and held as long as possible in a stretched position;
  6. It is helpful to stand on tiptoe while holding the back of a chair or bed.As with other exercises, it is necessary to stay at the top point for a few seconds and also tense the leg muscles;
  7. The gentle movement from toe to heel allows you to activate blood circulation in the lower extremities.These movements must be performed alternately: while one leg rests on the ball of the foot, the other on the heel and vice versa.All movements must be smooth;
  8. Leaning on the back of a chair or bed, stand on your heels for a minute, lifting your toes.If you cannot stay in this position for the specified time, you should start with less, gradually increasing it;
  9. A massage that is performed in a standing position.The legs should be rubbed with vigorous movements directed from the knee to the thigh.It is necessary to complete the massage by stroking the skin.

The doctor will conduct several sessions in the office and will show basic techniques so that the patient can massage the problem knee on his or her own.Competent actions improve the condition of the damaged area.

Massage and self-massage

Perform self-massage with your palm, edge of your palm, fingertips, or fist.Act gently on the sore knee, maintain forceful pressure on the affected area: strong patting, hitting and active kneading of tissues often worsen the condition.

Basic techniques:

  • the first stage is light clockwise movements, the second stage is counterclockwise circular movements;
  • Press one palm on the sore knee, tap it lightly with the fingertips of the other hand;
  • maintain the initial position of the palm, hitting not with your fingers, but with the edge of the palm;
  • Gently stroke the knee in a circle, gradually increase the pressure (but in moderation);
  • During therapy, massage the affected area twice a day for 10 to 15 minutes.As a preventive measure, it is enough to perform a light massage once every 7 days.

Before the procedure, apply an ointment or gel with an anti-inflammatory effect to the sore knee.

Physiotherapeutic treatment

All physiotherapy methods can be divided into several groups:

  1. Reduce pain;
  2. Reduce inflammation;
  3. Restore joint nutrition and accelerate the restoration of joint function.

The doctor can determine what type of treatment the patient needs based on existing symptoms and concomitant diseases.

Surgery for osteoarthritis

Surgical treatment refers to radical methods that partially or completely restore the function of the knee joint.Surgical treatment methods differ from each other in the degree of intervention in the affected joint.

  1. Arthroscopyrefers to the gentlest methods of surgical treatment.This technique is less traumatic and can be used as a therapeutic measure even in the early stages of osteoarthritis.Its main objective is to extend the life of the damaged joint.Arthroscopy is performed using an endoscope, a flexible tube with a camera on the end.Small punctures are made in the knee joint, through which an endoscope and auxiliary instruments are inserted.During the operation, damaged areas of tissue that cause pain are removed.The operation is more suitable for young people and, if necessary, can be repeated several times.
  2. endoprosthesesIt refers to the most radical surgical techniques.In this case, complete restoration of joint function occurs by replacing the entire knee joint or part of it with an implant.This method is the best alternative to the previously existing technique: arthrodesis (complete immobilization of the damaged joint).Currently, stent replacement provides up to 90% positive results and significantly improves the quality of life of patients.
  3. osteotomyIt is used when significant deformities have developed in the joint and the function of the joint is noticeably affected.Osteotomy involves the creation of an artificial bone fracture in a previously planned location.The bone parts are then aligned in the correct physiological position and allowed to grow together.Sometimes during the operation, artificial fixators of bone fragments can be used, which contribute to a more stable position of the bone.

Folk remedies

Traditional medicine will also help you.Many patients have long practiced using various lotions to relieve swelling and pain.Here are some useful recipes:

  1. burdock leaves.Take 5 burdock leaves and place them over boiling water to steam them.Lubricate the sore knee with vegetable oil and apply steamed leaves.Wrap your leg in plastic wrap and a warm scarf.Leave the lotion on for a couple of hours.
  2. Cabbage leaf lotion.It is made with fresh cabbage leaves soaked in May honey and applied to the leg.The therapeutic effect is enhanced by insulation of woolen fabric or plastic film.This product is suitable for people of all ages.
  3. Egg shells, kefir.Grind the shells of 2 eggs and mix with 1 tablespoon of kefir.Apply the mixture to your knee, wrap it with a cloth and plastic wrap and lie down under a blanket.Leave it like this for a couple of hours, then rinse the composition with water.This treatment can be used daily.
  4. horseradish compress.According to this popular recipe, to enhance the medicinal properties of horseradish, it is recommended to first crush and boil it.Then it should be applied to the affected area.
  5. Turpentine– an excellent warming agent for sore joints.He rubs his knee with turpentine before going to bed and ties it with a woolen scarf.Already after the first procedure, the patient experiences significant relief.The course of treatment is selected individually for each person.

Diet

The therapeutic diet consists of avoiding or minimally consuming canned, smoked and fried foods (to suppress appetite).To restore damaged cartilage, it is necessary to provide the body with complex carbohydrates (porridges, whole grain products).Juices (carrot, beet, apple) should also be included in the diet.They will eliminate toxins from the body and reduce the impact of inflammatory processes.

The diet should include fish and gelatin, which act as a kind of chondroprotector and help create new cartilage.It is worth remembering that you cannot prescribe a diet yourself;only a nutritionist (dietitian) can choose the best option.

Sample menu:

  • Breakfast: oatmeal with water without butter or sugar, fruit juice, boiled egg;
  • Second breakfast: a glass of low-fat natural yogurt;
  • Lunch: steamed meat or fish, stewed vegetables, unsweetened tea;
  • Snack: cottage cheese casserole with walnuts, a glass of fruit juice;
  • Dinner: vegetable salad, apple, unsweetened tea;
  • Second dinner: a glass of skimmed kefir.

Prevention

Prevent joint diseases:

  • dose the load on your legs during active sports;
  • create a diet that includes foods and dishes containing calcium, magnesium and gelatin;
  • if the job involves lifting or moving heavy objects, follow safety rules and do not carry loads that exceed a certain limit;
  • Perform self-massage regularly to prevent osteoarthritis, especially with constant tension in the legs;
  • eat right, limit "harmful" foods;
  • body weight control (excess weight means additional stress on the joints);
  • Get regular exams and treat acute and chronic illnesses.

Forecast

Provided that osteoarthritis of the knee joint is diagnosed in the early stages, the cause of the pathological process is eliminated and adequate treatment is provided, the prognosis is favorable.The therapy provided allows for long-term remission, but treatment is usually lifelong.

In the absence of the necessary treatment, as well as when the patient does not follow the doctor's instructions, osteoarthritis of the knee joint becomes a cause of disability.