Arthrosis is a joint pathology accompanied by damage to cartilaginous tissue. Synonyms for arthrosis are gonarthrosis, deforming osteoarthrosis, osteoarthritis - all these terms mean the development of degenerative processes in the cartilage covering the epiphyses of the articulating bones.
Despite the fact that the injury affects only cartilaginous structures, all joint elements are affected - the capsule, synovial membrane, 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 names: arthrosis of the hip joint is called coxarthrosis, arthrosis of the knee joint is called gonarthrosis.
Classification 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 arthrosis occurs after injury, due to congenital anomalies and against the background of systemic diseases.
Following 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 several 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 deformities of skeletal bones;
- hypothermia and poisoning by toxic compounds;
- constant joint injuries 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 a morphological, molecular, biochemical and biomechanical level. The consequence of the pathological process is softening, the formation of fibers and a reduction in the thickness of the articular cartilage. In addition, the surfaces of joint-forming bones become denser and bone spines - osteophytes - appear on them.
DOA of the knee joints develops in 3 stages and, in the initial stages, may manifest only minor pain and discomfort after prolonged physical activity. Sometimes one of the characteristic symptoms of arthrosis appears - morning stiffness. At this time, changes occur in the synovial membrane and in the composition of the intra-articular fluid.
As a result, the cartilaginous tissue does not receive enough nutrients and its ability to withstand pressure begins to decrease. Therefore, with intense exercise and long walks, pain occurs.
In the second stage of arthrosis, the destruction of cartilaginous tissue progresses and part of the increased load is taken on by the articular surfaces of the bones. As there is not enough area for support, the edges of the bones increase due to osteophytes. The pain no longer goes away at rest, as it used to, and bothers me even at night.
The duration of morning stiffness also increases, and it takes a long time to "work out" the leg to be able to walk normally. In addition, when the limb is bent, pops and clicks are heard, accompanied by sharp pain. It is not always possible to bend the leg completely, it seems to be stuck, and further attempts end in a violent crunch and pain.
Due to the occurrence of pain during any movement, the 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 deformities. The joint capsule becomes more rigid as the volume of fluid contained within it decreases. When osteophytes compress the surrounding soft tissues, synovitis and chronic inflammation appear.
When moving to the 3rd stage, the signs of arthrosis of the knee joint become very serious - the pain does not go away even at night, motor skills practically stop, the leg becomes crooked and does not bend. The third degree of osteoarthritis is characterized by an X- or O-shaped deformity, which makes movement extremely difficult. An advanced form of deforming gonarthrosis can only be treated surgically.
Diagnosis
The diagnosis of osteoarthritis of the knee joint is not particularly difficult: a doctor can assume gonarthrosis based on the existing symptoms and characteristic visual signs. To confirm the diagnosis, x-rays are taken. The images will show narrowing of the interarticular space, bone growths, and subchondral osteosclerosis of the bones.
X-rays are used to determine the cause of the disease. Bone deformations are especially visible in post-traumatic osteoarthritis. If cartilage degeneration is caused by arthritis, defects will be detected along the edges of the bones, as well as periarticular osteoporosis and atrophy of bone structures. In various congenital anomalies, a distortion of the axis of one of the bones is observed, which leads to inadequate distribution of the load and the occurrence of secondary osteoporosis.
Treatment
Treatment of gonarthrosis of the knee joint has 3 main objectives - restoration of cartilaginous tissue, improvement of joint mobility and slowing down the progression of the disease. Great importance is attached to eliminating or weakening symptoms - reducing the intensity of pain and inflammation. To solve these problems, medications, physiotherapy and exercise therapy are used. To obtain the maximum effect of therapy, dosed physical activity and adherence to the orthopedic regimen are necessary.
Drug treatment for knee osteoarthritis includes the use of analgesics and anti-inflammatories, as well as chondroprotectors that promote the regeneration of cartilage tissue. Medications can be prescribed in the form of injections, tablets, ointments and gels.
