Any type of osteoarthritis occurs with degenerative and dystrophic processes in the joint tissue. The disease always acquires a chronic character and is not completely cured, its progress can only be slowed or stopped.
According to the ICD-10, gonarthrosis (damage to the knee joints) belongs to the code group "M17". The emphasis in treatment is on drug therapy, surgical intervention is used only when the course is advanced.
What happens to the knee joint with osteoarthritis?
Osteoarthritis of the knee joint is accompanied by degenerative and dystrophic processes that, if left untreated, progress steadily. In this case, inflammatory processes are not observed, except for rare cases.
Degeneration and dystrophy of the joint initially has practically no effect on the functionality of the knee. Over time, these processes lead to a violation of the structure of the joint, it stops "sliding", bumps appear on its surface (due to deformational changes).
Blood circulation decreases, local metabolism (metabolic processes) worsens, which only increases the rate of disease progression. The process of degeneration of the hyaline cartilage begins very quickly, its thinning, stratification and subsequently the appearance of cracks in it.
The end result of the disease is the complete destruction (destruction) of the hyaline cartilage with exposure of the adjacent bone. But the problem does not end there: due to the exposure of the bone, the latter begins to thicken and bony growths appear on it (often in the form of spines).
All this also leads to deformation of the affected limb, followed by its curvature. It is for this reason that the disease is also called "deforming osteoarthritis". With an existing limb deformity, the disease cannot be cured without surgery.
The reasons for the development of the disease
Most often, the development of knee osteoarthritis is preceded by the appearance of various predisposing factors. It is not at all necessary to have congenital risk factors, the disease very often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Serious disorders of metabolic / metabolic processes in the body (any acute or chronic serious disease of the thyroid gland, adrenal glands).
- Circulatory disorders and presence of a tendency to capillary bleeding (due to its fragility).
- Overweight (obesity stage II-III) with a significant increase in the load on the musculoskeletal system as a whole.
- Injury to the knee joints (including direct injuries, penetrating wounds, tears of the ligamentous apparatus, injuries to the menisci, fractures, dislocations and subluxations, cracks).
- Inflammatory pathologies suffered in the recent past (mainly arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, people who play tennis, soccer, basketball).
- The aftermath of a long-term and poorly treated knee injury.
- Congenital defects and abnormalities in the structure of joint tissues, hereditary risk factors (genetic mutations).
There is a direct connection between the cause and the severity of osteoarthritis. If the cause is metabolic disorders or severe injuries, the prognosis is worse than in the case of the development of osteoarthritis in the context of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, osteoarthritis of the knee joint is very common; occupies one of the leading places among all forms of osteoarthritis in general. Approximately 20% of patients applying to specialized medical institutions suffer from gonarthrosis.
If we consider all diseases of the knee joints, among them, the proportion of osteoarthritis falls in about 53% of cases. Recently, there has been an increase in the number of cases of knee osteoarthritis among the population, especially in developed countries.
This is related to an increase in average life expectancy (the older a person is, the greater the risk of this form of osteoarthritis) and to the prevalence of a sedentary lifestyle. And this is really a problem, since doctors are not yet able to completely cure gonarthrosis.
Why is knee osteoarthritis dangerous?
The main danger of knee osteoarthritis is disability due to the development of complications that are not amenable to conservative treatment. First, it is a deformation of the joint and bone of the affected limb. Disability is already possible in the third stage of the disease.
The second danger is the development of severe chronic pain, which can be so disturbing to the patient that they will not be able to sleep normally. Constant awakening due to knee pain is one of the most common problems of stage 3-4 of knee osteoarthritis.
There are no lethal consequences precisely due to knee osteoarthritis. In theory, a serious injury could occur due to a sudden jamming of the joint. This is the so-called joint blockage symptom, which is most often observed in 3-4 stages of the disease.
The degree of knee osteoarthritis and the difference between them.
The disease is divided into four stages, which differ in the severity of the course, the severity and the number of symptoms and the final prognosis. Furthermore, each stage of osteoarthritis is treated in a special way (although the differences in treatment regimens may seem small to a non-physician).
The degree of knee osteoarthritis:
- first degree - the disease practically does not manifest itself in any way, only slight discomfort is possible, but in general the patient feels fine, and therefore it is very troublesome to diagnose the disease at the first stage;
- second degree - severe painful sensations appear, especially after a long walk or standing; a characteristic crunch develops during physical activity, the process of atrophy of the quadriceps femoris muscle can already begin;
- third degree - the pains become unbearable, constantly bother the patient, pronounced deforming changes appear in the joint, it becomes warm to the touch, it is impossible to walk normally or even run further;
- fourth degree - it is very difficult with severe deformities of the joint and constant pain that does not even allow the patient to sleep; joint dysfunctions are so pronounced that ankylosis (complete immobilization of the affected joint) is possible.
The first two degrees of gonarthrosis are considered conditionally favorable, since they practically do not interfere with the normal life of a person. The last two stages are very serious and lead to disability.
