Osteoarthritis of the knee joint is understood as a decrease in cartilage performance due to its curvature and destruction. Other terms are used to refer to this disease -gonarthrosisanddeforming osteoarthritis. Currently, several methods of treatment of the disease are used: a specific option is selected taking into account the individual characteristics of the patient.
disease specificity
Knee osteoarthritis usually develops progressively. As a rule, it occurs in women and elderly people who are overweight or have defects in their veins. The disease can occur in one or both knees at the same time.
The main stages of development of osteoarthritis in the knee:
- initial. There is a decrease in the joint depreciation parameters due to the mutual friction of the cartilage and an increase in its roughness. Sometimes the formation of cracks is observed.
- Second. At this stage, the bone begins to become covered with growths (osteophytes). On the inner surface of the joint bag, the curvature is fixed, stiffness is observed in the work of the limb. As a result, the knee joint gradually reduces its functionality. Due to the decrease in the thickness of the intercartilaginous lining, a reduction in the distance between the tibia and the femur is observed.
- Third. If nothing is done, the pain in the knee region becomes permanent due to irreversible damage to the cartilage tissue. The patient at this stage is no longer able to move normally.
The first symptoms of osteoarthritis of the knee joint are reason enough to consult a specialist. Otherwise, there is a real danger of becoming incapacitated.
Why does osteoarthritis appear?
The main causes of the development of osteoarthritis of the knee joint:
- hereditary tendency;
- temporary immobility of the knee joint as a result of an injury;
- surgical removal of the meniscus;
- high physical activity, constant hypothermia;
- obesity, overweight problems;
- rupture of the ligaments (their weakening);
- other joint diseases (arthritis, swelling, various inflammations);
- failures of normal metabolism, deficiency of calcium in the body;
- flat feet (failure of the center of gravity increases pressure on the joint);
- stress, general fatigue, lack of sleep.
Symptoms
Signs of likely presence of knee osteoarthritis:
- Pain in the knee joint. The pain appears suddenly, in the context of physical exertion. In the first phase, we are talking about almost imperceptible low back pain, then the disease becomes more serious.
- Visual violation of the shape of the knee. This happens in later stages.
- Fluid accumulation, Baker's cyst. They are tangible seals in the posterior region of the knee joint.
- The appearance of a cartilage crunch, against the background of sharp pain. This indicates the second or third stage of gonarthrosis.
- Inflammation of the inner region of the joint pouch. It is manifested by edema and cartilage enlargement.
- Knee stiffness due to severe pain, until complete immobilization. This happens in the advanced stages of the disease.
Treatment
Effective treatment of osteoarthritis of the knee joint is only possible using an integrated approach. Modern medicine still cannot offer a specific drug that can eliminate this disorder. The success of treatment procedures depends on the timeliness of detecting the problem, which makes it possible to start the fight against gonarthrosis in the early stages.
When starting treatment, the specialist pursues several goals:
- reduce pain symptoms as much as possible;
- to resume the normal flow of nutrients to the joint;
- increase the intensity of blood circulation in the knee area;
- restore the functionality of the supporting muscles in the problem area;
- make the knee as mobile as possible;
- expand the space between the connected bones.
The exact treatment algorithm is determined individually. Distinguish between conservative and surgical techniques.
conservative method
This approach is used in the early stages of the onset of the disease, and consists of the use of various drugs and therapeutic exercises.
Analgesics, anti-inflammatories
To eliminate or reduce pain in the knee joint, the doctor usually prescribes the use of non-steroidal anti-inflammatory drugs. In pharmacies, they are represented by pills, ointments and injections. Heated gels, ointments, patches and anesthetics demonstrate good efficacy in relieving pain.
A positive result in this case is usually achieved in 3-4 days. It should be understood that these drugs do not eliminate the disease, but only reduce pain. It is recommended to take painkillers only with the advice of a specialist and only to correct unbearable pain. The fact is that NSAIDs provoke the appearance of various side effects (especially the gastrointestinal tract suffers).
hormonal drugs
In some cases, to relieve pain in osteoarthritis of the knee, the doctor may prescribe hormone injections. This approach is used when the effectiveness of NSAIDs is poor in the context of a progressive disease.
Hormones are prescribed for a short period (1-10 days) during exacerbations of osteoarthritis and accumulation of fluid in the knee joint.
chondroprotectors
To restore and nourish the cartilaginous layer at the beginning of the development of the disease, the so-called. chondroprotectors (glucosamine, chondroitin sulfate). Glucosamine starts the process of cartilage regeneration, corrects metabolism, blocks destructive processes. Chondroitin sulfate disarms dangerous enzymes, increases the amount of collagen (this protein nourishes cartilage with moisture). According to leading physicians, these drugs currently demonstrate the greatest positive effect in the treatment of gonarthrosis.
In especially critical cases, when the cartilage tissue has suffered severe anomalies, chondroprotectors are ineffective. When prescribing glucosamine and chondroin sulfate, the doctor indicates specific daily doses. Only a systematic approach to taking these drugs offers a chance of positive results. On sale they are represented by pills, capsules, injections, gels.
Vasodilators
To remove spasms of the vascular system, optimize blood flow and metabolism in the knee area, the doctor prescribes funds for vasodilation. As a rule, they are prescribed in combination with chondroprotectors. If, against the background of arthrosis, fluid in the knee is not collected, then it is permissible to rub the joint with a warming ointment and participate in therapeutic massage sessions.
