The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slip.Malnutrition and loss of elasticity lead to its degeneration and resorption, while the bone tissue of the joint surfaces is exposed, sliding is impaired, the joint space narrows and the biomechanics of the joint changes.The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and serves as a physiological lubricant) is irritated, which leads to an increase in its quantity in the joint (synovitis).Against the background of narrowing of the joint space, the volume of the joint decreases, synovial fluid protrudes from the back wall of the joint capsule and a Becker cyst is formed (which, when reaching large sizes, can cause pain in the popliteal fossa).
The thin, delicate tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed.Blood circulation in the periarticular tissues is disrupted, underoxidized metabolic products, irritating chemoreceptors accumulate in them, and a persistent pain syndrome develops.Against the background of changes in the anatomy of the joint, disruption of the functioning of the surrounding muscles occurs, hypotrophy and spasm appear, and the gait is disrupted.A persistent limitation of the range of motion of the joint appears (contracture), sometimes so pronounced that only oscillating movements are possible (stiffness) or a complete lack of movement (ankylosis).
Gonarthrosis is a fairly common disease: it affects 10% of the entire population of the planet, and over the age of 60 it affects one in three people.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes mellitus, parathyroid diseases, hemochromatosis).
- Diseases of the muscular system and neuropathies (Charcot's disease).
In addition to the main reasons, there are also unfavorable underlying factors for the development of gonarthrosis, which include:
- excess weight (literally puts pressure on the lower limbs);
- age (especially elderly people are affected by the disease);
- female gender (statistically women get sick more often);
- increase in sporting and professional physical activity.
Symptoms of arthrosis of the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulty in habitual and physiological movements of the joints.
- A characteristic “creaking” of the joints.
- Increase in the size 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 feels only a slight sensation of discomfort or "heaviness" in the knee, which bothers when walking long distances or increasing physical activity.The x-ray examination will not be informative: only a slight narrowing of the joint space can be detected, there will be no other changes.At the beginning of the disease, a person does not turn to specialists, without attaching much importance to the symptoms that appear.
- The second phase is characterized by noticeable pain, the severity of which decreases with rest.Difficulty in movement of the joints appears, and when walking a characteristic "creak" is heard (from the patient you can hear a common phrase in everyday life: "knees creak").Radiographs reveal clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis passes to the next third stage, pain constantly bothers the patient, even at rest, and a disorder occurs in the configuration of the joints, that is, a deformation, aggravated by swelling at the time of inflammation.Radiographs show moderate joint space narrowing and numerous osteophytes.In the third stage, many people already seek medical help, because... the quality of life worsens significantly due to pain and difficulty walking normally.
- The fourth stage is accompanied by incessant and debilitating pain.Minimal attempts at movement become a difficult test for a person, deformation of the joints is visually noticeable, and walking is extremely difficult.X-ray reveals significant changes: the joint space is practically not defined in the images, more coarse osteophytes, "joint mice" (fragments of deteriorated bone falling into the joint cavity) are revealed.This stage of gonarthrosis almost always involves a disability: often the outcome of the disease is the complete fusion of the joint, its instability and the formation of a "false joint".
Who treats arthrosis of the knee joint?
Qualified medical care for gonarthrosis can be provided to the patient by a therapist, a rheumatologist and a general practitioner (family doctor), but these specialists treat the knee joint with uncomplicated arthrosis.When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, one cannot do without the help of an orthopedist.In situations where surgical assistance is required, the patient is sent to a specialized orthopedics and traumatology department.
How and with what to treat arthrosis of the knee joint?
The currently known methods of treating arthrosis of the knee joint are divided into non-medicinal conservative, medicinal and surgical.
Non-pharmacological methods
Many patients ask the question: "How to cure arthrosis of the knee joint without pills?"Answering this question, we regret to say that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many of the non-pharmacological methods currently existing to combat this disease can significantly slow its progression and improve the patient's quality of life, especially if used in the early stages of the disease.If a doctor is consulted promptly and the patient is sufficiently motivated to recover, sometimes it is sufficient to eliminate the negative factors.For example, it has been proven that losing excess weight reduces the manifestation of the main symptoms of the disease.
The elimination of pathological physical activity and, on the contrary, performing therapeutic exercises using rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have effects comparable to anti-inflammatory drugs.
If we are treating arthrosis of the knee joint, then we must strive for proper nutrition: products containing large amounts of animal collagen and chondroitin (shrimps, crabs, krill), fresh vegetables and fruits rich in plant collagen and antioxidants will help improve the elastic properties of articular cartilage, and the passion for smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, enhances metabolic disorders in the body and the accumulation of overweight upto obesity.
