The disease begins with changes in the articular cartilage, causing the articular surfaces of the bones to slip.Malnutrition and loss of elasticity lead to its degeneration and resorption, the bone tissue of the joint surfaces is exposed, the ability to slide is impaired, the joint space narrows and the biomechanics of the joint change.The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) becomes irritated, leading to an increase in its amount in the joint (synovitis).Against the background of the narrowing of the joint space, the joint volume decreases, the synovial fluid protrudes from the posterior wall of the joint capsule and a Becker cyst is formed (which, if it reaches a large size, can cause pain in the popliteal fossa).
The thin and delicate tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.The periarticular bone tissue grows and osteophytes (pathological bone growths) form.The blood flow to the periarticular tissue is disturbed, under-oxidized metabolic products accumulate there, which irritate chemoreceptors and a persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, dysfunction of the surrounding muscles occurs, hypotrophy and spasms occur, and gait is disrupted.There is a persistent restriction of movement in the joint (contracture), sometimes so severe that only rocking movements (stiffness) or complete immobility (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the entire world population, and over 60 years old it affects every third person.
Causes of gonarthrosis
- Injuries to bones and joints.
- Inflammatory joint diseases (rheumatism, gout).
- Disturbances of mineral metabolism in various endocrinopathies (diabetes mellitus, parathyroid diseases, hemochromatosis).
- Muscular diseases and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which include, among others:
- Excess weight (literally puts pressure on the lower limbs);
- age (older people in particular are affected by the disease);
- female gender (statistically speaking, women get sick more often);
- increased sport and occupational physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases when walking and decreases at rest.
- Difficulty with habitual, physiological movements in the joints.
- A characteristic “crunch” in the joints.
- Enlargement of the 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, a person only feels a slight discomfort or “feeling of heaviness” in the knee, which is annoying when walking long distances or during increased physical activity.An X-ray examination is not very informative: only a slight narrowing of the joint space can be detected, otherwise no changes occur.At the beginning of the disease, a person does not turn to specialists and does not attach great importance to the symptoms that appear.
- The second stage is characterized by noticeable pain, the intensity of which decreases with rest.Difficulty moving in the joints occurs and a characteristic “creaking” sound is heard when walking (a common phrase is heard from the patient in everyday life: “knee creaking”).The x-ray shows clearly visible narrowing of the joint space and isolated osteophytes.
- When the gonarthrosis moves to the next, third stage, the patient is constantly tormented by pain, even at rest, and there is a disruption in the joint configuration, i.e.h.to a deformation aggravated by swelling at the time of inflammation.Radiographs show moderate joint space narrowing and multiple osteophytes.In the third stage, many people seek medical help because... the quality of life is significantly impaired due to pain and difficulty walking normally.
- The fourth stage is accompanied by unabated, debilitating pain.Minimal attempts at movement become a severe torture for people, deformations of the joints are visually noticeable and walking is extremely difficult.X-rays show significant changes: the joint space is practically not defined in the images, several coarse osteophytes, “joint mice” (fragments of decaying bones that fall into the joint cavity) are visible.This stage of gonarthrosis is almost always accompanied by disability: often the disease leads to complete fusion of the joint, its instability and the formation of a “false joint”.
Who treats osteoarthritis of the knee joint?
The patient can be guaranteed qualified medical care for gonarthrosis by a therapist, rheumatologist and general practitioner (family doctor), but these specialists treat the knee joint in uncomplicated osteoarthritis.If synovitis occurs or the treatment prescribed by the therapist does not bring the desired effect, you cannot do without the help of an orthopedist.In situations where surgical care is required, the patient is referred to a specialized department of 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 non-drug conservative, drug and surgical methods.
Non-drug methods
Many patients ask the question: “How to cure arthrosis of the knee joint without pills?”When answering this question, we unfortunately have to realize that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many currently existing non-pharmacological methods to combat 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.If you see 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.
Abstaining from pathological physical activity and, on the contrary, performing therapeutic exercises with rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have comparable effects to anti-inflammatory medications.
When treating arthrosis of the knee joint, we need to strive for proper nutrition: products containing large amounts of animal collagen and chondroitin (shrimp, crab, krill), fresh vegetables and fruits rich in vegetable collagen and antioxidants help to improve the elastic properties of the articular cartilage, and the passion for smoked meats, marinades, preservatives and sweet and salty dishes, on the contrary, increases metabolic disorders in thebody and the accumulation of overweight and obesity.
