One of the most common pathologies of the musculoskeletal system is osteoarthritis of the knee joint (aka gonarthrosis) - a chronic disease accompanied by degeneration and destruction of the joint structures of the knee.
The result of destructive processes is a strong limitation or complete loss of joint mobility and, as a result, a decrease in performance, disability.
Adverse consequences can only be avoided with early diagnosis and prompt treatment.
Osteoarthritis of the knee is of primary and secondary origin. Primary develops as an independent disease, is more often diagnosed in the elderly and, in this case, is due to age-related tissue changes. Secondary knee osteoarthritis becomes a consequence of other diseases and disorders of the body.
The development of knee osteoarthritis is favored by:
- injuries (dislocations, fractures, meniscal injuries);
- diseases of the musculoskeletal system (congenital deformity of the legs, knee dysplasia, chondrocalcinosis, arthritis, osteoporosis);
- constant high loads on the joint caused by professional activity, professional sport;
- overweight, obese;
- endocrine diseases, including diabetes mellitus, hypothyroidism, acromegaly;
- metabolic disorders;
- genetic predisposition.
Inflammation of osteoarthritis of the knee is accompanied by two main clinical manifestations: pain and edema. The intensity and frequency of occurrence of the pain syndrome depends on the depth of damage to the structures of the joint. At the initial stage, the pain is felt only on exertion, quickly passes to rest. With advanced knee osteoarthritis, aching pain is constantly present, intensifies during movement, when the weather changes.
Other signs of osteoarthritis of the knee:
- crunch while moving;
- joint stiffness, impaired motor function;
- knee deformity (with advanced knee osteoarthritis).
Knee osteoarthritis may be accompanied by synovitis (accumulation of fluid in the joint cavity) and subsequent formation of a Baker's cyst (elastic formation at the back of the knee).
Degree of osteoarthritis
The symptoms of osteoarthritis of the knee joint differ depending on the depth of damage to the structures of the knee, and therefore there are 3 stages of pathology.
- Osteoarthritis of the knee joint of the 1st degreeis manifested by a slight pain on exertion (passes immediately at rest), a slight stiffness after sleep. The x-ray image shows an insignificant narrowing of the joint space (less than a third), the presence of single osteophytes (bone growths).
- Osteoarthritis of the knee joint of the 2nd degreeis accompanied by a pain syndrome and a characteristic tightening during movement. The pain remains at rest for a while. Morning stiffness, limitation in range of motion is noted. Diagnostic procedures reveal a pronounced narrowing of the joint space (more than half) and several osteophytes.
- Grade 3 osteoarthritis of the kneeis accompanied by constant pain, which increases with movement and at night. Morning stiffness persists for more than an hour with exacerbation of inflammation and at least half an hour during periods of remission. Joint mobility is severely limited or completely lost. The x-ray image shows several large osteophytes, cysts. The joint gap is reduced by more than two-thirds of the norm.
Depending on the degree of osteoarthritis of the knee joint, the patient is prescribed conservative or surgical treatment.
Diagnosis of osteoarthritis of the knee joint includes visual examination, analysis of patient complaints, laboratory results (urinalysis, general and biochemical blood tests) and methods ofinstrumental examination.
The following diagnostic procedures allow you to confirm or deny the diagnosis:
- ultrasound (ultrasound);
- MRI (magnetic resonance imaging);
- CT (computed tomography);
- arthroscopy and scintigraphy (if a tumor is suspected).
Thanks to these methods, it is possible to identify the narrowing of the joint space, the degree of thinning and deformation of the cartilage, the presence of fluid in the joint cavity, structural changes in the synovium, theproliferation of osteophytes and foci of cartilage ossification.
Conservative treatment methods can reduce pain and inflammation, improve blood circulation and nutrition of periarticular tissues, and strengthen the muscle system.
For this purpose, the following actions are performed:
- drug treatment
- physiotherapy and manual therapy;
- physiotherapy exercises.
Adherence to a therapeutic regimen is also an important part of the treatment of osteoarthritis.
Conservative treatment of osteoarthritis of the knee joint will be effective at the initial stage of the disease, with minor degenerative changes in the cartilage, inflammation and dysfunction of the synovial membrane.
Medication includes an appointment:
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- hyaluronic acid.
Nonsteroidal anti-inflammatory drugs help relieve inflammation and reduce its main symptoms - swelling and pain.
Preparations are prescribed in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration). Capsules and tablets for osteoarthritis of the knee joint of the NSAID group are taken as a short course, since the drugs have a strong irritant effect on the gastric mucosa and can provoke the development of peptic ulcer, havelots of other side effects.
In addition, external drugs (ointments, gels, creams) based on non-steroidal anti-inflammatory components are prescribed. Local therapy is allowed for a longer period.
NSAIDs have a pronounced anti-inflammatory effect, but with prolonged use they contribute to further destruction of cartilage.
NSAIDs are symptomatic drugs. They help to eliminate the unpleasant symptoms of the disease, but do not affect the condition of the cartilage. Unlike these agents, chondroprotectors and hyaluronic acid accelerate the regeneration of cartilage tissue and slow down its destruction.
Preparations of the chondroprotective group contain chondroitin and glucosamine (structural elements of cartilage) and help restore the knee in cases of osteoarthritis of the knee joint. They are available in the form of tablets, powder for oral administration, solution for injection.