Symptoms of gonarthrosis in different stages.
The clinical picture of knee osteoarthritis depends on the stage of the disease. In the first stage, there may be no symptoms, while in the fourth stage they are very pronounced and do not cease to bother the patient even under powerful drug therapy.
Stage 1 symptoms:
- Mild discomfort or pain with strong stress on the joint.
- Barely perceptible creak.
- Subtle increase in joint size.
Stage 2 symptoms:
- pain of moderate intensity, which usually occurs with a period of exacerbations and remissions;
- the joint becomes warm to the touch;
- possible redness of the skin over the affected joint;
- moderate dysfunctions of the knee (it is still possible to walk and run, but with some difficulty);
- increased pain in the morning and after prolonged standing.
Stage 3 symptoms:
- severe pains that bother the patient throughout the day, but during periods of exacerbation (triggers of exacerbation for each patient), the pain intensifies several times;
- visible deforming changes in the knee, its increase in size;
- the affected joint becomes warm on palpation;
- normal movement is impossible due to partial immobilization of the joint;
- possibly curvature of the lower leg.
Stage 4 symptoms:
- the pains become unbearable, they do not allow the patient to do everyday things (including intellectual ones, since pain affects cognitive functions);
- the appearance of synovitis due to the accumulation of effusion in the cartilage cavity of the knee;
- now deformational changes are already clearly visible not only in the joint, but also in the limb as a whole;
- a feeling of fluctuation on palpation of the patella and surrounding tissues;
- almost complete or even complete immobilization of the knee joint (in this case, only surgery will help restore the functionality of the limb).
If it is not possible to eliminate or significantly reduce pain in the 3-4 stages of osteoarthritis, doctors resort to analgesic blockades, but blockades cannot be performed on a daily basis.
Diagnostics
The emphasis in the diagnosis of osteoarthritis of the knee is on imaging techniques, while laboratory tests usually show nothing.
Diagnostic methods used:
- Examination by an orthopedist with palpation of the affected joint, linear measurements of bones, angiometry.
- Clinical blood tests (total and erythrocyte sedimentation / ESR), determination of fibrinogen levels in blood and urine and, above all, urea, as well as other biochemical parameters.
- X-ray (reveals joint space narrowing, deformities, cartilage sclerosis, accumulation of salts, and even bone osteophytes).
- Ultrasound examination (for differential diagnosis only).
- Magnetic resonance imaging or computed tomography (the most informative diagnostic methods, in terms of imaging).
An X-ray is usually sufficient to make a diagnosis, especially if the disease is in an advanced stage. In relatively rare cases, magnetic resonance imaging or computerized imaging is required.
Treatment of gonarthrosis: methods.
Treatment of knee osteoarthritis is only complex, since no treatment method is isolated from others with good effect (even drugs). The treatment is long, it can last for years, sometimes it is even prescribed for the rest of your life.
Treatment methods used:
- drug therapy - the basis of treatment;
- physical therapy exercises;
- diet therapy;
- physiotherapy treatment;
- Surgical intervention.
The main thing in the treatment of arthrosis is the systematic nature of the process and unconditional compliance with the recommendations of the attending physician. Attempts to treat knee osteoarthritis independently, even ignoring the doctor's prescription, usually end in disability.
Exercise therapy
Physiotherapy exercises are best suited for the treatment of 1-2 stages of osteoarthritis of the knee joints. At such stages, this is almost the main method of treatment, since physical education can slow down the progression of the disease and eliminate most of the symptoms.
However, classical physical education does not have a special meaning, it can also be harmful. Therefore, the patient is prescribed special exercises and individually (since gonarthrosis may proceed differently in individual patients).
There is no time frame for treatment with exercise therapy methods; Ideally, you should participate in prescribed exercises for life, occasionally visiting a doctor for dynamic joint control. It is very useful to combine exercise therapy with exercises in the pool (there the load on the joints is much less).
Diet
Although nutritional correction can be very helpful, it is not a mandatory treatment method. Only in 40% of cases, diet therapy gives remarkable results, and generally in those people in whom the onset of osteoarthritis was caused by endocrine pathologies.
The patient is instructed to stop consuming fatty, fried, salty, and smoked foods. A ban on the use of alcoholic beverages is introduced, sometimes tobacco smoking is also prohibited. At the same time, the consumption of large amounts of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or sausages can not be called meat products. The patient is instructed to consume lean meats, boiled chicken is especially useful (due to the relatively low calorie content and high protein content).
Physiotherapy
Physiotherapy procedures are useful only in terms of relieving the symptoms of osteoarthritis, but they do not directly affect the disease. That is, it is impossible to cure even the first stage of osteoarthritis with the help of physiotherapy, no matter what some "specialists" say there.
Physical therapy is good for pain relief, but only if it is mild. With severe pain (stage 3-4 of arthrosis), physical therapy will not help, as will most drugs (especially for oral use).
