Deforming osteoarthritis of the knee joints (known as knee joint or abbreviated DOA)- degenerative-dystrophic disease of the knee joint, which is characterized by chronic, steadily progressive course, damage to all structural elements (vitreous cartilage, periarticular bone structures, synovial membrane, capsule and joint ligaments) and leads to articular deformity, reduced deformityand often disability.
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 dystrophy and absorption, while the bone tissue of the articular surfaces is exposed, the slippage is disturbed, the gaps of the articular knee narrow, the industrial of the joint changes. The synovial membrane that aligns the joint and produces synovial fluid (which nourishes the cartilage and plays the role of normal lubricant) is irritated, which leads to an increase in its amount in the joint (arthritis). Against the background of narrowing of the joint space, the volume of the joint decreases, the synovial fluid protrudes into the posterior wall of the joint capsule and a Becker cyst forms (which, reaching large sizes, can cause pain in the joint cavity). thin tissue of the joint capsule is replaced by thick connective tissue, the shape of the joint changes. The periarticular bone tissue develops, osteophytes are formed (abnormal bone growths). Blood circulation to the periarticular tissues is disrupted, oxidized metabolic products that irritate the receptors accumulate in them and persistent pain syndrome develops. As part of the changes in the anatomy of the joint, there is a violation of the surrounding muscles, there is a scholarship and spasm and gait is disturbed. There is a persistent limitation of range of motion in the joint (contraction), sometimes so severe that only rocking movements (stiffness) or complete absence of movements (anchoring) are possible.
Regarding arthritis of the knee joint, we can say that it is a fairly common disease: it affects 10% of the total population of the planet and over 60 years, it affects every third person.
Causes of gonarthritis
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
- Violation of metal metabolism in various endocrine diseases (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Diseases of the muscular apparatus and neuropathy (Charcot's disease).
In addition to the main reasons, there are also unfavorable key factors for the development of gonarthritis, which include:
- overweight (literally puts pressure on the lower extremities).
- age (mainly the elderly are prone to the disease).
- female gender (according to statistics, women get sick more often).
- increased exercise and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases at rest.
- Difficulty in normal, normal movements in the joints.
- The characteristic "stinging" in the joints.
- Enlargement of the joints and visible deformity.
Stages of gonarthritis
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There are several stages of arthritis:
- In the first stage, a person experiences only symptoms such as.little inconvenienceor "heaviness" in the knee, annoying when walking long distances or exercising. X-ray examination will be of minimal information: only a small narrowing of the joint space can be detected, there will be no other changes. At the beginning of the defeat of arthritis of the knee joint, a person does not turn to specialists, without paying much attention to the symptoms that have appeared.
- For the second stage of arthritis of the knee joint,tangible pain, the severity of which decreases at rest. There is difficulty moving the joints, when you walk, you hear a characteristic "squeak" (from the patient you can hear a common phrase in everyday life - "knees creak"). During the X-ray, a clearly visible narrowing of the joint space and individual osteophytes are observed.
- With the transition of gonarthritis to the next, third stage,the symptoms of pain will constantly bother the patient, including calm, there is a violation of the formation of the joints, i. e. deformity, aggravated by swelling at the time of inclusion of inflammation. On radiographs, a moderate stenosis of the joint space and multiple osteophytes are identified. In the third stage, many are already seeking medical help, because the quality of life is significantly affected by pain and difficulty walking normally.
- The fourth stage of knee joint arthropathy is accompanied bypain lime, exhausting. . . Minimal movement effort becomes a difficult test for a person, joint deformity is visually noticeable, walking is extremely difficult. X-rays reveal significant changes: the joint space is virtually undetectable in the images, revealing multiple gross osteophytes, "joint mice" (fragments of collapsing bone falling into the joint cavity). This stage of gonarthritis almost always involves disability: often the result of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who treats knee joint arthritis?
Special medical care for knee arthritis can be provided to the patient by a therapist, rheumatologist and general practitioner (family doctor), but these specialists deal with the treatment of the knee joint for simple arthritis.
When arthritis occurs or the treatment prescribed by the therapist does not give the desired result, then one can not do without the help of an orthopedist. In situations where surgical care is required, a patient with knee arthropathy is referred to a specialized orthopedic and trauma department.
How and how to deal with knee joint arthritis?
The currently known methods of treating patients with arthritis of the knee joint are subdivided into non-pharmaceutical preservatives, medical and surgical.
Non-pharmaceutical methods
Many patients ask themselves, "How do you treat arthritis of the knee without pills? "However, many of the current non-pharmacological (ie, drug-free) methods of treating 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.
With a timely visit to a doctor and adequate motivation of the patient for treatment, sometimes it is enough to eliminate the negative factors. For example, being overweight has been shown to reduce the onset of the main symptoms of the disease.
Elimination of abnormal physical activity and, conversely,therapeutic gymnasticsby using rational physical programs, they reduce the intensity of the pain. Exercises to strengthen the quadriceps femur have been shown to be substantially comparable to anti-inflammatory drugs.
If we are dealing with arthritis of the knee joint, then it is necessary to tryproper nutrition: improving the elastic properties of articular cartilage will help products that contain large amounts of animal collagen (meat and fish foods) and cartilage components (shrimp, crabs, krill), fresh vegetables and fruits saturated with plant collagen and antioxidantsfor smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, enhances the disruption of metabolic processes in the body and the accumulation of excess weight until obesity.
Considering the most effective treatment for knee arthropathy, it is worth remembering such an effective treatment and prophylactic method asorthotics: The fixation of the knees, the orthoses, the elastic bandages and the orthopedic insoles reduce and distribute the load correctly in the joint, thus reducing the intensity of the pain in it. The use of a cane is also recommended as an effective relief of the knee joints. It should be in the hand opposite the affected limb.