The minimum duration of taking pills and powder is 3 months. After a break, the course is repeated 2-3 more times. Treatment with the solution includes 12-15 injections, repeated 2-3 times a year.
The first positive results of treatment with chondroprotectors are not noticeable until a few months after the start of treatment.
Hyaluronic acid is injected into the affected joint. The medicine for osteoarthritis of the knee joint acts as a lubricant - it envelops the joint surfaces, thereby reducing the friction between them.
Therapy with hyaluronic acid preparations increases the elasticity of cartilage tissue, prevents further destruction of joint structures, thereby improving the mobility of the joint, reducing symptoms of inflammation. The drugs are well tolerated and do not cause side effects. Their only drawback is their high cost.
Treatment with hyaluronic acid usually consists of 3-4 injections, which are given at intervals of 10 to 14 days.
If nonsteroidal anti-inflammatory drugs fail to relieve knee pain in osteoarthritis, a blockage is performed - a method of treatment in which drugs are injected directly into the affected tissues to relieve thepain and inflammation. In the treatment of osteoarthritis, joint blockage (injections into the joint cavity) and periarticular (into the periarticular cavity) is used.
The main advantage of the method is an instant targeted action, because with such an introduction the maximum concentration of the active substance is created precisely in the area of inflammation. In addition, drugs do not enter the systemic circulation, which significantly reduces the risk of side effects.
In the later stages of knee osteoarthritis, the joint space narrows, osteophytes develop, the joint surfaces are deformed, therefore, only periarticular blockages are allowed.
Knee block in osteoarthritis can be done with anesthetics and corticosteroids.
Anesthetics are usually given in combination with steroid hormones to reduce the pain of the procedure.
Hyaluronic acid and chondroprotectors can also be injected directly into the joint. But in this case, we are not talking about blockage, but intra-articular injection, because these drugs do not block pain impulses, but trigger the processes of regeneration of cartilage tissue.
Physiotherapy and manual therapy
The main physiotherapy methods used in the treatment of osteoarthritis are:
- laser treatment
- ; ultrasound therapy
- ; cryotherapy
- paraffin and ozokerite therapy; Mud therapy
The main task of all physiotherapeutic procedures is to stimulate blood circulation to nearby tissues, improve the nutrition of cartilage.
Pain syndrome causes a patient with knee osteoarthritis to limit physical activity, resulting in atrophy of nearby ligaments and muscles. This condition negatively affects joint tissue, as it is during movement that nutrients enter from the synovial fluid into the cartilage. If the joint is constantly at rest, dystrophic processes are aggravated.
That is why physiotherapy exercises are an integral part of conservative therapy. Moderate physical activity allows you to strengthen the muscular system, improve the nutrition of joint structures, eliminate stiffness and improve motor function of the knee.
Exercises of restorative gymnastics are developed by the doctor individually for each patient, taking into account the depth of the lesion and the functional state of the joint structures.
General recommendations for exercise therapy for osteoarthritis of the knee joint:
- do not begin training until signs of acute inflammation have relieved;
- perform all exercises smoothly, without sudden movements;
- increase the load gradually;
- excludes high loads on the joint (increased flexion / extension of the knee);
- Stop training if you experience pain or discomfort.
In knee osteoarthritis, the patient's diet should include foods containing:
- amino acids (dairy products, lean meats);
- collagen (dishes with added gelatin);
- essential fatty acids (vegetable oils, fish);
- sulfur and selenium (legumes, grains, cabbage and apples, beef, chicken, eggs).
- exclude the use of smoked meats, pickles, marinades;
- limit salt intake;
- stick to a fivefold diet;
- observe the drinking regime.
Being overweight is one of the main factors in the development of osteoarthritis of the knee joint. Therefore, the task of overweight patients is to reduce their body weight. In this case, the result can only be achieved with the help of a diet, since intense sports are harmful to the inflamed joint.
To reduce body weight, it is recommended to exclude from the menu:
- fatty meat and fish;
- cream, homemade sour cream and other high fat dairy products;
- margarine, mayonnaise, various sauces;
- confectionery; fast food
- sugary drinks.
Grade 3 osteoarthritis of the knee joint does not lend itself to conservative treatment, so the only outcome for the patient is surgery.
There are two surgical options:
- corrective osteotomy- performed at the initial stage of development of stage 3 of knee osteoarthritis, if the cartilage tissue is partially destroyed, it is possible to remove osteophytes;
- endoprostheses- replacement of a joint or its destroyed parts is carried out with complete destruction of the cartilage.
Pathological changes in the structures of the joint are gradual, irreversible. However, with early diagnosis and proper treatment, it is possible to completely stop the inflammation and stop dystrophic changes in cartilage tissue - osteoarthritis of the knee joint of the 1st degree lends itself well to treatmentconservative.
In the case of 2nd degree osteoarthritis, which is accompanied by the destruction of cartilage and the formation of osteophytes, conservative techniques make it possible to slow down or suspend the deformation of the cartilage, to stop the inflammation andimprove motor activity. However, doctors are often forced to resort to blockages and arthroscopy.
It is impossible to cure grade 3 osteoarthritis of the knee conservatively. Surgery is the only way to restore mobility to the knee.