All types of osteoarthritis occur with degenerative and dystrophic processes in the joint tissue. The disease always takes on a chronic character and is not completely cured, you can only slow down or stop its progress.
Gonarthrosis (damage to the knee joints) belongs to the ICD-10 group under the code "M17". The focus of treatment is on drug therapy, surgical interventions are only carried out at an advanced stage.
What happens to the knee joint in osteoarthritis?
Osteoarthritis of the knee joint is accompanied by degenerative and dystrophic processes that, if left untreated, will progress steadily. In this case, with the exception of rare cases, inflammatory processes are not observed.
Degeneration and dystrophy of the joint initially have 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 deforming changes).
Blood circulation decreases, local metabolism (metabolic processes) deteriorates, which only increases the progression of the disease. The process of degeneration of hyaline cartilage begins very quickly, its thinning, layering, and later the appearance of cracks.
The end result of the disease is the complete destruction (destruction) of the hyaline cartilage with exposure of the adjacent bone. But the problem doesn't end there: as the bone is exposed, it begins to thicken and bone growths appear (often in the form of thorns).
All of this also leads to deformation of the affected limb, followed by its curvature. For this reason, the disease is also known as "deforming osteoarthritis". If the extremity is already deformed, the disease cannot be cured without surgery.
The reasons for the development of the disease
In most cases, the development of knee osteoarthritis is preceded by the appearance of several predisposing factors. Congenital risk factors are not necessary at all, the disease very often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Severe metabolic disorders / metabolic processes in the body (all acute or chronic severe diseases of the thyroid gland, adrenal glands).
- Circulatory disorders and the presence of a tendency to capillary bleeding (due to their fragility).
- Overweight (obesity stage II-III) with serious strain on the entire musculoskeletal system.
- Injury to the knee joints (including direct injuries, penetrating wounds, ruptures of the ligamentous apparatus, injuries to the menisci, fractures, dislocations and subluxations, tears).
- In the recent past he suffered from inflammatory pathologies (mainly arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, tennis, football, basketball players).
- The consequences of a longstanding, 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 the osteoarthritis. If metabolic disorders or severe injuries are the cause, the prognosis is worse than in the case of the development of osteoarthritis against the background of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, osteoarthritis of the knee joint is very common, and among all forms of osteoarthritis it occupies one of the top positions. About 20% of patients who turn to specialized medical institutions suffer from osteoarthritis of the knee.
If one considers all diseases of the knee joints, among them the proportion of osteoarthritis is around 53% of the cases. Recently, the number of osteoarthritis of the knee has increased in the population, especially in developed countries.
This is associated with an increase in average life expectancy (the older a person is, the greater the risk for this form of osteoarthritis) and with a predominance of a sedentary lifestyle. And this is really a problem as doctors still cannot completely cure osteoarthritis of the knee.
Why is osteoarthritis of the knee dangerous?
The main danger of osteoarthritis of the knee is disability due to the development of complications that are inaccessible to conservative therapy. First of all, this is a deformation of the joint and bone of the affected limb. A disability is already possible in the third stage of the disease.
The second danger is the development of chronic severe pain, which can disturb the patient so that he cannot sleep normally. Constant awakening to knee pain is one of the most common problems in stage 3-4 osteoarthritis of the knee.
There are no fatal consequences precisely due to osteoarthritis of the knee. In theory, sudden congestion in the joint can cause serious injury. This is the so-called symptom of joint blockage, which is most often observed in 3-4 stages of the disease.
The degree of osteoarthritis of the knee and the difference between them
The disease is divided into four stages, which differ in the severity of the course, the severity and number of symptoms, and the final prognosis. In addition, each stage of osteoarthritis is treated in a different way (although the differences in treatment regimens may seem minor to a non-doctor).
The degree of osteoarthritis of the knee:
- first degree: the disease practically does not manifest itself, only slight discomfort is possible, but in general the patient is comfortable, and therefore it is very problematic to diagnose the disease at the first stage;
- second degree: there are strong painful sensations, especially after a long walk or standing; during physical activity a characteristic crunch develops, the process of atrophy of the hamstring quadriceps can already begin;
- third degree: pain becomes unbearable, constantly disturbing the patient, pronounced deformative changes appear in the joint, it becomes hot, normal walking or even more walking is impossible;
- fourth degree: it is very difficult with severe deformity of the joint and constant pain that does not even allow the patient to sleep; Joint dysfunction is so pronounced that ankylosis (complete immobilization of the affected joint) is possible.
The first two degrees of osteoarthritis of the knee are considered conditionally beneficial, as they practically do not interfere with a person's normal life. The last two stages are very serious and lead to disability.
