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Osteoarthritis of the knee joint

osteoarthritis of the knee joint on x-ray

Osteoarthritis of the knee joint is a specific disease that has a destructive effect on the cartilage of the knee joint.

When such a disease occurs, doctors observe serious disturbances in the blood circulation processes in the bone vessels, leading to deformation and destruction of the cartilaginous tissue, the person experiences severe pain that restricts all movement of his legs and knees, and observes swelling and changes in the appearance of the knees.

To avoid the development of serious consequences of gonarthrosis (deformity of the limb and ankylosis - immobilization of the joint), when only arthroplasty can help the patient, the disease must be promptly identified and treated.Also, do not treat independently with traditional methods and advertised remedies, but under the supervision of qualified doctors.

What are the reasons?

The mechanisms of osteoarthritis in medicine are generally divided into:

  • Primary- which occurs in older people due to the natural aging of body tissues and against the background of certain factors provoking this disease, such as obesity (10% of cases), heredity and increased stress throughout life.
  • Secondary- it represents 30% of all cases of osteoarthritis of the knee joint;it generally manifests itself after an injury, a fracture of the tibia, a rupture of the ligaments or an injury to the meniscus.In addition, with such osteoarthritis of the knee joint, symptoms of the disease appear in most cases after 3-4 years, but after a serious injury this is possible even after 2-3 months.

In 50-60% of cases, the cause of osteoarthritis of the knee joint is a spasm of the muscles of the anterior surface of the thigh.

What happens to the knee joint in osteoarthritis?

With excessive regular loads, genetic predisposition, metabolic disorders in the body, prolonged muscle spasms and injuries, the knee cartilage loses its softness and begins to thin out.The gentle sliding of the articulated bones is replaced by strong friction and the first degree of gonarthrosis develops, in which the cartilage loses its shock-absorbing properties.

The degradation process continues to progress and poor shock absorption leads to flattening of bone surfaces with the formation of osteophytes in the form of bony growths.In this case, the disease already has a second degree and is accompanied by degeneration of the synovial membrane and the joint capsule.Lack of pumping and movement atrophies the structure of the knee joint, the consistency of the knee fluid becomes more viscous, the process of cartilage nutrition is disrupted, which leads to an even greater deterioration in the patient's condition.

Thinning cartilage results in a reduction in the distance between articulating bones by up to 80%.When walking, due to abnormal friction and the absence of a shock absorber, destructive processes in the joint increase rapidly, which quickly leads to the development of the third degree of osteoarthritis with pronounced symptoms:

  • Pain when moving, especially going up or down stairs.
  • Pain both during exercise and at rest, morning stiffness.
  • The patient begins to limp, trying to spare the painful joint.
  • Severe cases of the disease require the use of crutches or a cane.

The third degree of osteoarthritis of the knee joint is characterized by an almost complete absence of cartilage tissue, which leads to a minimal decrease in joint mobility.Therefore, no magic methods, super drugs or ointments can restore worn-out cartilage tissue, and given the degree of bone deformation, normal functioning of the joint is impossible.In this case, only surgery can help.

destruction of the knee joint due to osteoarthritis

Osteoarthritis stages

As osteoarthritis progresses, the following stages or degrees are distinguished:

  • The initial stage, or stage 1, is often called compensated, since there are no pronounced clinical signs of pathology yet.The patient may feel discomfort in the knees after physical activity, which disappears quickly after rest;the joints are still fully functional.
  • With osteoarthritis of degree 2, subcompensated, the symptoms of the disease intensify.A pronounced pain syndrome is formed, which, however, is relieved by locally used anesthetic ointments and gels.Motor activity is impaired and joint instability appears.In the vast majority of cases, patients turn to doctors at this stage.
  • The 3rd degree, decompensated, can also be called deforming.The knee joint is twisted, unstable, immobile and completely non-functional.The pain syndrome is constant and requires serious medical intervention.To unload the joint and move around, a person needs a cane.

Symptoms and first signs

Depending on the severity of symptoms, the development of the disease is divided into 3 stages.Symptoms of early development of knee OA vary greatly and are nonspecific.

At the first stage of pathology, the following signs are possible:

  1. knee pain when squatting or climbing stairs;
  2. pain in the joint after prolonged exercise or cooling;
  3. the knee may hurt at the end of the day or in the morning;
  4. morning stiffness and pain disappear after daily work.

Subsequently, symptoms characteristic of stages 2 and 3 appear (in ascending order):

  • the pain becomes acute and prolonged;
  • swelling of the joint area;
  • fluid may appear in the joint;
  • between the joint surfaces, pinching of particles of cartilage, meniscus, synovial villi is possible, which leads to abrupt immobility (it can also pass abruptly);
  • it is difficult to walk on his foot;
  • joint immobility develops.

