Osteoarthritis is a joint pathology that is accompanied by damage to the cartilage tissue. Synonyms for osteoarthritis are gonarthrosis, deforming osteoarthritis, arthrosis - all these terms denote the development of degenerative processes in the cartilage covering the epiphyses of the articulated bones.
Despite the fact that the lesion only affects the cartilaginous structures, all joint elements are affected: the capsule, the synovial membrane, the subchondral bones, as well as the ligaments and muscles surrounding the joint. Osteoarthritis can affect one or more joints.
The most common localized forms of the disease have their own name: arthrosis of the hip is called coxarthrosis, arthrosis of the knee joint is called gonarthrosis.
Ranking and reasons
Knee osteoarthritis can be primary or secondary. The first group includes pathologies whose cause has not been established, that is, they are idiopathic. Secondary osteoarthritis occurs after injury, due to congenital anomalies and against the background of systemic diseases.
Here are the causes of osteoarthritis of the knee joint:
- autoimmune pathologies – rheumatoid arthritis, lupus erythematosus, scleroderma, etc. ;
- joint inflammation caused by a specific infection (syphilis, gonorrhea, encephalitis);
- hereditary diseases of the musculoskeletal system and joints, type 2 collagen mutations.
There are also a number of factors that negatively affect the joints and can cause pathological changes in them:
- old age, overweight, osteoporosis;
- hormonal changes, including decreased estrogen synthesis during the postmenopausal period in women;
- metabolic disease;
- deficiency of microelements and vitamins in the diet;
- congenital and acquired malformations of the skeletal bones;
- hypothermia and poisoning by toxic compounds;
- constant injury to the joint during sports training or hard work;
- operations on the knee joint - for example, to remove the meniscus.
Symptoms and stages
Deforming osteoarthritis of the knee joint is characterized by intracellular changes at the morphological, molecular, biochemical and biomechanical levels. The consequence of the pathological process is softening, fibering and reduction in thickness of the articular cartilage. In addition, the surfaces of the bones forming the joints become denser and bone spines - osteophytes - appear on them.
DOA of the knee joints develops in 3 stages and in the early stages may manifest only minor pain and discomfort after prolonged physical activity. Sometimes one of the characteristic symptoms of osteoarthritis appears: morning stiffness. At this stage, changes occur in the synovial membrane and in the composition of the intra-articular fluid.
As a result, the cartilage tissue does not receive enough nutrients and its ability to resist pressure begins to decline. Therefore, with intense exercise and long walking, pain occurs.
In the second stage of osteoarthritis, the destruction of cartilage tissue progresses and part of the increased load is borne by the articular surfaces of the bones. Since there is not enough supporting surface, the edges of the bones increase due to osteophytes. The pain no longer disappears at rest like before and even bothers me at night.
The timing of morning stiffness also increases and it takes a long time to "work" the leg so that you can walk normally. In addition, when the limb is bent, crunches and clicks are heard, accompanied by sharp pain. It is not always possible to completely bend the leg, it seems stuck, and further attempts end with a sharp crunch and pain.
Due to the appearance of pain during any movement, a person tends to move less, which negatively affects the muscles surrounding the joint. A change in the size of the epiphyses of the bones leads to displacement of the axis of the limb and the development of deformity. The joint capsule becomes stiffer as the volume of fluid it contains decreases. When osteophytes compress the surrounding soft tissues, synovitis and chronic inflammation occur.
When moving to the 3rd stage, the signs of osteoarthritis of the knee joint become very severe - the pain does not disappear even at night, motor skills practically stop, the leg seems twisted and does not bend. Third degree osteoarthritis is characterized by an X- or O-shaped deformity, making movement extremely difficult. An advanced form of deforming gonarthrosis can only be treated surgically.
Diagnostic
Diagnosis of osteoarthritis of the knee joint is not particularly difficult: a doctor can assume gonarthrosis based on existing symptoms and characteristic visual signs. To confirm the diagnosis, x-rays are taken. The images will show narrowing of the joint space, bony growths and subchondral osteosclerosis of the bones.
X-rays are used to determine the cause of the disease. Bone deformities are particularly visible in post-traumatic osteoarthritis. If cartilage degeneration is caused by arthritis, defects along the edges of the bones are detected, as well as periarticular osteoporosis and atrophy of bone structures. With various congenital anomalies, distortion of the axis of one of the bones is observed, which led to poor distribution of the load and the appearance of secondary osteoporosis.
Treatment
Treatment of gonarthrosis of the knee joint has 3 main goals: restoration of cartilaginous tissue, improvement of joint mobility and slowing down the progression of the disease. Great emphasis is placed on eliminating or weakening symptoms, thereby reducing the intensity of pain and inflammation. To solve these problems, medications, physiotherapy and exercise therapy are used. To achieve the maximum effect of therapy, dosed physical activity and compliance with the orthopedic regime are necessary.
Drug treatment of knee osteoarthritis includes taking painkillers and anti-inflammatories, as well as chondroprotectors that promote the regeneration of cartilage tissue. Medicines can be prescribed in the form of injections, tablets, ointments and gels.
If first degree osteoarthritis of the knee is diagnosed, physiotherapeutic methods, physiotherapy and massage are used in the treatment. The early stages of the disease are much easier to treat and you can expect a full recovery. An important condition is to lose weight in order to reduce the load on the painful joint.
