One of the most common pathologies of the musculoskeletal system is the osteoarthritis of the knee joint (otherwise gonartrosis) is a chronic disease, accompanied by dystrophy and the destruction of the knee joint structures.
The result of destructive processes is an acute restriction or a complete loss of joint mobility and, as a result, a decrease in performance, disability.
It is possible to prevent adverse consequences only if you are diagnosed early and therapy in time.
Reasons
By origin, knee osteoarthritis is primary and secondary.It develops primary as an independent disease, it is more frequently diagnosed in older people, and in this case it is due to changes related to the age that occur in the tissues.Secondary gonarrosis becomes the result of other diseases and body disorders.
The development of gonarrosis contributes to:
- lesions (dislocations, fractures, meniscus damage);
- Musculoskeletic system diseases (congenital legs of the legs, knee dysplasia, chondrocalcinosis, arthritis, osteoporosis);
- High constant loads in the articulation due to professional activities, professional sports;
- overweight, obesity;
- Endocrine diseases, which include diabetes, hypothyroidism, acromigalia;
- metabolic disorders;
- Genetic predisposition.
Symptoms
The inflammation with osteoarthritis of the knee joint is accompanied by two main clinical manifestations: pain and edema.The intensity and frequency of the appearance of pain depends on the depth of damage to the joint structures.In the initial stage, the pain feels alone with a load, it goes quickly at rest.With advanced gonarrosis, painful pain is constantly present, intensifies during movements, with a change in climate.
Other signs of osteoarthritis of the knee joint:
- Crunch when moves;
- stiffness in the joint, violation of the motor function;
- Knee deformation (with careless gonarrosis).
Gonarrosis can be accompanied by a synovitis (accumulation of liquid in the joint cavity) and the subsequent formation of a bakery cyst (elastic formation on the back of the knee).
Degree of osteoarthritis
The symptoms of the osteoarthritis of the knee joint differ depending on the depth of the damage to the knee structures and, therefore, the 3 stages of the pathology are distinguished.
- Osteoarthritis of the knee joint 1 gradeIt is manifested by weak pain in loads (at rest it happens at the same time), with a slight rigidity after sleep.In the radiographic image, there is an insignificant narrowing of the articular gap (less than one third), the presence of individual osteophytes (superior bone) is observed.
- Knee joint osteoarthritis 2 degreesIt is accompanied by characteristic pain and crunch during the movements.The pain persists for some time at rest.Morning rigidity, restriction of the amplitude of the movements is observed.Diagnostic procedures reveal pronounced narrowing of the articular gap (more than half) and multiple osteophytes.
- Knee osteoarthritis 3 degreesIt is accompanied by constant painful pain, which, during the movements and at night, intensifies.The stiffness of the morning remains more than an hour with an exacerbation of inflammation and at least half an hour, during the remission periods.The mobility of the joint is very limited or completely lost.In the radiographic image, multiple large osteophytes are seen, the cysts are visible.The joint gap is reduced by more than two thirds of the standard.
Depending on the degree of osteoarthritis of the knee joint, the patient is prescribed conservative or surgical treatment.
Diagnosis
The diagnosis of osteoarthritis of the knee joint includes visual exam, analysis of patient complaints, laboratory tests (urine analysis, general blood and biochemical analysis) and instrumental exam methods.
The following diagnostic procedures allow you to confirm or refute the diagnosis:
- radiography;
- Ultrasound (ultrasound);
- MRI (magnetic resonance image);
- CT (computerized tomography);
- Arthroscopy and scamma (with suspicion of a tumor).
Using these methods, it is possible to detect the narrowing of the articular gap, the degree of thinning and deformation of the cartilage, the presence of liquid in the joint cavity, structural changes in the synovial membrane, the growth of osteofitis and the foci of the cartilage ossification.
Conservative treatment
Conservative treatment methods can reduce pain and inflammation, improve blood circulation and drizzle nutrition, strengthen the muscle device.
For this purpose, they are carried out:
- Pharmacological therapy;
- blockade;
- Physiotherapy and manual therapy;
- Medical Physical Education.
An important component of the treatment of osteoarthritis is the observance of a therapeutic diet.
The conservative treatment of the osteoarthritis of the knee joint will be effective in the initial stage of the disease, when lower distribution cartridges of cartilage, inflammation and deteriorated functions of the synovial cover are observed.
Drugs
Drug treatment includes the appointment:
- Non -steroidal anti -inflammatory drugs (NSAIDs);
- condoprotectors;
- Hyaluronic acid.
Aoño
Non -steroidal anti -inflammatory medications help relieve inflammation, reduce their main symptoms: edema and pain.
Preparations are prescribed in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration).The capsules and tables of the osteoarthritis of the knee joint of the NSAID group are taken in short courses, since drugs have a strong irritating effect on the gastric mucosa and can cause the development of peptic ulcers, they have many other side effects.
In addition, prescription external medications (ointments, gels, creams) based on non -steroidal anti -inflammatory components.Local therapy is allowed for longer.
NSAIDs have a proclaimed anti -inflammatory effect, but with prolonged use they contribute to the additional destruction of the cartilage.
NSAIDs are symptomatic therapy.They help eliminate unpleasant symptoms of the disease, but do not affect the condition of the cartilage.Unlike these products, condoprotectors and hyaluronic acid accelerate the regeneration of the cartilage tissue and slow down their destruction.