Consequences

If left untreated, the following complications of knee osteoarthritis may develop:

  • Joint deformation.In fact, joint deformity is probably not a complication, but the last stage of the disease.
  • Infection in a joint.Infection usually occurs due to microtrauma.They can be thought of as small cracks in the cartilage tissue.Pathogenic microorganisms are introduced into the joint through blood or lymph flow from other areas.This often occurs after infectious diseases.
  • Dislocations and fractures.These complications are caused by a dysfunction of the knee joint.In osteoarthritis, there is no uniform distribution of load from the femur to the bones of the lower leg.The ligaments that normally strengthen the joint also weaken.Because of this, at some point (even during normal walking), the bones of the leg can be put under excessive stress, which will lead to a fracture or dislocation.To avoid this, people with severe structural and functional deficiencies of the knee joint must ambulate using a crutch or cane.
  • Ankylosis.Ankylosis is the fusion of two bones where a joint once existed.This complication is perhaps the most serious, because the joint simply disappears.The tibia and femur gradually fuse together and the tibia is fixed in one position.Of course, movement is impossible.

Diagnosis

To diagnose knee osteoarthritis, use:

  • blood tests (general and biochemical);
  • x-ray;
  • arthroscopy;
  • Ultrasound;
  • MRI.

Radiography is the most important diagnostic method to confirm the diagnosis of knee osteoarthritis.Although it is not possible to examine the early stages of the disease and the condition of the cartilage tissue on x-rays, bone changes of stages 2 and 3 are nevertheless clearly visible.This:

  1. narrow joint space;
  2. marginal spines located along the contour of the bones, the edges of the patella - osteophytes;
  3. changes in the periosteum;
  4. change in height of one of the condyles and the others.

However, the changes can be examined in more detail arthroscopically.

Ultrasound and MRI help detect changes in the soft tissues of the knee joint in the early stages of osteoarthritis.These methods also provide a good indication of the condition of the cartilage tissue, synovium and fluid.

How to treat osteoarthritis?

Treatment for knee osteoarthritis is long and sometimes painful.The duration is due to the fact that once the illness has manifested itself, it will be constantly remembered for as long as the person lives.

Thus, to correctly treat knee osteoarthritis, a fairly solid financial base and discipline are necessary.How seriously the patient takes treatment plays an important role, because often, in order to reduce the frequency of exacerbations of the disease, the patient is forced to change his daily activity, his favorite profession, engage in joint development, quit smoking and drinking alcoholic beverages.

Treatment of deforming osteoarthritis of the knee joint involves three main stages.

The first stage of treatment includes:

  • communicate to patients the essence of their illness, risk factors and secondary prevention measures;
  • daily gymnastics with stretching elements;
  • contrast shower;
  • swim in the pool 2-3 times a week;
  • weight loss.

The second stage of treatment includes:

  • external fixation of the joint using calipers, bandages, elastic bandages and orthotics;
  • the use of ointments and creams based on nonsteroidal anti-inflammatory drugs to relieve inflammation and pain;
  • the use of drugs from the group of chondroprotectors to reduce the rate of cartilage destruction.

The third stage of treatment includes:

  • course of oral NSAID use;
  • intra-articular injections of hormonal anti-inflammatories;
  • additional use of drugs with a pronounced analgesic effect;
  • surgical replacement of a diseased joint with an implant.

Along with drug treatment, modern medicine uses methods such as:

  1. Physiotherapy.In this case, the treatment of osteoarthritis of the knee joint is carried out using special exercises.The load is selected depending on the degree of development of the disease and the physical fitness of the patient.
  2. Ozone therapy.This is an effect on a painful knee joint thanks to ozone.With this method of physiotherapeutic treatment, the substance can be administered by injection or used externally.
  3. food supplement.Biologically active supplements are an attractive alternative to other medications.
  4. Homeopathy.This involves taking medications in small doses.Treatment lasts only a few weeks, but during this time, provided that the drugs are correctly selected, blood circulation and normal nutrition of cartilage tissue cells are completely restored.
  5. Exercisesallow you to improve blood circulation in the knee joint, restore the elasticity of the ligaments, improve the nutrition of the cells of the cartilage tissue and promote its restoration.

Drug treatment

All drugs used in the treatment of gonarthrosis can be divided into those that help eliminate the main symptoms of the disease and those that restore the function of the knee joint and prevent the progression of the pathology.The first type of drugs includes nonsteroidal anti-inflammatory drugs and hormonal drugs.The second group includes chondroprotectors and hyaluronic acid.

Non-steroidal anti-inflammatories

Drug treatment of osteoarthritis begins with the elimination of pain.It is they who cause patients the greatest moral and physical suffering and lead to loss of working capacity.Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown good results among analgesics.

