One of the most common pathologies of the musculoskeletal system is knee joint arthrosis (otherwise gonarthrosis) is a chronic disease, accompanied by dystrophy and destruction of knee joint structures.
The result of destructive processes is a clear restriction or complete loss of joint mobility and, as a result, a decrease in performance, disability.
Adverse consequences can be avoided only if you are diagnosed early and time therapy.
Reasons
By origin, knee arthrosis is primary and secondary.Primary develops as an independent disease, is more often diagnosed in the elderly and, in this case, is due to changes related to the age that occur in tissues.Secondary gonarthrosis becomes the result of other diseases and disorders in the body.
The development of gonarthrosis contributes to:
- lesions (displacements, fractures, damage to the meniscus);
- Diseases of the musculoskeletal system (congenital leg deformation, knee dysplasia, chondrocalcinosis, arthritis, osteoporosis);
- High loads on the board due to professional activities, professional sports;
- overweight, obesity;
- Endocrine diseases, including diabetes, hypothyroidism, acromigalia;
- metabolic disorders;
- Genetic predisposition.
Symptoms
Inflammation with knee joint arthrosis is accompanied by two main clinical manifestations - pain and edema.The intensity and frequency of the appearance of pain depends on the depth of damage to joint structures.In the early stages, the pain is felt only with one load, quickly passes at rest.With advanced gonarthrosis, painful pain is constantly present, intensifies during movements, with a change in climate.
Other signs of knee articulation arthrosis:
- crispy when moving;
- Articulation stiffness, violation of motor function;
- Knee deformation (with neglected gonarthrosis).
Gonarthrosis can be accompanied by synovitis (fluid accumulation in the joint cavity) and the subsequent formation of a baker cyst (elastic background in the back of the knee).
Degree of arthrosis
The symptoms of knee joint arthrosis differ depending on the depth of damage to knee structures and, therefore, the three stages of the pathology are distinguished.
- Knee Articulation Arthrosis 1 DegreeIt is manifested by weak load pain (at rest, passes at once), with slight stiffness after sleep.In the radiographic framework, an insignificant narrowing of the joint gap (less than one third) is observed the presence of unique osteophytes (bone growth).
- Knee articulation arthrosis 2 degreesIt is accompanied by pain and characteristic crisis during the movements.The pain persists for some time at rest.Morning stiffness, observing restriction of the amplitude of the movements.Diagnosis procedures reveal a pronounced narrowing of the joint gap (more than half) and multiple osteophytes.
- Knee arthrosis 3 degreesIt is accompanied by painful constant pain, which, during movements and at night, intensifies.Morning stiffness remains more than an hour with an exacerbation of inflammation and at least half an hour - during periods of remission.Articulation mobility is markedly limited or completely lost.In the radiographic image, several large osteophytes, the cysts are visible.The joint gap is reduced by more than two thirds of the norm.
Depending on the degree of knee joint arthrosis, the patient receives conservative or surgical treatment.
Diagnosis
The diagnosis of knee joint arthrosis includes visual examination, analysis of patient complaints, laboratory tests (urine analysis, general blood and biochemical tests) and instrumental examination methods.
The following diagnostic procedures allow you to confirm or refute the diagnosis:
- Radiography;
- Ultrasound (ultrasound);
- Magnetic resonance imaging (magnetic resonance imaging);
- CT (computed tomography);
- Arthroscopy and scintigraphy (with suspected tumor).
Using these methods, it is possible to detect narrowing of joint gap, the degree of striking and deformation of the cartilage, the presence of fluid in the joint cavity, structural changes in the synovial membrane, the growth of osteophite and outbreaks of cartilage ossification.
Conservative treatment
Conservative treatment methods can reduce pain and inflammation, improve blood circulation and periastate tissue nutrition, strengthen the muscular apparatus.
For this purpose, they are kept:
- Drug Therapy;
- block;
- Physiotherapy and Manual Therapy;
- Medical Physical Education.
An important component of arthrosis treatment is the observance of a therapeutic diet.
Conservative treatment of knee joint arthrosis will be effective at the early stage of the disease, when lower dystrophic cartridges of cartilage, inflammation and impaired synovial shell.
Drug
The drug treatment includes the appointment:
- Non -Steroid (NSAIDs) anti -inflammatory drugs;
- Condropoprotectors;
- Hyaluronic acid.
Aine
Non -esteroid anti -inflammatory drugs help alleviate inflammation, reduce their main symptoms -dema and pain.
Preparations are prescribed in the form of solutions (for intramuscular administration) or compresses, capsules (for oral administration).The Capsules and compresses of arthrosis of the Knee Articulation of the AINE group are performed in short courses, as medications have a strong annoying effect on the gastric mucosa and can cause the development of peptic ulcer, have many other side effects.
In addition, prescribed external drugs (ointments, gels, creams) based on non -esteroid anti -inflammatory components.Local therapy can be performed longer.
NSAIDs have a pronounced anti -inflammatory effect, but with prolonged use contributes to the additional destruction of the cartilage.
NSAIDs are symptomatic therapy.They help eliminate unpleasant symptoms of the disease, but do not affect the condition of cartilage.In contrast to these products, chondoprotectors and hyaluronic acid accelerate the processes of cartilage tissue regeneration and decrease its destruction.
