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The disease is also known as gonarthrosis (from the Latin genu - knee), osteoarthrosis (as the disease was previously called) and osteoarthritis (the term reflects the mechanism of development and the modern understanding of the disease).Deforming osteoarthritis of the knee joint has a chronic course and develops over several years.Most patients are over 50 years old.In 2/3 of the cases, women dominate.
How does the disease develop?
Under the influence of external and internal factors, blood supply and tissue nutrition are disrupted, degenerative-dystrophic damage to articular cartilage develops, with subsequent involvement of the underlying bone in the inflammatory process.Destruction of joint surfaces leads to loss of joint function, limits movement and interferes with the patient's quality of life.
Causes and risk factors
The main reasons for the development of osteoarthritis:
- Hard physical work.Constant loads on the legs lead to cartilage microtrauma and the development of an inflammatory process.Loaders, installers, miners and quarry workers are at risk.Often deforming osteoarthritis affects professional athletes (weightlifters, cyclists, tennis players, soccer players, basketball players, hockey players, etc.).
- Injuries.Damage to ligaments, tendons, meniscus, bruises and fractures lead to disruption of joint biomechanics.If it is treated incorrectly, it leads to the development of post-traumatic arthrosis.
- Surgical operations on the knee can lead to the development of pathology of the articular cartilage and surrounding tissues.
- Excess weight increases the load on the joints of the lower extremities.Up to 80-90% of the progression of all osteoarthritis is related to joint overload.
- Old age.In people over 50-60 years old, regenerative processes slow down, collagen production decreases, and hormonal levels also suffer.Which leads to the development of pathology.
- Hormonal changes in women.During menopause, the production of estrogen decreases, which disrupts the absorption of calcium, leads to a weakening of the musculoskeletal system and makes the bones fragile.The risk of developing osteoporosis increases.
- Thyroid problems.Thyroid hormones are involved in the metabolic processes of calcium and phosphorus in the body.Their lack or excess can cause knee arthrosis.
- Genetic predisposition.Mutation of collagen can cause disorders in the elements of the connective tissue, which leads to the deterioration of the cushioning function of the articular cartilage.
- Heredity.There is a high probability of developing the disease if the patient's family has relatives diagnosed with gonarthrosis, mostly on the female line.
- Inflammatory diseases.Infectious arthritis, bursitis, synovitis caused by bacterial or viral infection are often complicated by the development of gonarthrosis.
- Vascular diseases.The tissues do not receive adequate nutrition, the blood supply is disturbed, which leads to the development of ischemia and degenerative-dystrophic changes in the articular cartilage.
- Poor nutrition and metabolic disorders.Eating foods with a high purine (protein) content contributes to salt deposition in the knee, for example, gouty arthritis.
- Specific diseases such as gonorrhea, tuberculosis, syphilis, chlamydia and influenza can cause serious joint damage.
- Intoxication of the body by various chemicals, including some medicines.
- Autoimmune disorders are associated with a violation of the body's immune defenses when antibodies are created against its own cells, for example rheumatoid arthritis.
Symptoms of the disease
Main symptoms of gonarthrosis:
- Pain in the joint, of a painful nature, sometimes at night, in case of aggravation, severe stinging;
- Crackling and clicking during movement are caused by a violation of the concordance of joint surfaces, the presence of osteophytes and cartilage defects;
- Swelling and swelling are associated with the development of an inflammatory process in the joint and surrounding soft tissues;
- Deformation of the joint space and axis of the limb indicates the progression of the disease;
- Atrophy and weakness of the thigh muscles, the volume of the quadriceps and biceps muscles decreases;
- Limitation of mobility and stiffness of the joint is caused by pain, the development of adhesions and the appearance of osteophytes (bone spurs).
The first signs of osteoarthritis to look out for are pain that occurs during or after exercise.The pain goes away with rest and does not require treatment.Stiffness in the knee in the morning, initial pain, before getting up and walking after sleeping, it takes some time for the joint to develop.
Signs of exacerbation
With the development of the pathology, the symptoms of arthrosis become brighter: the knees begin to hurt at rest and at night, during bending and extension of the joint, foreign sounds appear - crackling, creaking, clicking.Lameness develops, stiffness of movement and swelling of soft tissues appears.
The following facts indicate the progression of the disease:
- appearance of limb axis deformation in the form of O-shaped legs;
- constant nature of the pain, pain at night and when the weather changes (weather sensitivity);
- further deterioration of joint mobility, with the development of flexion contracture;
- weakness and atrophy of the thigh muscles.
