All types of osteoarthritis occur with degenerative and dystrophic processes in the joint tissue. The disease always becomes chronic and is not completely cured, you can only slow down or stop its development.
According to ICD-10, gonarthrosis (damage to the knee joints) belongs to the group under the code "M17". The emphasis in treatment is on drug therapy, surgery is used only when the course is advanced.
What happens to the knee joint with osteoarthritis?
Osteoarthritis of the knee joint is accompanied by degenerative and dystrophic processes, which, if left untreated, progress steadily. In this case, no inflammatory processes are observed, except in rare cases.
At first, degeneration and dystrophy of the joint have practically no effect on the functionality of the knee. Over time, these processes lead to disruption 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 rate of disease progression. The process of degeneration of hyaline cartilage begins very quickly, its thinning, stratification and later the appearance of cracks on it.
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: due to the exposure of the bone, the bone begins to thicken and bone growths (often in the form of thorns) appear on it.
All this leads to deformation of the affected limb, followed by its distortion. It is for this reason that the disease is also called "deforming arthrosis". With a pre-existing deformity of the limb, the disease cannot be cured without surgery.
The reasons for the development of the disease
Most often, the development of osteoarthritis of the knee is preceded by the appearance of several predisposing factors. It is not necessary to have congenital risk factors at all, the disease often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Severe disorders of metabolic / metabolic processes in the body (any 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 a serious increase in the load on the musculoskeletal system as a whole.
- Injury of the knee joints (including direct injuries, penetrating wounds, ruptures of the ligament apparatus, injuries of the menisci, fractures, dislocations and subluxations, cracks).
- Inflammatory pathologies suffered in the recent past (mainly arthritis or rheumatism).
- Excessive physical activity (risk group includes athletes, gymnasts, people playing tennis, football, basketball).
- The consequences of long-term, poorly treated knee injury.
- Congenital defects and abnormalities in the structure of joint tissues, hereditary risk factors (genetic mutations).
There is a direct relationship between the cause and severity of osteoarthritis. If metabolic disorders or severe injuries are the cause, the prognosis is worse than in the case of the development of osteoarthritis on the background of joint overload or age-related dystrophic changes.
Morbidity statistics
Statistically, osteoarthritis of the knee joint is very common; it occupies one of the leading places among all forms of osteoarthritis in general. Approximately 20% of patients applying to specialized medical institutions suffer from gonarthrosis.
If we take into account all diseases of the knee joints, then among them the share of osteoarthritis falls on about 53% of cases. Recently, there has been an increase in the number of cases of gonarthrosis among the population, especially in developed countries.
This is associated with an increase in life expectancy (the older a person is, the greater the risk of this form of osteoarthritis) and the predominance of a sedentary lifestyle. And that's really a problem, because doctors still can't completely cure gonarthrosis.
Why is gonarthrosis dangerous?
The main danger of gonarthrosis is disability due to the development of complications that are not subject to conservative therapy. First of all, it is a deformation of the joint and bone of the affected limb. Disability is possible in the third stage of the disease.
The second danger is the development of chronic severe pain, which can disturb the patient so much that he will not be able to sleep normally. Constant waking due to knee pain is one of the most common problems in stage 3-4 of gonarthrosis.
Fatal consequences precisely because of gonarthrosis do not occur. In theory, a serious injury can occur due to a sudden blockage of the joints. This is the so-called symptom of joint blockade, most often observed in 3-4 stages of the disease.
The degree of gonarthrosis 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. Also, each stage of osteoarthritis is treated in a special way (although differences in treatment regimens may seem small to a non-physician).
The degree of gonarthrosis:
- first degree: the disease practically does not manifest itself in any way, only slight discomfort is possible, but in general the patient feels well and therefore it is very problematic to diagnose the disease in the first stage;
- second degree: severe painful sensations appear, especially after a long walk or standing; during physical activity a characteristic crisis develops, the process of atrophy of the quadriceps femoris muscle can already begin;
- third degree: the pain becomes excruciating, constantly bothers the patient, there are pronounced deformative changes in the joint, it becomes hot to the touch, normal walking or even more running is impossible;
- fourth degree: it is very difficult with severe deformities of the joint and constant pain that does not even allow the patient to sleep; joint dysfunctions are so pronounced that ankylosis (complete immobilization of the affected joint) is possible.
The first two degrees of gonarthrosis are considered conditionally favorable, as they practically do not interfere with a person's normal life. The last two stages are very severe and lead to damage.