Comprehensive treatment of arthritis of the knee joint also involves the appointment of very effective, even with advanced forms of the diseasephysiotherapy. . . Widely used in different categories of patients suffering from arthritis of any degree, it has proven its effectivenessmagnetotherapy: after several procedures, the intensity of the pain decreases, as a result of the improved blood circulation, the reduction of the swelling and the elimination of the muscle spasm, the mobility of the joint increases. The effect of magnetotherapy is particularly strong with the development of active inflammation in the joint: the severity of the swelling is significantly reduced, the symptoms of arthritis subside. Not so popular, but no less effective in treating the knee joint for arthritis, are physiotherapy methods such as.laser treatmentandcryotherapy(exposure to cold), which have a strong analgesic effect.
Medication
In the effective treatment regimens for arthritis of the knee joint, the following drugs are used.
Non-steroidal anti-inflammatory drugs (NSAIDs), produced in forms for external (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 inhibiting inflammation at the enzymatic level, they eliminate pain and swelling of the joints and slow down the progression of the disease. With early manifestations of the disease, topical use of these drugs in combination with non-pharmaceutical methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills and sometimes NSAID injections are necessary. We must remember that prolonged systemic intake of NSAIDs can cause the development and worsening of ulcerative processes in the gastrointestinal tract and, in addition, adversely 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 the laboratory performance of internal organs.
Glucocorticosteroids (GCS)- hormonal drugs with a strong anti-inflammatory effect. They are recommended when previously prescribed NSAIDs to the patient do not address the elimination of the manifestations of inflammation. Being a powerful anti-inflammatory agent, GCS in the treatment of arthritis has some contraindications, as it can cause a number of important side effects. In systemic forms with knee disease, they are practically not prescribed. As a rule, for the effective treatment of arthritis, GCS injections are used at the points of joint pain, which increases the intensity of the fight against inflammation and minimizes the risk of side effects of the drug. This manipulation can be done by a rheumatologist or trauma specialist. With concomitant arthritis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single GCS administration, the effect of such a treatment lasts up to 1 month. According to the national guidelines for the treatment of osteoarthritis, do not make more than three injections of the drug per year into the same joint.
With advanced, "neglected" osteoarthritis, when a person experiences unbearable pain that does not subside even at rest, disrupts normal sleep and is not removed with NSAIDs, GCS and non-drug methods, it may be prescribedopioid analgesics. . . These drugs are used only with a prescription, which examines the suitability of their appointment in each case.
Chondroprotective(literally translates as "cartilage protection"). This name is understood as different drugs, united by one property - a structural modification of action, ie the ability to slow down the degenerative changes in cartilage and narrowing of the joint space. They are produced in forms for both oral administration and insertion into the joint cavity. Of course, these drugs do not work wonders and do not "grow" new cartilage, but they can stop its destruction. To achieve a lasting result, they must be applied for a long time, with regular courses several times a year.
Surgical treatment of arthritis of the knee joints
There are frequent cases that, despite adequate complex treatment, the disease progresses, consistently reducing the quality of human life. In such situations, the patient begins to ask questions: "What to do if prescription drugs do not help arthritis of the knee joint? " "Is surgery appropriate for knee arthritis? " In answering these questions, it should be clarified thatIndications for surgical treatment of osteoarthritis of the knee joints is a syndrome of intractable pain and significant joint dysfunction, which can not be eliminated with the use of complex conservative treatment, which is possible with the last, fourth degree of the disease.
The most popular type of surgery for third and fourth degree arthritis isendoprosthesis, ie removal of your own joint with simultaneous installation of a metal replacement prosthesis, the design of which resembles the anatomy of the human knee joint. In this case, a prerequisite for this type of surgical treatment is: the absence of large deformities of the joint, formed "false joints", muscle contractions and severe muscle atrophy. In case of severe osteoporosis (significant reduction in bone density), endoprosthesis is also not indicated: the "sugar" bone will not withstand the insertion of metal pins and the rapid absorption (absorption) of bone tissue will begin at the site of their installation, pathological fractures. Therefore, an early decision on the need for stent placement seems to be so important - it should be made when the age and general condition of the human body still allow surgery. According to the results of long-term studies, the duration of the effect of endoprosthesis in patients with advanced arthritis, ie the temporary duration of the absence of significant mobility restrictions and the maintenance of a decent quality of life is about ten years. The best results of surgical treatment are observed in people 45-75 years old with low body weight (less than 70 kg) and relatively high standard of living.
Despite the widespread use of knee arthroplasty, the results of such surgeries are often unsatisfactory and the complication rate is high. This is due to the design features of the stents and the complexity of the surgery itself (replacement of the hip joint is much easier from a technical point of view). This dictates the need to perform organ preservation functions (joint preservation). These include bypass surgery and corrective osteotomy.
Arthromolar bypass- connection of the medullary canal of the femur with the cavity of the knee joint using a branch - a hollow metal tube. This allows the fatty bone marrow from the lower third of the femur to enter the knee joint, nourishing and lubricating the cartilage, thus significantly reducing pain.
When changing the lower extremity axis (but with a slight reduction in range of motion), it is effectivecorrective osteotomy- cross section of the tibia with correction of its axis, followed by fastening with plate and screws in the desired position. At the same time, two goals are achieved - the normalization of the industrial due to the restoration of the axis of the limbs, as well as the activation of blood circulation and metabolism during bone fusion.
Summarizing the above, I would like to note that the treatment of gonarthritis is a complex social task. And although medicine today is not able to offer a cure that will get rid of it forever or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations canstop its evolution.