Chondoprotectors
CondoProtective group medications contain chondroitin and glucosamine (structural elements of cartilage) and help restore the knee with knee joint arthrosis.They are available in the form of tablets, powder for oral administration, a solution for injection.
The minimum course to take pills and powder is 3 months.After a break, the course is repeated 2-3 times.The course of treatment with a solution includes 12 to 15 injections is repeated 2-3 times a year.
The first positive results of chondroprotective treatment are visible just a few months after therapy began.
Hyaluronic acid
Hyaluronic acid is introduced injected into the affected joint.The cure for knee joint arthrosis plays the role of lubrication - involves joint surfaces, thus reducing friction between them.
Hyaluronic acid therapy medications help increase the elasticity of cartilage tissue, prevents additional destruction of joint structures, which improves joint mobility, symptoms of inflammation are reduced.The medications are well tolerated, do not cause side effects.Their only disadvantage is their high cost.
The course of hyaluronic acid treatment usually includes 3-4 injections, which are performed at intervals of 10 to 14 days.
Blockade
If with anti -inflammatory drugs non -esteroids, it is not possible to relieve knee pain with arthrosis, a blockade -a method of treatment in which medications are injected directly into the tissues affected to relieve pain and inflammation.In arthrosis therapy, joint blocks (injections in the joint cavity) and periarticular (in the periarticular cavity) are used.
The main advantage of the method is an instant intentional action, because with this introduction, the maximum concentration of the active substance is created precisely in the inflammation zone.In addition, medicines do not fall into the systemic bloodstream, which significantly reduces the risk of adverse reactions.
In the posterior stages of gonarthrosis, joint gaps narrow, osteophytes grow, joint surfaces are deformed;Therefore, only the periricular block is allowed.
Knee joint block for arthrosis can be performed using anesthetics and corticosteroids.
Anesthetics are usually introduced in combination with steroid hormones to reduce the pain of the procedure.
Hyaluronic acid and chondroprotectors can also be introduced directly into the joint.But in this case, we are not talking about blocking, but about intra -articular injection, since these medications do not block the impulses of pain, but trigger the processes of cartilage tissue regeneration.
Physiotherapy and Manual Therapy
The main methods of physiotherapeutic effects that are used in the treatment of arthrosis include:
- laser treatment;
- Ultrasound therapy;
- Cryotherapy;
- Paraffin and OzoKerite therapy;
- Mud.
The main task of all physiotherapeutic procedures is to stimulate blood circulation in nearby tissues, improve cartilage nutrition.
Exercise therapy
Pain syndrome forces a gonarthrosis patient to limit motor activity as a result of which nearby ligaments and muscles atrophe.This condition negatively affects joint tissues, as it is during movement that nutrients penetrate the synovial fluid in cartilage.If the joint is constantly at rest, the dystrophic processes will be aggravated.
This is why physical therapy exercises are an integral component of conservative therapy.Moderate physical activity allows to strengthen the muscle tract, improve the power of joint structures, eliminate rigidity and improve knee motor function.
Therapeutic exercise exercises are developed by the doctor individually for each patient, taking into account the depth of the lesion and the functional state of joint structures.
General recommendations for performing exercises for knee joint arthrosis:
- Start the classes only after interruption of acute inflammation signs;
- Perform all exercises without problems, without sudden movements;
- The load is gradually increased;
- eliminate high loads on the joint (flexion/improved knee extension);
- If pain or discomfort appears, stop training.
Diet
With gonarthrosis, products containing: containing:
- Amino acids (dairy products, varieties of low -fat meat);
- collagen (dishes with gelatin);
- irreplaceable fatty acids (vegetable oils, fish);
- Sulfur and selenium (vegetables, cereals, cabbage and apples, beef, chicken, eggs).
It is also important:
- eliminate the use of smoked meat, pickles, marinated;
- Limit salt consumption;
- adhere to a diet 5 times;
- Note the way of drinking.
Excessive body weight is one of the main factors that cause the development of knee joint arthrosis.Therefore, the task of overweight patients is a decrease in body weight.In this case, you can achieve the result only with the help of a diet, as intensive sports are harmful to the inflamed joint.
To reduce body weight, it is recommended to delete from the menu:
- fatty varieties of meat and fish;
- Cream, homemade sour cream and other dairy products with a high percentage of fat content;
- Margarine, mayonnaise, various sauces;
- confectionery;
- fast food;
- Sweet drinks.
Surgical treatment
Third degree knee arthrosis is not subject to conservative therapy;Therefore, the operation is the only output for the patient.
There are two options for surgical intervention:
- Corrective osteotomy- It is performed at the early stage of development of the third stage of gonarthrosis, if the cartilage is partially destroyed, it is possible to remove osteophytes;
- Endoprostrate- The replacement of the joint or its destroyed pieces is performed with the complete destruction of the cartilage.
Forecast
Pathological changes in joint structures are progressive, irreversible.However, with early diagnosis and proper treatment, you can completely interrupt inflammation and interrupt dystrophic changes in cartilage tissue - the arthrosis of the 1st degree knee joint is well led to conservative therapy.
With the arthrosis of the 2nd degree, which is accompanied by the destruction of the cartilage and the formation of osteophytes, conservative methods allow to decelerate or suspend cartilage deformation, interrupt inflammation and improve motor activity.However, doctors are often forced to resort to blockade, arthroscopy.
It is impossible to cure 3 -degree knee arthrosis in a conservative way.The only way to restore knee mobility is surgical intervention.