When thinking about what is the most effective treatment for knee arthrosis, it is worth remembering such an effective treatment and preventive method as orthotics: fixing knee braces, orthoses, elastic bandages and orthopedic insoles reduces and correctly distributes the load on the joint, thereby reducing the intensity of pain.
Comprehensive treatment of arthrosis of the knee joint also involves the appointment of very effective physical procedures, even in advanced forms of the disease.Widely used in different categories of patients suffering from this disease, magnetic therapy has proven its effectiveness: after a few procedures, the intensity of pain decreases, as a result of improving blood circulation, reducing swelling and eliminating muscle spasm, joint mobility increases.The effect of magnetic therapy is especially pronounced when active inflammation develops in the joint: the severity of the edema decreases significantly and the symptoms of synovitis regress.Not so popular, but no less effective in the treatment of the knee joint with arthrosis, are physiotherapy methods such as laser therapy and cryotherapy (cold exposure), which have a pronounced analgesic effect.
Pharmacological treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs), available in forms for external use (various gels, ointments) and systemic use (tablets, suppositories, solutions), have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling and slow the progression of the disease.For early manifestations of the disease, topical use of these drugs in combination with non-medicinal methods is effective.But with advanced arthrosis of the knee joints, you cannot do without pills.It should be remembered that prolonged systemic use of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, negatively affect the function of the kidneys and liver.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 case of advanced, "advanced" arthrosis, when a person feels unbearable pain that does not decrease even at rest, interrupts normal sleep and is not relieved by NSAIDs, corticosteroids and non-drug methods, opioid painkillers can be prescribed.These drugs are used only upon prescription from the doctor, who evaluates the opportunity to prescribe them in each specific case.
Chondroprotectors (literally translated as “cartilage protectors”).This name refers to various drugs that have one property in common: the structure-modifying effect, i.e. the ability to slow down the degenerative changes of the cartilage and the 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 "grow" new cartilage, but they can stop its destruction.To achieve a lasting effect, they must be used for a long time, in regular cycles several times a year.
Surgical treatment of arthrosis of the knee joints
There are often cases when, despite adequate comprehensive treatment, the disease progresses, constantly reducing the quality of a person's life.In such situations, the patient begins to ask questions: "what to do if the prescribed drugs do not help with arthrosis of the knee joint?", "Is surgical treatment indicated for arthrosis of the knee?", "How is arthrosis of the knee joint treated surgically?"When answering these questions, it is necessary to clarify that the indications for surgical treatment of arthrosis of the knee joints are intractable pain syndrome and significant dysfunction of the joint, which cannot be eliminated with the use of complex conservative therapy.
The most common type of surgery for gonarthrosis is the endoprosthesis, i.e. the removal of one's joint with the immediate installation of a metal prosthesis that replaces it, the structure of which is similar to the anatomy of the human knee joint.At the same time, a prerequisite for carrying out this type of surgical treatment is the absence of gross deformities of the joint, formation of “false joints”, muscle contractures and pronounced muscle atrophy.
In case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthesis is also not indicated: the “sugar” bone will not resist the introduction of metal pins, and at the site of their installation, rapid resorption of bone tissue will begin and pathological fractures may occur.Therefore, a timely decision on the need to install an endoprosthesis seems so important: it should be made when the age and general condition of the human body still allows the operation to be performed.According to the results of long-term studies, the duration of the effect of the endoprosthesis, that is, the temporary duration of the absence of significant motor limitations and maintenance of a decent 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 construction features of the endoprosthesis and the complexity of the surgical intervention itself (hip replacement is much simpler in technical terms).These include arthromedullary bypass surgery and corrective osteotomy.The arthromedullary shunt is a connection of the medullary canal of the femur with the cavity of the knee joint using a shunt, a hollow metal tube.Thanks to this, the fatty bone marrow of the lower third of the femur enters the knee joint, nourishing the cartilage and lubricating it, thus achieving a significant reduction in pain.
When the axis of the lower limb changes (but under the condition of a slight limitation of the amplitude of movements), corrective osteotomy is effective: intersection of the tibia with correction of its axis, followed by fixation with plate and screws in the desired position.In this case, two goals are achieved: the normalization of biomechanics due to the restoration of the limb axis, as well as the activation of blood circulation and metabolism during bone fusion.And although today medicine is not able to offer a drug that will eliminate it forever, or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and compliance with the doctor's recommendations can stop its progression.