Symptoms of osteoarthritis of the knee in various stages
The clinical picture of osteoarthritis of the knee depends on the stage of the disease. Symptoms may not appear in the first stage, while in the fourth stage they are very pronounced and do not bother the patient even with strong drug therapy.
Stage 1 symptoms:
- Mild discomfort or pain with heavy stress on the joint.
- Hardly noticeable crunch.
- Slight enlargement of the joint.
Stage 2 symptoms:
- Moderate pain, usually with a period of exacerbations and remissions;
- the joint feels warm;
- Reddening of the skin over the affected joint is possible;
- moderate knee dysfunction (walking and running are still possible, but with some difficulty);
- increased pain in the morning and after standing for a long time.
Stage 3 symptoms:
- severe pain that disturbs the patient around the clock, but in phases of exacerbation (trigger for the exacerbation for each patient) the pain increases several times;
- visible deforming changes in the knee, its increase in size;
- the affected joint becomes hot when palpated;
- normal movement is impossible due to partial immobilization of the joint;
- possibly curvature of the lower leg.
Stage 4 symptoms:
- Pain becomes unbearable, does not allow the patient to do everyday things (including intellectual things, since pain affects cognitive functions);
- the appearance of synovitis due to the accumulation of effusion in the cavity of the knee cartilage;
- deforming changes are now clearly visible not only in the joint but in the entire extremity;
- a sense of fluctuation in 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 the pain in 3-4 stages of osteoarthritis, doctors resort to analgesic blockages, but blockages cannot be done on a daily basis.
diagnosis
The focus in the diagnosis of knee osteoarthritis is on imaging procedures, while laboratory tests usually show nothing.
Diagnostic methods used:
- Examination by an orthopedic surgeon with palpation of the affected joint, length measurements of the bones, angiometry.
- Clinical blood tests (total and erythrocyte sedimentation / ESR), determination of the fibrinogen level in blood and urine and above all urea as well as other biochemical parameters.
- Radiography (narrowing of the joint space, deformities, cartilage sclerosis, salt accumulation and even bone osteophytes become visible).
- Ultrasound examination (only for differential diagnosis).
- Magnetic resonance imaging or computed tomography (the most informative in terms of diagnostic imaging).
An x-ray is usually sufficient for diagnosis, especially if the disease is at an advanced stage. In relatively rare cases, computed or magnetic resonance imaging is required.
Treatment of osteoarthritis of the knee: methods
The treatment of knee osteoarthritis is only complex, as no treatment method is isolated from others with good effects (not even with drugs). Treatment is long, can last for years, and sometimes it is prescribed for the rest of life.
Treatment methods used:
- drug therapy - the basis of treatment;
- physiotherapy exercises;
- Diet therapy;
- physiotherapy treatment;
- surgical intervention.
The main thing in the treatment of osteoarthritis is the systematics of the process and unconditional compliance with the recommendations of the attending physician. Attempts to treat osteoarthritis of the knee on their own, including ignoring doctor's prescription, usually end in disability.
Exercise therapy
Physical therapy exercises are best for treating 1-2 stages of osteoarthritis of the knee joints. At such stages, it is almost the main method of treatment, as physical education classes can slow the progression of the disease and eliminate most of the symptoms.
However, there is no special sense from classical physical education, it can also be harmful. Therefore, the patient is prescribed special exercises and individually (since gonarthrosis can develop differently in individual patients).
There is no timeframe for treatment with movement therapy methods - ideally, you need to perform the prescribed exercises for a lifetime and see a doctor from time to time for dynamic monitoring of the joint. It is very useful to combine exercise therapy with exercises in the pool (the stress on the joints is much less there).
diet
While nutritional correction can be very useful, it is not a mandatory method of treatment. Diet therapy leads to noticeable results in only 40% of cases, usually in people in whom the onset of osteoarthritis was provoked by endocrine pathologies.
The patient is instructed to avoid fatty, fried, salty and smoked foods. The consumption of alcoholic beverages is prohibited, and sometimes tobacco smoking is also prohibited. At the same time, the consumption of large quantities of vegetables, fruit and meat products is mandatory.
Sausages, sausages or wieners cannot be called meat products in this case. The patient is instructed to consume lean meats, cooked chicken is especially useful (due to its relatively low calorie and high protein content).
physical therapy
Physiotherapeutic procedures are only useful for alleviating the symptoms of osteoarthritis, but do not have a direct effect on the disease. This means that it is impossible to cure the first stage of osteoarthritis with the help of physiotherapy, no matter what some "specialists" there say.