Medications can be used in two ways: topically or orally (in tablet form).Topical treatments (preferred) often include patches, ointments or gels.As a rule, the analgesic effect occurs on days 3-4, and its maximum develops on days 7-10.

The duration of treatment with non-steroidal drugs should be limited to 10-14 days.NSAIDs have a limited range of use and are used with great caution in the treatment of elderly patients.

Hormonal drugs

In cases where treatment with NSAIDs is not enough and the disease continues to progress, the doctor may prescribe hormonal injections.They belong to the means of “heavy artillery” and help to quickly eliminate pain, relieve inflammation and swelling of surrounding tissues.

Due to the large number of side effects, hormonal drugs are prescribed in short courses, only during the acute period of the disease, when inflammatory fluid accumulates in the joint cavity.The drug is administered into the joint space no more than once every 10 days.

Chondroprotectors

To prevent further destruction of the cartilaginous surfaces of the joint, chondroprotectors are prescribed.

These medications also help reduce pain and signs of inflammation in surrounding soft tissues.In addition, chondroprotectors slow down the destruction of joint tissues and stabilize the disease thanks to their cushioning and lubricating functions.Chondroprotectors improve cartilage nutrition, normalize the composition and properties of intra-articular fluid and protect pain receptors from excessive irritation.

Hyaluronic acid

Hyaluronic acid is called intra-articular fluid fluid prosthesis.In its properties, it is similar to natural synovial (intra-articular) fluid, which nourishes cartilaginous tissue and cushions the knee joint during movements.

Hyaluronic acid preparations are injected into the joint, creating a thin protective film that prevents the cartilage surfaces from rubbing against each other.Injections are carried out only after the acute phase of the disease.

Exercise therapy and exercises for osteoarthritis

Physical exercise helps restore joint function and strengthen it.They should be performed slowly and carefully so as not to cause sprains and not to exceed the permissible load.

The following exercises are considered the most effective:

  1. Slowly raise your legs straight one at a time while lying on your stomach.This exercise works the muscles of the thighs and calves.The load must not be able to be transferred to the rear.You should also not raise your legs too high.The key is to tense your muscles at the top;
  2. This exercise is similar to the first, only now you need to raise your leg with the knee bent.At the top, the thigh muscles should be more tense.The exercise should be performed the same number of times on each leg;
  3. Lying on the floor (on your stomach), raise your legs straight, then spread them apart and bring them together.This exercise requires strong and trained abdominal muscles, so it is not suitable for all patients.In addition, carrying it out can increase blood pressure.For patients suffering from hypertension or other diseases of the cardiovascular system, it is better to avoid it;
  4. To perform the following exercise, you need to lie on your side, bend your leg lying on the floor at knee level, slowly raise the other and hold it at the highest point.It is important that the angle when performing on each leg is the same;
  5. You will need a chair for this exercise.Sitting on it, the legs are straightened one by one, raised and kept in the straightened position for as long as possible;
  6. It helps to stand up on tiptoes while holding the back of a chair or bed.As with other exercises, you should linger at the highest point for a few seconds and additionally strain your leg muscles;
  7. Smooth movement from toes to heel allows you to activate blood circulation in the lower extremities.These movements should be performed alternately: while one leg rests on the toe, the other on the heel and vice versa.All movements must be fluid;
  8. Leaning on the back of a chair or bed, place yourself on your heels for a minute, raising your toes.If you cannot stay in this position for the specified time, you should start with less, gradually increasing it;
  9. A massage that is performed in a standing position.The legs should be rubbed with vigorous movements directed from the knee to the thigh.The massage must be completed with caresses on the skin.

The doctor will perform several sessions in the office and demonstrate basic techniques so that the patient can massage the problem knee themselves.Competent actions improve the condition of the damaged area.

Massage and self-massage

Perform self-massage with your palm, the edge of your palm, your fingertips, or your fist.Act gently on the sore knee, maintain strong pressure on the affected area: strong tapping, blowing, active kneading of the tissues often aggravate the condition.

Basic techniques:

  • the first stage consists of light clockwise movements, the second stage consists of counterclockwise circular movements;
  • Press one palm on the painful knee, tap it lightly with the fingertips of the other hand;
  • hold the initial position of the palm by tapping not with your fingers, but with the edge of your palm;
  • gently stroke the knee in a circle, gradually increase the pressure (but in moderation);
  • During treatment, massage the affected area twice a day for 10 to 15 minutes.As a preventative measure, simply do a light massage once every 7 days.

Before the procedure, apply an ointment or gel with an anti-inflammatory effect to the painful knee.

Physiotherapeutic treatment

All physiotherapy methods can be divided into several groups:

  1. Reduce pain;
  2. Reduce inflammation;
  3. Restore nutrition to the joint and accelerate the restoration of joint function.