The most preferred for the treatment of osteoarthritis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Shock physiotherapy techniques are prohibited due to the threat of further joint damage.
Operation
Surgical intervention is required only in 3-4 stages of the disease, when conservative methods are no longer necessary. Different types of procedures can be used: drainage of the joint cavity, removal of bone osteophytes, replacement (prosthesis) of the joint.
To restore the functionality of the joint, it is best to transplant it, but the problem is that it is a very expensive procedure. As a result, only 10-15% of patients can afford such an operation. But even with the required amount of money, it is not always possible to replace the joint.
The fact is that such a procedure is contraindicated in patients in serious condition or in patients older than 65-70 years. Keep in mind that any knee surgery has its own risks of complications (even lethal complications are possible, but they are very rare).
Medicine
Together with physiotherapy exercises they are the basis of treatment and its mandatory component. If other procedures cannot yet be used, then it is impossible to do without drug therapy in conjunction with exercise therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed painkillers (with severe pain - blockage), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, hyaluronic acid injections (which replace the physiological lubrication of the joints) are possible.
Medications can really affect the disease only in stages 1-2 of osteoarthritis. In the 3-4 stages of the disease, drug therapy plays only the role of one way to treat symptoms, while nothing more than an operation can affect the disease.
The nuances of treatment in the stage of exacerbation and in remission.
The approaches to treating osteoarthritis of the knee during exacerbation and remission are somewhat different. At the stage of exacerbation, aggressive therapy is used, aimed at the fastest possible restoration of joint function and the elimination of symptoms.
Pain reaches its peak precisely at the stage of exacerbation of the disease, therefore, in such cases, drug blocks can be prescribed.
Nonsteroidal anti-inflammatory drugs may be prescribed. Although osteoarthritis usually develops without inflammation, it can occur in the acute stage. The patient is prescribed bed rest, minimal stress on the affected joint, and avoiding overheating of the limb.
On the contrary, in the remission stage, physical exercises are prescribed, and generally an increase in physical activity is prescribed. The reason is that it is in the remission stage that normal gait is possible, since it improves joint function and the pain is usually of moderate intensity.
It is necessary to use remission skillfully - this is the period when classes in swimming pools, classes with a rehabilitation therapist, and attempts to restore the functionality of the joint are possible. You cannot do without medication at this stage.
Most often, chondroprotectors, oral analgesics are prescribed (at the discretion of the patient, since if the pain is barely noticeable, it is not necessary to take them). Ointments, gels and creams may be prescribed, including those with a warming effect (which are better not to use during an exacerbation).
Also, massage may be prescribed, including manual therapy (only if the disease is in stages 1-2). With the doctor's permission, special gymnastic techniques may be used.
Remission is the ideal time for physical therapy, but the choice of specific physical therapy should be managed by the physician, not the patient. At the end, if necessary, during remission, injections of hyaluronic acid preparations can be given.
With an exacerbation of arthrosis, hyaluronic acid is not prescribed, since against the background of inflammation, such injections will have serious consequences. Please note: injections should only be administered by a suitably qualified person.
Ordinary doctors, and even more so mid-level medical personnel (paramedics, nurses), cannot perform such injections. Self-injections into the joint are fraught not only with disability, but also with death (due to the threat of anaphylactic shock or a blood clot if the needle accidentally enters the vessel).
Treatment prognosis
The prognosis for the treatment of knee osteoarthritis differs depending on the stage of the disease and the general health of the patient. If this is stage 1-2 and treatment is started immediately, the prognosis is very good, especially in people of working age.
With stage 3-4 osteoarthritis, the prognosis is extremely poor, both in young patients and in older people. Although it has been observed that young people tolerate osteoarthritis much more easily in these stages, it still inevitably leads to disability.
However, having stage 3-4 osteoarthritis does not amount to a sentence. In fact, with the help of a surgical intervention, you can try to restore, if not all the functionality of the knee, most of it. Implantation of an artificial joint can give an excellent result.
Prevention of osteoarthritis of the knee joint.
Osteoarthritis is a group of diseases that can be completely prevented by following fairly simple preventive measures. Of course, such measures do not guarantee 100% protection, but they can reduce the risks of disease (especially in people at risk).
Precautionary measures:
- It is necessary to avoid unnecessary stress on the joints (such loads include professional sports).
- Rational nutrition, with a predominance of fruits and vegetables in the daily diet.
- Maintain a good physical shape, regular gymnastics.
- Prevention or elimination of obesity (more body mass, more stress on the body's joints).
- Preventive treatment with chondroprotectors from 45 years of age (only after medical consultation).
- Adequate daily fluid intake (approximately 1. 5 liters of water per day), minimizing salt intake.
The main thing is not to overdo it with physical activity, as it is useful only in moderation (if there is no wear and tear on the musculoskeletal system). Physical education is useful, sports are not, especially for the joints and cardiovascular system.