Condroprotectors
The medications of the group of condoprotectors contain chondroitin and glucosamine (structural cartilage elements) and help restore knee with osteoarthritis from the knee joint.They are available in tablets, dust for oral administration, a solution for injection.
The minimum course of taking tablets and dust is 3 months.After a break, the course is repeated 2-3 times.The course of treatment with a solution includes 12-15 injections, is repeated 2-3 times a year.
The first positive results of condoprotective treatment are notable only a few months after the start of therapy.
Hyaluronic acid
Hyaluronic acid is introduced injected into the affected joint.The cure for the osteoarthritis of the knee joint performs the role of lubrication: wraps the articular surfaces, thus reducing friction between them.
Hyaluronic acid therapy drugs help increase the elasticity of cartilage tissue, avoid the additional destruction of joint structures, which improves the mobility of the joint, inflammation symptoms are reduced.Medications are well tolerated, they do not cause side effects.Its only inconvenience is the high cost.
The course of hyaluronic acid treatment generally includes 3-4 injections, which are carried out with 10-14 days breaks.
Blockade
If with non -steroid anti -inflammatory medications, it is not possible to relieve knee pain with osteoarthritis, a blockage is performed, a treatment method in which medications are injecting directly into affected tissues to relieve pain and inflammation.In osteoarthritis therapy, an articular block is used (injections in the joint cavity) and periarticular (in the periarticular cavity).
The main advantage of the method is an instant action with purpose, since with such introduction the maximum concentration of the active substance is created precisely in the inflammation zone.In addition, medications do not fall into the systemic blood torrent, which significantly reduces the risk of adverse reactions.
In the posterior stages of gonarrosis, the narrow articular gap, the growing osteophytes culture, the articular surfaces are deforms, therefore, only perirticular block is allowed.
The block lock of the knee for osteoarthritis can be carried out using anesthetic and corticosteroids.
Anesthetics are generally introduced in combination with steroid hormones to reduce the pain of the procedure.
Hyaluronic acid and condoprotectors can also be introduced directly into the joint.But in this case, we are not talking about blocking, but of intra -articular injection, since these medications do not block pain impulses, but trigger the processes of regeneration of the cartilage tissue.
Physiotherapy and manual therapy
The main methods of physiotherapeutic effects that are used in the treatment of osteoarthritis include:
- laser treatment;
- ultrasound therapy;
- cryotherapy;
- therapy with paraffin and ozokerita;
- Mud.
The main task of all physiotherapeutic procedures is to stimulate blood circulation in nearby tissues, improve cartilage nutrition.
Exercise therapy
Pain syndrome forces a patient with gonarrosis to limit motor activity, as a result of which ligaments and nearby muscles.This condition negatively affects joint tissues, since it is during the movement that nutrients penetrate from the synovial fluid to the cartilage.If the articulation is constantly at rest, the distribution processes are aggravated.
That is why physiotherapy exercises are an integral component of conservative therapy.Moderate physical activity allows you to strengthen the muscle apparatus, improve the power of articular structures, eliminate rigidity and improve the motor function of the knee.
The doctor develops the therapeutic exercises for each patient, taking into account the depth of the injury and the functional status of the articular structures.
General recommendations to perform exercise therapy for the osteoarthritis of the knee joint:
- Start classes only after stopping the signs of acute inflammation;
- Perform all exercises gently, without sudden movements;
- The load increases gradually;
- eliminate high loads on the joint (improved flexion/extension of the knee);
- If pain or discomfort appears, stop training.
Diet
With gonarrosis, products containing: which contain:
- amino acids (dairy products, varieties of low fat);
- collagen (gelatin dishes);
- irreplaceable fatty acids (vegetable oils, fish);
- Sulphides and selenium (legumes, cereals, cabbage and apples, beef, chicken, eggs).
It is also important:
- Eliminate the use of smoked meats, pickles, marinates;
- limit salt consumption;
- adhere to a diet 5 times;
- Observe the mode of alcohol consumption.
Excess body weight is one of the main factors that cause the development of the osteoarthritis of the knee joint.Therefore, the task of excess weight patients is a decrease in body weight.In this case, you can achieve the result only with the help of a diet, since intensive sports are harmful to the inflamed joint.
To reduce body weight, it is recommended to exclude from the menu:
- Fat varieties of meat and fish;
- cream, homemade sour cream and other dairy products with a high percentage of fat content;
- Margarina, mayonnaise, several sauces;
- confectionery;
- Fast food;
- Sweet drinks.
Surgical treatment
The osteoarthritis of the third grade knee joint is not susceptible to conservative therapy, so the operation is the only output for the patient.
There are two options for surgical intervention:
- Corrective osteotomy- It is carried out in the initial stage of development of the third stage of gonarrosis, if the cartilage is partially destroyed, it is possible to eliminate osteophytes;
- Endoprotetics- The replacement of the joint or its destroyed parts is carried out with the complete destruction of the cartilage.
Forecast
Pathological changes in joint structures are progressive, irreversible.However, with early diagnosis and proper treatment, it can completely stop inflammation and stop the distribution changes in cartilage tissue: the osteoarthritis of the first grade knee joint lends itself well to conservative therapy.
With the osteoarthritis of the second grade, which is accompanied by the destruction of the cartilage and the formation of osteophytes, the conservative methods allow it to reduce speed or suspend the deformation of the cartilage, stop inflammation and improve motor activity.However, doctors are often forced to resort to blocking, arthroscopy.
It is impossible to cure the osteoarthritis of the knee joint of 3 degrees conservatively.The only way to restore knee mobility is surgical intervention.