Types and forms of the disease
there are:
- Primary.It develops as an independent disease.More often, such knee gonarthrosis is associated with changes in age and heredity.
- Secondary.It appears against the background of certain diseases or injuries, for example post-traumatic osteoarthritis.
Depending on the causes, the following types of arthrosis are distinguished:
- Ischemic, associated with problems with blood supply to tissues and vascular disorders;
- Post-infectious is caused by infections, viruses, autoimmune processes;
- The idiopathic nature of the development of the pathology remains unclear;
- It is metabolically associated with metabolic disorders - gout, hemochromatosis, chondrocalcinosis;
- Involutional, as a result of age-related changes in the body;
- Post-trauma, history of trauma;
- Dyshormonal - a consequence of hormonal imbalance in the body.
Stages of development
I. Arthrosis of the 1st degree - the initial stage is associated with the deterioration of the quality and quantity of synovial fluid (joint fluid, provides nourishment to the cartilage, has cushioning properties, promotes sliding of joint surfaces).Malnutrition leads to wear and tear of cartilage tissue, and the appearance of the first signs of inflammation.In the initial phase, the movements are not damaged.Patients feel mild pain, tingling, and sometimes the joints may crack when moving.Symptoms occur during and after physical activity.From the outside, the knee looks quite healthy.
II.Osteoarthritis of the 2nd degree - leads to a thinning of the cartilage to 1.5-2.0 mm (normally 2.5-3.0 mm), a narrowing of the joint space is observed and small individual bone growths (osteophytes) appear.The inflammatory process has a wavy character, alternating between phases of remission and exacerbation.Gonarthrosis 1-2 degrees is accompanied by swelling and weakness of the thigh muscles.The pain bothers me at rest, when the weather changes, and after walking I feel tired.Movements become more rigid, morning stiffness and creaking in the wrist appear.It is at this stage that patients most often turn to a doctor.
III.Gonarthrosis of the 3rd degree is manifested by external deformation of the joint, curvature of the limb axis.The cartilage tissue is severely damaged, thinned to 1-1.5 mm, and exposed bone is visible in some places.Bony growths can be easily felt under the skin, and the range of motion is significantly reduced.At 2-3 degrees of osteoarthritis, the joint space narrows, the joints cannot be bent and separated, all movements are accompanied by pain and creaking, and morning stiffness intensifies.A characteristic joint contracture develops.I am worried about the sharp pain in my knee, even at rest.Patients often suffer from insomnia due to the fact that they cannot take a comfortable position that does not cause pain, and they feel changes in the weather.
IV.Gonarthrosis of the 4th degree is characterized by complete destruction of joint surfaces, exposed bone is visible, and cartilage is represented by rare "islands".The joint space is almost invisible.Pronounced deformity of the lower extremities in the shape of the letter O and swelling are noticeable.Mobility is almost completely lost.Treatment with non-surgical methods at this stage is ineffective;joint replacement with an endoprosthesis is indicated.
Comment from the orthopedist: In order to accurately determine the degree of arthrosis of the knee joint, in addition to examining the patient, it is extremely important to perform an instrumental examination (ultrasound, radiography or MRI of the joint).Bilateral gonarthrosis is very common, so it is recommended to examine both the left and right knee joints.This will help you choose the optimal treatment, and thus prevent further progression of the disease.
Diagnostics
An X-ray or ultrasound of the knee joint is usually enough to make a diagnosis.In severe cases, a laboratory examination and magnetic resonance imaging (MRI) are prescribed.If pathological fluid accumulates in the joint, a puncture and subsequent examination may be required.
Ultrasound diagnostics
It helps to recognize the disease at an early stage.It allows measuring the thickness of the cartilage layer, joint relief, the presence of joint fluid, the size of osteophytes and ossification.
Radiography
Carry out to assess the degree of damage, the state of bone and cartilage tissue.It will show the presence of osteophytes, narrowing of the joint space and deformation of the joint.In the initial stages of the disease, the examination is not informative.
Analysis
General tests of blood and urine, blood biochemistry show signs of inflammation, the presence of infection and disorders in bone and cartilage tissue.They allow you to assess the general condition of the body, determine the cause of the disease, gonarthrosis and rule out pathologies with similar symptoms.
MRI
Magnetic resonance A very precise diagnostic method that helps visualize the smallest changes.It will help in establishing a diagnosis both at an early stage and in complex cases before surgical treatment.
Which doctor treats you?