Hyaluronic acid
In its chemical composition, this substance is very close to the intra-articular fluid. After being introduced into the joint, the acid generates a film that protects the cartilage from mutual friction. It is allowed to use the drug after the cessation of exacerbation.
therapeutic exercise
For osteoarthritis of the knee, resort to exercise therapy, but only under the strict supervision of the treating physician or an experienced trainer. Self-medication is strictly prohibited due to the enormous risks of careless movement and loading. Proper use of physical therapy exercises helps keep the joint in working condition, removes muscle spasms and relieves unpleasant symptoms. It is strictly forbidden to practice physiotherapy exercises during exacerbations or in unsuitable conditions.
Physiotherapy
By correctly applying physical therapy techniques, you can significantly reduce pain in the knee area, relieve inflammation, and improve the flow of nutrients to the joint tissue. Before prescribing physical therapy, the orthopedist performs a detailed diagnosis of the problem area, prescribes general and special examinations, sends an ultrasound or X-ray. This approach allows you to sketch a real picture of the problem and select the best methods.
The following types of physical therapy have a good analgesic effect:
- UV irradiation. Due to exposure to ultraviolet rays, there is a decrease in the sensitivity of nerve endings and a decrease in pain. As a rule, it is prescribed in the later stages of the disease. The standard duration of treatment is 7 to 8 sessions.
- Local magnetotherapy. It improves the patient's overall health by reducing pain, inflammation, muscle spasms. Magnetotherapy is usually prescribed in the first fixation of the symptoms of knee arthrosis. The default number of procedures is 20 to 25 sessions of 30 minutes each.
- Infrared laser therapy, UHF, SMW devices, ultrasound, therapeutic baths, etc.
If the disease has progressed to the stage of dystrophic and deforming changes, the doctor recommends health resort treatment. A specific list of procedures is compiled after a careful study of the patient's history.
Surgery
This approach, with proper implementation, is capable of partially or completely resuming work on the knee joint. The formation of the surgical intervention algorithm takes into account the level of destruction of cartilage tissue, the degree of inflammation, the amount of fluid collected, etc. As a rule, surgical intervention is practiced in the final stages of gonarthrosis. This approach implies a fragmentary or complete replacement of the affected joint by an endoprosthesis.
The main approaches to surgical treatment:
- Arthrodesis of the joint. During surgery, the surgeon fixes the leg in the most comfortable position for the patient, followed by immobilization of the knee joint. Defective cartilage is completely eliminated. Such a radical approach is relevant only in extreme cases.
- Arthroscopic debridement. It is used in the second stage of development of knee arthrosis. A surgical removal of damaged cartilage tissues is performed, which makes it possible to save a person from pain for several years (usually for 2-3 years).
- Endoprostheses. In this case, the knee joint or its separate part is replaced by a plastic, ceramic or metal implant that completely repeats the anatomical configuration of the natural joint. Endoprosthesis today is considered the most effective way to return a complete lifestyle to a knee that suffers from osteoarthritis for the next 15 to 20 years.
Competent planning and implementation of surgical treatment make it possible to improve the patient's well-being and restore their mobility (partially or completely). At the same time, it should be understood that after the operation, a long recovery period will be required, participating in physical therapy exercises, mechanotherapy, diet, etc.
Rehabilitation
On average, the rehabilitation period after surgical treatment takes 90 days:
The main tasks of rehabilitation:
- the resumption of the patient's ability to move normally;
- optimization of the functioning of muscles and joints;
- creation of a protective block for the prosthesis.
Drainage is removed 2-3 days after the operation, after which you can try to walk carefully. To relieve pain, the doctor prescribes medications with a cooling effect. Minor pain symptoms sometimes persist for a year after the operation: this is due to the fact that the prosthesis needs time to heal. Elderly patients recover more: to alleviate their condition, NSAIDs are prescribed. In some situations, the attending physician prescribes hormonal agents that have a pronounced effect.
A week later, the patient enters the rehabilitation center under the care of an experienced physical therapist. When developing an exercise therapy course, individual body characteristics are taken into account. Classes are held regularly (daily), with gradually increasing loads: this protects against injuries and tissue ruptures.
Period after discharge
At the end of the stay at the rehabilitation center, the patient is discharged, giving him detailed recommendations on his future lifestyle. Dancing and light gymnastics are permitted after 6 months from the date of operation. As for heavy loads (sprinting, jumping, sports games, heavy squats), they should be completely excluded. Otherwise, the prosthesis will quickly fail.
Do not lift heavy objects weighing more than 25 kg. Inside the house, it is necessary to install support handrails: they are placed on the stairs, in the shower room and in the bathroom. All furniture must be fully functional (especially chairs). These and other measures will maximize the life of the prosthesis. You should also be prepared for postoperative osteoarthritis of the knee joint, which can last up to 3 years.
Prevention of the onset of the disease
The best way to deal with any illness is to prevent it from occurring.
effective waysknee osteoarthritis prevention:
- Proper nutrition while maintaining a normal weight. It is better to eliminate fatty and fried foods, alcohol, coffee, etc. , an experienced nutritionist can give detailed advice on this.
- Be careful when playing sports. It is desirable to minimize the load on the joints as much as possible.
- Be on the lookout for any diseases (especially infectious ones), treat them properly, and avoid chronic stages.
- Watch your posture, don't be negligent with diseases of the bones and spine.
- Include light physical activity in your daily routine (biking, swimming, walking, doing joint strengthening exercises).
- Avoid any self-treatment options for knee arthritis. At the first symptoms of the disease, you should immediately contact the clinic.
- Lead a calm lifestyle without stress and lack of sleep.
- Take steps to strengthen immunity (hardening, vitamin intake).
- Dress warmly in the cold season.
By applying the principles of a healthy lifestyle to your life and seeking timely medical help, you can minimize your risks of developing osteoarthritis of the knee joints. When choosing a clinic, preference should be given to proven treatment centers equipped with modern equipment.