Symptoms of gonarthrosis at different stages
The clinical picture of gonarthrosis depends on the stage of the disease. In the first stage there may be no symptoms, while in the fourth stage they are very pronounced and do not cease to bother the patient even with powerful drug therapy.
Symptoms of stage 1:
- Mild discomfort or pain with severe stress on the joint.
- Barely noticeable crisis.
- Slight increase in joint size.
Symptoms of stage 2:
- pain of moderate intensity, usually occurring with a period of exacerbations and remissions;
- the joint becomes warm to the touch;
- reddening of the skin over the affected joint is possible;
- moderate knee dysfunction (walking and running is still possible, but with some difficulty);
- increased pain in the morning and after a long stay in an upright position.
Symptoms of stage 3:
- severe pain that bothers the patient around the clock, but during periods of exacerbation (causes exacerbation for each patient), the pain intensifies several times;
- visible deformative changes in the knee, its increase in size;
- the affected joint becomes hot on palpation;
- normal movement is impossible due to partial immobilization of the joint;
- possibly a curvature of the lower leg.
Symptoms of stage 4:
- the pain becomes excruciating, does not allow the patient to do everyday things (including intellectual, because the pain impairs cognitive functions);
- the appearance of synovitis due to the accumulation of effusion in the cavity of the knee cartilage;
- now the deformative changes are now clearly visible not only in the joint but also in the limb as a whole;
- sensation of oscillations on 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 blockades, but the blockades can not be done daily.
Diagnosis
The emphasis in diagnosing osteoarthritis of the knee is on imaging techniques, while laboratory tests usually show nothing.
Diagnostic methods used:
- Examination by an orthopedist with palpation of the affected joint, linear bone measurements, angiometry.
- Clinical blood tests (total and erythrocyte sedimentation rate / ESR), determination of fibrinogen levels in the blood and urine and especially urea, as well as other biochemical parameters.
- Radiography (narrowing of the joint space, deformities, sclerosis of cartilage, accumulation of salts and even bone osteophytes).
- Ultrasound examination (for differential diagnosis only).
- Magnetic resonance imaging or computed tomography (the most informative, in terms of image, diagnostic methods).
An X-ray is usually sufficient to make a diagnosis, especially if the disease is advanced. In relatively rare cases, computed tomography or magnetic resonance imaging is required.
Treatment of gonarthrosis: methods
The treatment of osteoarthritis of the knee is only complex, as no method of treatment is isolated from others with good effect (even drugs). The treatment is long, can last for years, sometimes even prescribed for the rest of your life.
Used treatment methods:
- drug therapy - the basis of treatment;
- physiotherapy exercises;
- dietary therapy;
- physiotherapy treatment;
- surgical intervention.
The main thing in the treatment of osteoarthritis is the systemic nature of the process and the indisputable observance of the recommendations of the attending physician. Attempts to treat gonarthrosis independently, including disregarding the doctor's prescription, usually end in disability.
Exercise therapy
Physiotherapy exercises are most suitable for the treatment of 1-2 stages of osteoarthritis of the knee joints. At such stages, this is almost the main method of treatment, as physical education can slow the progression of the disease and eliminate most of the symptoms.
However, there is no special meaning from the classical physical education, it can be harmful. Therefore, the patient is prescribed special exercises and individually (because gonarthrosis can occur differently in different patients).
There are no deadlines for treatment with exercise therapy methods - ideally you should engage in prescribed exercises for life, visiting a doctor from time to time for dynamic monitoring of the joint. It is very useful to combine exercise with exercises in the pool (there the load on the joints is much less).
Diet
Although dietary correction can be very helpful, it is not a mandatory method of treatment. Only in 40% of cases dietary therapy gives noticeable results and usually in those people in whom the appearance of osteoarthritis is provoked by endocrine pathologies.
The patient is instructed to give up fatty, fried, salty and smoked foods. A ban on the use of alcoholic beverages is introduced, and sometimes smoking is banned. At the same time, the consumption of large quantities of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or wingers can not be called meat products. The patient is instructed to eat lean meat, boiled chicken is especially useful (due to the relatively low calorie content and high protein content).
Physiotherapy
Physiotherapy procedures are useful only in terms of relieving the symptoms of osteoarthritis, but do not directly affect the disease. That is, it is not possible to cure even the first stage of osteoarthritis with the help of physiotherapy, no matter what some "specialists" say there.