If first-degree knee arthrosis is diagnosed, physiotherapeutic methods, physiotherapy and massage are used in 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 to reduce the load on the sore joint.
Treatment of arthrosis of the knee joint of the second stage necessarily includes exercise therapy, the use of orthopedic devices and adherence to a diet. To relieve pain, non-steroidal anti-inflammatory drugs, chondroprotectors and intra-articular injection of hyaluronic acid are prescribed.
Acute osteoarthritis is characterized by severe pain, for which conventional NSAIDs are not sufficient. In this case, strong analgesics and injection of glucocorticosteroids into the joint cavity are used.
If conservative methods are ineffective, an operation is performed, which can be corrective or radical (replacement of a joint with a prosthesis).
Deforming arthrosis of the knee joint of the third stage is characterized by the complete absence of the interarticular space, replaced by a bone 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. Medicines that are part of the NSAID group and can be used in tablets or topically have been shown to be effective.
The analgesic effect does not always occur immediately, but after two or three days it reaches its peak and the pain passes. The course of treatment with NSAIDs is limited to two weeks, as longer use increases the risk of side effects. Particular care should be taken by people who have problems with the gastrointestinal tract, as well as people suffering from hypertension.
If there is no result, hormonal medications are prescribed to relieve inflammation. In the case of left-sided gonarthrosis, drugs are injected into the left knee, with the right side - into the right.
Hormone injections can be given once every 10 days, not more often. The indication for this treatment is a large accumulation of fluid in the joint due to inflammation. As symptoms subside, they switch to tablet medications.
Chondroprotectors and hyaluronic acid
Chondroprotective agents act in three directions - they restore damaged cartilaginous tissue, reduce pain and eliminate inflammatory reactions. Taking chondroprotectors helps to normalize the composition and properties of synovial fluid, nourish cartilage and protect pain receptors from irritation.
As a result, the destruction of cartilaginous structures and, consequently, the progression of the disease slows down. After a period of using the medications, the shock absorption and lubrication 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 more effective. Modern methods of treating arthrosis include the use of combined agents, which contain 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. This is, in fact, a biological lubricant that gives elasticity, elasticity and resistance to cartilage.
With the development of joint pathologies, the volume of hyaluronic acid can decrease by 2 to 4 times, which necessarily leads to excessive friction of the bones. With intra-articular injection of hyaluron, 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, but also for diagnosis of joint pathology. This procedure makes it possible to identify damages that are 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, stress resistance increases and motor activity returns.
In case of significant deformities, 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 and then combines the bones in the most physiological position. If necessary, the resulting gap is filled with bone graft. During the healing period, the structure is fixed with special clamps.
Endoprosthesis replacement is an alternative method to the old-fashioned arthrodesis procedure, the essence of which is the partial or complete replacement of a diseased joint with a prosthesis. As a result, knee function is completely restored in more than 90% of cases, significantly improving patients' quality of life.
Physiotherapy
Physiotherapy 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, certain procedures allow for the administration of medications through the skin, thus reducing the dosage of oral medications.
For damaged joints, the following techniques are recommended:
- magnetic therapy;
- medium wave ultraviolet (WUV);
- infrared laser;
- UHF;
- ultrasound;
- modulated diademic and sinusoidal currents (amplipulse therapy);
- Darsonval.
Effective procedures for arthrosis are also therapeutic baths - radon, hydrogen sulfide, bischofite, mineral and sage. They have anti-inflammatory, analgesic and joint restorative effects.
Finally
If you suspect knee osteoarthritis, you should consult an orthopedic doctor 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 and smoked meats, in addition to reducing the consumption of table salt. The diet should be dominated by foods rich in vitamins and minerals and vegetable oils. Also, 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, which are selected individually by a physiotherapy instructor.
Therefore, taking medication, performing physical procedures, eating a balanced diet and exercising are what will definitely help a patient with osteoarthritis. And to avoid traumatic surgeries, you should seek medical help as early as possible. Be healthy!