Physiotherapy is good for relieving pain, but only if it's mild. Physiotherapy does not help with severe pain (stage 3-4 of osteoarthritis), as do most medications (especially for oral use).
The most preferred ones for treating osteoarthritis are magnetotherapy, quantum therapy, mud therapy, acupuncture, and hirudotherapy (leech therapy). Physiotherapy shock techniques are prohibited because of the risk of additional joint damage.
operation
Surgical intervention is required only at 3-4 stages of the disease, when conservative methods are no longer necessary. Various types of procedures can be used: drainage of the joint cavity, removal of bone osteophytes, replacement (prosthetics) of the joint.
The best way to restore the functionality of the joint is 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 over 65-70 years of age. Remember that every knee surgery has its own risk of complications (even fatal complications are possible, but they are very rare).
medication
In addition to physiotherapy, exercises are the basis of treatment and their mandatory part. However, if other procedures cannot be used, drug therapy in connection with exercise therapy cannot be dispensed with (conventional medicine cannot replace drug therapy).
The patient is prescribed pain relievers (with severe pain - blockade), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid (as a substitute for physiological lubrication of the joints) are possible.
Medicines can only really influence the disease in stages 1-2 of osteoarthritis. In 3-4 stages of the disease, drug therapy only plays the role of dealing with the symptoms, while only surgery can affect the disease.
The nuances of treatment at the stage of exacerbation and in remission
Approaches to treating knee osteoarthritis during exacerbation and remission are somewhat different. At the stage of exacerbation, aggressive therapy is used, aimed at restoring joint function and eliminating symptoms as quickly as possible.
The pain reaches its peak precisely at the stage of exacerbation of the disease, so in such cases drug blocks can be prescribed.
Nonsteroidal anti-inflammatory drugs can be prescribed. Although osteoarthritis usually proceeds without inflammation, it can occur in the acute stage. The patient is prescribed bed rest, minimal stress on the affected joint and avoidance of overheating of the extremity.
On the contrary, at the stage of remission, physical exercises are prescribed and, in general, an increase in physical activity is prescribed. The reason for this is that normal walking is possible in the remission stage, as the function of the joint improves and the pain is usually of moderate intensity.
It is necessary to skillfully use remission - it is precisely during this period that courses in the pools, courses with a rehabilitation therapist and attempts to restore the functionality of the joint are possible. You can not do without medication at this stage.
Most often, chondroprotectors and oral pain relievers are prescribed (at the discretion of the patient, since the pain is barely noticeable, they do not need to be taken). Ointments, gels and creams, including those with a warming effect, can be prescribed (it is better not to use them during an exacerbation).
In addition, massage can be prescribed, including manual therapy (only if the disease is stage 1-2). With the permission of the doctor, special gymnastics techniques can be used.
Remission is the ideal time for physical therapy, but the choice of specific physical therapy should be made by the doctor, not the patient. In the end, injections of hyaluronic acid preparations can be given if necessary during remission.
With an exacerbation of osteoarthritis, hyaluronic acid is not prescribed, since on the background of inflammation, such injections lead to serious consequences. Please Note: Injections should only be given by a suitably qualified person.
Ordinary doctors and even more middle-level medical personnel (paramedics, nurses) are not allowed to perform such injections. Self-injecting into the joint is associated not only with disability, but also death (due to the risk of anaphylactic shock or a blood clot if the needle accidentally enters the vessel).
Treatment prognosis
The prognosis for treatment of osteoarthritis of the knee 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 for people of working age.
With osteoarthritis stage 3-4, the prognosis is extremely poor in both young patients and the elderly. Although it has been found that young people in such stages tolerate osteoarthritis much more easily, it still inevitably leads to disability.
However, stage 3-4 osteoarthritis is not the same as a penalty. In fact, with the help of surgery, you can try, if not to restore all the functionality of the knee, then most of it. The 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 simple preventive measures. Of course, such measures do not guarantee 100% protection, but they can reduce the risk of disease (especially in people at risk).
Precautions:
- It is necessary to avoid unnecessary loads on the joints (such loads include professional sports).
- Rational diet, with an excess of fruits and vegetables in the daily diet.
- Maintaining good physical condition, regular gymnastics.
- Prevention or elimination of obesity (more body mass - more stress on the joints in the body).
- Preventive treatment with chondroprotectors after the age of 45 (only after consulting a doctor).
- Sufficient daily fluid intake (approx. 1. 5 liters of water per day) to minimize salt intake.
The main thing is not to overdo it with physical activity, since it makes sense only in moderation (if the musculoskeletal system is not worn out). Exercise makes sense, exercise doesn't, especially for the joints and the cardiovascular system.