The following specialists treat gonarthrosis of the knee:
- Orthopedic doctor - diagnoses disease, intra-articular injections, plasma therapy, provides high-tech assistance, surgical treatment.
- Physiotherapist - responsible for instrumental physiotherapy treatment.
- Rheumatologist - will help if the disease is associated with autoimmune disorders.
- A sports doctor - will be needed in case of a sports medical history.
- A nutritionist is needed if the patient is overweight.
In the recovery phase, the doctor may involve other specialists:
- Massager - massages the lower extremities, restores muscle tone, thereby stimulating blood circulation and helping restore joint mobility.
- Physiotherapy doctor - chooses special exercises and controls their performance.
- Rehabilitator - helps in social adaptation of the patient;the specialist was especially sought after after a difficult reconstructive surgery on the knee.
What treatment is prescribed?
The earlier the disease is detected and the treatment of osteoarthritis symptoms begins, the greater the chances of recovery.Otherwise, the disease can lead to irreversible consequences and significantly worsen the quality of life.
Therefore, treatment of arthrosis of the knee joint of degree 1-2 has a good chance of completely restoring the function of the knee joint.Unfortunately, patients do not always seek medical help in the initial stages.
How to relieve pain quickly and how to treat it?
First of all, it is necessary to remove pain and inflammation.prescribed:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and pain relievers.Medicines allow you to quickly remove inflammation in arthrosis and help reduce pain and swelling.
- Corticosteroids are used when NSAIDs and analgesics do not help, for example, in the treatment of arthrosis of the knee joint 3-4 degrees.The patient is given a drug block - drugs are injected directly into the joint cavity.this helps to reduce pain and achieve relief within minutes of the injection.
- Special ointments and plasters for pain relief.
Orthopedist's comment: The treatment of arthrosis of the knee joint of degree 2-3 is always complex, as a rule, it includes more than 15 (!) points of recommendation in the prescription.It's not just drugs and injections.This is a whole series of rehabilitation measures aimed at correcting the biomechanics of the joint and the patient's lifestyle.Only this approach will help preserve the joint and stop the progression of the disease.
Preparations that strengthen bone and cartilage tissue:
- Chondroprotectors based on chondroitin and glucosamine are the nutritional basis of chondrocytes.
- Hyaluronic acid preparations serve as analogues of synovial fluid.
- Medicines that improve microcirculation and blood flow to articular cartilage.
- Calcium and vitamin D supplements strengthen the bones that form the knee joint.
- Intra-articular injections of hyaluronic acid preparations, an artificial analogue of synovial fluid, help lubricate joint surfaces.
- Blockade with drugs helps to quickly relieve swelling, pain and inflammation.As a rule, the effect is noticeable already the next day.
Treatment of osteoarthritis of the knee joint also includes physiotherapy:
- Electrophoresis.With the help of electric current, the drug penetrates the affected area.Electrophoresis is used to treat knee pain caused by gonarthrosis.
- Phonophoresis.The medicine under the influence of sound waves enters the area of inflammation.An additional advantage of the method in the treatment of deforming gonarthrosis is the thermal effect.
- Shock wave therapy.The procedure improves blood circulation, stimulates tissue nutrition, and is used to destroy osteophytes and scar tissue.
- Traction therapy (joint traction) - helps relieve the joint space, stretching it by a few millimeters, which reduces the mutual pressure of the joint surfaces.
- Electromyostimulation - stimulates blood flow and muscle function using electric current, restores muscle tone.
- Mechanotherapy helps to develop movement in the joint and combat contracture using special robotic simulators.
- Laser therapy creates deep tissue heating and reduces the inflammatory response.
- Magnetotherapy.The therapeutic effect is based on the properties of the magnetic field to reduce pain, inflammation and tissue swelling.
Orthobiological methods are aimed at stimulating regeneration and replacing defects in cartilage tissue:
- Plasmolifting is a plasma-based drug, made from the patient's own blood, which initiates regeneration processes and contains growth factors.
- PRP therapy - plasma obtained from the patient's blood is used as medicine.Platelet-rich plasma stimulates the regeneration of chondrocytes and alleviates the inflammatory process.
- SVF therapy is based on the use of cells of the stromal vascular fraction obtained from the patient's own adipose tissue.
- SVF therapy + PRP therapy - the simultaneous use of concentrated plasma and progenitor cells enables the best results to be achieved.
- Stem cell treatment.The method is based on the use of bone marrow cells and is currently under development.
Each case is individual and requires the creation of a special rehabilitation program for the treatment of arthrosis of the knee joint.
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