Physiotherapy is good for relieving pain, but only if it is mild. In severe pain (stage 3-4 of osteoarthritis) physiotherapy will not help, as well as most drugs (especially for oral administration).
The most preferred for the treatment of osteoarthritis are magnetic therapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Impact physiotherapy techniques are prohibited due to the threat of additional joint damage.
Operation
Surgery is required only at 3-4 stages of the disease, when conservative methods are no longer needed. Different types of procedures can be used: drainage of the joint cavity, removal of bone osteophytes, replacement (prosthesis) of the joint.
To restore the functionality of the joint, it is best to transplant it, but the problem is that this 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 change the joint.
The fact is that such a procedure is contraindicated in patients in severe condition or in patients over 65-70 years. Keep in mind that each knee operation has its own risk of complications (even fatal complications are possible, but they are very rare).
Medicines
Along with physiotherapy exercises are the basis of treatment and its mandatory component. If other procedures still cannot be used, then it is impossible to do without drug therapy along with exercise (traditional medicine cannot replace drug therapy).
The patient is prescribed painkillers (with severe pain - blockade), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid are possible (replacing the physiological lubrication of the joints).
Medications can really affect the disease only in 1-2 stages of osteoarthritis. In stages 3-4 of the disease, drug therapy only acts as a way to deal with the symptoms, while nothing but surgery can affect the disease.
The nuances of treatment in the acute stage and in remission
Approaches to treating osteoarthritis of the knee during exacerbation and remission are slightly different. In the exacerbation stage, aggressive therapy is used, aimed at the fastest possible recovery of joint function and elimination of symptoms.
The pain reaches its peak exactly at the stage of exacerbation of the disease, which is why in such cases drug blockades can be prescribed.
Nonsteroidal anti-inflammatory drugs may be prescribed. Despite the fact that osteoarthritis usually occurs 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 limb.
On the contrary, in the remission stage, physical exercises are prescribed and, in general, an increase in physical activity is prescribed. The reason is that in the remission stage, normal walking is possible, as joint function improves and the pain is usually of moderate intensity.
It is necessary to skillfully use remission - this is the very period when classes in swimming pools, classes with a rehabilitation therapist and attempts to restore the functionality of the joint are possible. At this stage you can not do without medication.
Chondroprotectors, oral painkillers are most often prescribed (at the patient's discretion, because if the pain is barely noticeable, you do not need to take them). Ointments, gels and creams, including those with a warming effect (which is better not to use during exacerbations) may be prescribed.
In addition, massage may be prescribed, including manual therapy (only if the disease is in stages 1-2). With the permission of the doctor, special gymnastic techniques can be used.
Remission is the ideal time for physiotherapy, but the choice of a specific physiotherapy should be made by the doctor, not the patient. Finally, if necessary, during remission, injections of hyaluronic acid preparations can be given.
In exacerbation of osteoarthritis hyaluronic acid is not prescribed, as against the background of inflammation such injections will lead to serious consequences. Please note: injections should only be given by a suitably qualified person.
Ordinary doctors and even more so paramedics (paramedics, nurses) are not allowed to give such injections. Self-injections into the joint are fraught not only with injury but also with death (due to the threat of anaphylactic shock or a blood clot if the needle accidentally enters the vessel).
Prognosis for treatment
The prognosis for the treatment of gonarthrosis varies 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 in people of working age.
In stage 3-4 of osteoarthritis, the prognosis is extremely poor, both in young patients and in the elderly. Although it has been observed that young people tolerate osteoarthritis much more easily at such stages, it still inevitably leads to damage.
However, the presence of osteoarthritis stage 3-4 is not equivalent to a sentence. In fact, with the help of surgery, you can try to restore, if not all the functionality of the knee, then most of it. 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 following fairly 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 excessive strain on the joints (such loads include professional sports).
- Rational nutrition, with a predominance of fruits and vegetables in the daily diet.
- Maintaining good physical shape, regular gymnastics.
- Prevention or elimination of obesity (more body weight - more stress on the joints in the body).
- Preventive treatment with chondroprotectors after the age of 45 (only after consulting a doctor).
- Adequate daily fluid intake (about 1. 5 liters of water per day), minimizing salt intake.
The main thing is not to overdo physical activity, as it is useful only in moderation (if there is no wear and tear of the musculoskeletal system). Physical education is useful, sports are not, especially for the joints and cardiovascular system.