When thinking about what is the most effective treatment for knee arthrosis, one should remember such an effective method of treatment and prevention as orthosis: fixing knee pads, orthoses, elastic bandages and orthopedic insoles reduce and correctly distribute the load on the joint, thereby reducing the intensity of pain in the joint.
The comprehensive treatment of arthrosis of the knee joint also includes the appointment of very effective physical interventions, even in advanced forms of the disease.With widespread use in various categories of patients suffering from this disease, magnetic therapy has proven to be effective: after just a few procedures, the intensity of pain decreases, as a result of improved blood circulation, reduction of swelling and elimination of muscle spasms, joint mobility increases.The effect of magnetic field therapy is especially pronounced when active inflammation develops in the joint: the severity of the edema decreases significantly and the symptoms of synovitis resolve.Not so popular, but no less effective in the treatment of the knee joint with arthrosis, are methods of physiotherapy such as laser therapy and cryotherapy (exposure to cold), which have a pronounced pain-relieving effect.
Drug treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), available in forms for external (various gels, ointments) and systemic use (tablets, suppositories, solutions), have long proven their effectiveness in the treatment of arthrosis and are widely prescribed by doctors.By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling and slow disease progression.In early manifestations of the disease, local use of these drugs in combination with non-drug methods is effective.But if you have advanced osteoarthritis of the knee joints, you can't do without pills.It must be remembered that prolonged systemic use of NSAIDs can lead to the development and exacerbation of ulcerative processes in the gastrointestinal tract, and, in addition, can negatively affect kidney and liver function.Therefore, patients taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor laboratory parameters of the functioning of internal organs.
In advanced, "advanced" arthrosis, when a person experiences unbearable pain that does not subside even at rest, disrupts normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, it is possible to prescribe opioid painkillers.These medications are only used with a doctor's prescription, who examines the advisability of prescribing them in each individual case.
Chondroprotectors (literally translated as “protective cartilage”).This name covers a variety of medicines that have one common property: a structure-changing effect, i.e.h.the ability to slow down degenerative cartilage changes and narrowing of the joint space.They are produced both in forms for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these drugs do not work miracles and do not allow new cartilage to grow, but they can stop its destruction.In order to achieve a lasting effect, they must be used over a longer period of time, in regular courses several times a year.
Surgical treatment of arthrosis of the knee joints
It often happens that the disease progresses despite adequate and comprehensive treatment and increasingly limits the quality of life of those affected.In such situations, the patient begins to ask questions: “What to do if the prescribed medications do not help with arthrosis of the knee joint?”, “Is surgical treatment for knee arthrosis indicated?”, “How is arthrosis of the knee joint treated surgically?”When answering these questions, it should be clarified that the indications for surgical treatment of arthrosis of the knee joints are persistent pain syndrome and significant dysfunction of the joint, which cannot be corrected by the use of complex conservative therapy.
The most popular type of surgical treatment of gonarthrosis is endoprosthetics, i.e. the removal of one's own joint with the immediate installation of a metal prosthesis that replaces it and whose structure is similar to the anatomy of the human knee joint.At the same time, a prerequisite for carrying out such surgical treatment is the absence of gross joint deformities, formed “false joints”, muscle contractures and pronounced muscle atrophy.
In cases of severe osteoporosis (significant decrease in bone mineral density), endoprosthetics is also not indicated: the “sugar” bone does not withstand the insertion of metal pins, and rapid resorption of bone tissue begins at the installation site, and pathological fractures can occur.That is why a timely decision about the need to install an endoprosthesis seems so important - it should be made when the age and general condition of the human body still allow the operation to be carried out.According to the results of long-term studies, the duration of the effect of endoprosthetics, i.e. the temporary period of absence of significant motor restrictions and the maintenance of an adequate quality of life, is approximately ten years.The best results of surgical treatment are observed in people aged 45 to 75 years 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 such 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 procedure itself (hip joint replacement is technically much simpler).These include artromedullary bypass surgery and corrective osteotomy.The arthromedullary shunt is a connection between the medullary canal of the femur and the cavity of the knee joint via a shunt - a hollow metal tube.As a result, fatty bone marrow from the lower third of the femur enters the knee joint, nourishes and lubricates the cartilage, providing significant pain relief.
If the axis of the lower extremity changes (but under the condition of a slight limitation of the range of motion), a 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 by restoring the limb axis and activation of blood circulation and metabolism during bone fusion.And although medicine today is not able to offer a drug that will eliminate the disease forever or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following doctor's recommendations can stop its progression.