The doctor can determine what type of treatment the patient needs based on existing symptoms and concomitant diseases.

Osteoarthritis surgery

Surgical treatment refers to radical methods that partially or completely restore the functioning of the knee joint.Surgical treatment methods differ from each other in the degree of intervention in the affected joint.

  1. Arthroscopyrefers to the most gentle methods of surgical treatment.This technique is less traumatic and can be used as a therapeutic measure even in the early stages of osteoarthritis.Its main purpose is to extend the life of the damaged seal.Arthroscopy is performed using an endoscope - a flexible probe with a camera at the end.Small perforations are made in the knee joint, through which an endoscope and auxiliary instruments are inserted.During the operation, damaged areas of tissue that cause pain are removed.The operation is particularly suitable for young people and, if necessary, can be repeated several times.
  2. Endoprosthesesrefers to the most radical surgical techniques.In this case, complete restoration of joint function occurs by replacing the entire or part of the knee joint with an implant.This method is the best alternative to the existing technique - arthrodesis (complete immobilization of the damaged joint).Currently, stent replacement provides up to 90% positive results and significantly improves patients' quality of life.
  3. OsteotomyIt is used when significant deformities have developed in the joint and the function of the joint is noticeably affected.Osteotomy involves creating an artificial bone fracture in a previously planned location.Then the parts of the bone are aligned in the correct physiological position and can grow together.Sometimes during the operation, artificial bone fragment fixators can be used, which contribute to a more stable position of the bone.

Folk remedies

Traditional medicine will also help you.The use of various lotions to relieve swelling and pain has long been practiced by many patients.Here are some useful recipes:

  1. Burdock leaves.Take 5 burdock leaves and hold them over boiling water to steam them.Lubricate the sore knee with vegetable oil and apply steamed leaves.Wrap your leg in cling film and a warm scarf.Leave the lotion on for a few hours.
  2. Cabbage leaf lotion.It is made from fresh cabbage leaves dipped in May honey and applied to the leg.The therapeutic effect is enhanced by insulation made of woolen fabric or plastic film.This product is suitable for people of all ages.
  3. Eggshells, kefir.Grind the shells of 2 eggs and mix with 1 spoon of kefir.Apply the mixture to your knee, wrap it with a cloth and cling film and lie down under a blanket.Leave it like this for a few hours, then rinse the composition with water.This treatment can be used daily.
  4. Horseradish compress.According to this popular recipe, to enhance the medicinal properties of horseradish, it is recommended to crush and boil it beforehand.Then it should be applied to the affected area.
  5. Turpentine– an excellent warming agent for painful joints.The knee is rubbed with turpentine before going to bed and tied with a woolen scarf.Already after the first procedure, the patient feels significant relief.The course of treatment is chosen individually for each person.

Diet

The therapeutic diet consists of avoiding or consuming little canned, smoked and fried foods (to suppress appetite).In order to restore damaged cartilage, it is necessary to provide the body with complex carbohydrates (porridges, whole foods).Juices (carrot, beetroot, apple) should also be included in the diet.They will remove toxins from the body and reduce the impact of inflammatory processes.

The diet should include fish and aspic, which act as a kind of chondroprotector and help create new cartilage.It is worth remembering that you cannot prescribe a diet for yourself - only a nutritionist (food specialist) can choose the best option.

Example menu:

  • Breakfast: oatmeal with water without butter or sugar, fruit juice, hard-boiled egg;
  • Second breakfast: a glass of low-fat natural yogurt;
  • Lunch: steamed meat or fish, stewed vegetables, unsweetened tea;
  • Afternoon snack: cottage cheese casserole with nuts, a glass of fruit juice;
  • Dinner: vegetable salad, apple, sugar-free tea;
  • Second dinner: a glass of low-fat kefir.

Prevention

Prevent joint diseases:

  • dose the load on your legs during active sports;
  • create a diet that includes foods and dishes containing calcium, magnesium, and gelatin;
  • if the work involves lifting or moving heavy objects, follow safety rules and do not carry loads exceeding a certain limit;
  • Do regular self-massage to prevent osteoarthritis, especially if there is constant stress on your legs;
  • eat well, limit “harmful” foods;
  • body weight control (excess weight means additional stress on the joints);
  • Have regular checkups and treat acute and chronic illnesses.

Forecast

Provided that osteoarthritis of the knee joint is diagnosed at an early stage, the cause of the pathological process is eliminated and adequate treatment is administered, the prognosis is favorable.The proposed therapy achieves long-term remission, but treatment generally lasts a lifetime.

In the absence of the necessary treatment, as well as when the patient does not follow the doctor's instructions, osteoarthritis of the knee joint becomes a cause of disability.