Treatment of knee osteoarthritis of the second stage necessarily includes exercise therapy, wearing orthopedic devices and following a diet. To relieve pain, nonsteroidal anti-inflammatory drugs, chondroprotectors and intra-articular injection of hyaluronic acid are prescribed.
Acute osteoarthritis is characterized by intense pain, for which classic NSAIDs are not sufficient. In this case, strong painkillers and injection of glucocorticosteroids into the joint cavity are used.
If conservative methods are ineffective, an operation is performed, which can be either corrective or radical (replacement of a joint with a prosthesis).
Deforming osteoarthritis of the knee joint of the third stage is characterized by the complete absence of the interarticular space, replaced by a bony structure. This condition requires surgical intervention, since other methods are powerless in this case.
NSAIDs and corticosteroids
To save patients from physical and mental suffering, treatment of acute osteoarthritis begins with pain relief. Drugs that are part of the NSAID group and can be used in tablet form or topically have proven themselves well.
The analgesic effect does not always occur immediately, but after two or three days it reaches its peak and the pain disappears. The duration of treatment with NSAIDs is limited to two weeks, since longer use increases the risk of side effects. Particular caution should be exercised by people with gastrointestinal problems, as well as those suffering from high blood pressure.
If there are no results, hormonal drugs are prescribed to relieve inflammation. In the case of left-sided gonarthrosis, drugs are injected into the left knee, from the right side - into the right.
Hormonal injections can be given once every 10 days, not more often. The indication for such treatment is a significant accumulation of fluid in the joint due to inflammation. As the symptoms subside, they move on to medication in pill form.
Chondroprotectors and hyaluronic acid
Chondroprotective agents act in three directions: they restore damaged cartilage tissue, reduce pain and eliminate inflammatory reactions. Taking chondroprotectors allows you to normalize the composition and properties of synovial fluid, nourish the cartilage and protect pain receptors from irritation.
As a result, the destruction of cartilage structures and, as a result, the progression of the disease slows down. After a course of medication, the shock-absorbing and lubricating function of the joint is restored.
In the early stages of the disease, chondroprotectors can be used in the form of an ointment or gel. However, intra-articular injections are the most effective. Modern methods of treating osteoarthritis include the use of combined agents containing not only chondroprotective substances, but also anti-inflammatory components and vitamins.
Hyaluronic acid is the main component of synovial fluid, responsible for its viscosity and consistency. It is actually a biological lubricant that gives cartilage elasticity, elasticity and strength.
With the development of joint pathologies, the volume of hyaluronic acid can decrease by 2-4 times, which necessarily leads to excessive friction of the bones. With intra-articular hyaluron injection, knee function is normalized and the person can move normally.
Surgery
Surgery is a radical method by which the functionality of the joint is partially or completely restored. The degree of intervention may be different and depends on the stage of osteoarthritis. The most gentle operation is arthroscopy - the rehabilitation period after its implementation is the least painful for the patient.
Important:arthroscopy can be performed not only for treatment purposes, but also to diagnose joint pathology. This procedure makes it possible to identify damage inaccessible to other studies.
The goal of arthroscopy is to extend the life of the joint by removing dead and damaged tissue from the joint cavity. As a result, pain disappears, resistance to stress increases, and motor activity returns.
In cases of significant deformities, an osteotomy is indicated, creating an artificial bone fracture in a specific area. Knee osteotomy literally means "cutting the bones": during the operation, the surgeon removes a wedge-shaped segment of the femur or tibia, then brings the bones together in the most physiological position. If necessary, the resulting gap is filled with a bone graft. During the healing period, the structure is secured with special clamps.
Endoprosthesis replacement is an alternative method to the outdated arthrodesis procedure, the essence of which is the partial or complete replacement of a diseased joint with a prosthesis. Thus, knee function is completely restored in more than 90% of cases, considerably improving patients' quality of life.
Physiotherapy
Physiotherapeutic procedures play an important role in the treatment of osteoarthritis, due to their beneficial effect on damaged joints. A course of physiotherapy accelerates regeneration processes, eliminates pain and muscle spasms. Additionally, some procedures allow for the administration of medications through the skin, thereby reducing the dosage of oral medications.
For damaged joints, the following techniques are recommended:
- magnetic therapy;
- medium-wave ultraviolet (WUV);
- infrared laser;
- Ultra-high frequency;
- ultrasound;
- modulated diadem and sinusoidal currents (amplipulse therapy);
- Darsonval.
Effective procedures for osteoarthritis are also therapeutic baths - radon, hydrogen sulfide, bischofite, minerals and sage. They have an anti-inflammatory, analgesic and restorative effect on the joints.
Finally
If you suspect knee osteoarthritis, you should consult an orthopedist or traumatologist who diagnoses and treats these pathologies. In order not to aggravate the disease, it is necessary to avoid excessive physical activity on the legs and get rid of excess weight.
There is no special diet for osteoarthritis, but it is recommended to avoid concentrated meat and fish broths, fatty meats and smoked meats, and also reduce the consumption of table salt. The diet should be dominated by foods rich in vitamins, minerals and vegetable oils. Additionally, once a week it is advisable to organize a fasting day - kefir, cottage cheese or fruits and vegetables.
To strengthen the muscular corset of the lower extremities and increase blood flow, it is necessary to regularly perform therapeutic exercises, selected individually by a physiotherapy instructor.
So, taking medications, physical interventions, a balanced diet and physical exercise are what will definitely help a patient suffering from osteoarthritis. And to avoid traumatic surgery, you need to consult a doctor as soon as possible. To be in a good health!