Osteoarthritis of the knee joint (gonarthrosis) is a degenerative lesion of the joint, which eventually leads to its deformity. In it, the cartilage tissue begins to collapse. Gradually, the functionality of the knee is impaired and the patient loses the ability to move normally. This disease is very common.
Treatment for osteoarthritis of the knee is long term, but it cannot completely cure the problem. However, therapy is necessary in order to preserve the mobility and functionality of the joint for as long as possible, as well as to improve the patient's quality of life.
Types of diseases
It is possible to classify gonarthrosis of the knee joint for the reasons of its development. It is primary and secondary. The first type of disease occurs most often. It also has another name - idiopathic osteoarthritis. The exact reason for the development of this form of osteoarthritis of the knee is difficult to establish, as there are too many influencing factors.
The secondary type of pathology is clearly related to one reason or another. For example, it often occurs after a knee injury due to intense physical exertion of the knee joint. Such knee osteoarthritis is often genetically determined. Some diseases can also cause dystrophic changes in the knee joint: diabetes mellitus, rheumatoid arthritis, congenital deformity of the lower extremities.
Why the pathology develops
The knee joint is one of the most complex joints in the human body. It is formed by the femur, the tibia and the kneecap. The joint also includes triangular cartilage with curved edges - the menisci. The well coordinated work of the knee is ensured by the musculo-ligamentous apparatus. Almost all the bony surfaces of the joint are covered with cartilage tissue, the thickness of which is about 0. 5 cm. It feeds on blood vessels, as well as diffusely (obtaining useful substances from synovial fluid).
Knee cartilage allows bone surfaces to slide and cushion them. If the nutrition of this tissue is disturbed, then dystrophic processes begin in it, it becomes thinner. If left untreated, the cartilage completely disappears and the knee joint stops moving. The reason for the development of osteoarthritis may be different. For example, the following factors can provoke the appearance of a secondary form of pathology:
- Excessive stress on the knee joint. In this case, changes may occur that the person is not even aware of. Therefore, the load should be moderate, especially in the elderly. The greatest harm comes from squatting and running on hard surfaces (asphalt).
- Knee injury. It can include meniscus damage, joint dislocation, fracture. This reason contributes to the development of the disease in young people. After repairing the limb, blood circulation deteriorates. Damage or removal of the menisci in 90% of cases leads to osteoarthritis.
- Too much body weight. Excessive weight can damage the menisci. The restoration of the knee joint is long and difficult. In obese people, bilateral knee osteoarthritis often occurs. An additional negative point is the presence of varicose veins. In this case, the patient develops the most severe form of knee osteoarthritis of the knee.
- Weakness of the ligamentous apparatus. Because of this, joint mobility is too high. Despite the fact that a person can sit on the twine without any problems, even without warming up, the joint is currently suffering from microtrauma. If the knee is damaged enough, osteoarthritis begins to develop.
- Violation of metabolic processes. In this case, the knee joint is not receiving enough nutrients.
- Joint pathologies. The presented pathology can be caused by arthritis of the knee joint (reactive, rheumatoid). It is characterized by the development of inflammation and the accumulation of too much fluid in the joint cavity. The cartilage tissue in the knee begins to deteriorate.
- Stressful situation. Mood swings, the constant presence of the nervous system in a state of tension can provoke osteoarthritis of the knee joint.
- Congenital diseases of muscles, ligaments and dysplasia.
- Chondrocalcinosis (premature deposition of calcium salts in the cartilage of the knee). The pathology is systemic.
- Osteomyelitis. This is an inflammation of the bone marrow, in which purulent masses are formed. They negatively affect the surrounding tissues. Over time, the purulent masses protrude from the bone of the knee joint. Lack of treatment threatens the development of sepsis.
- Acromegaly. This is an endocrine disease in which the level of growth hormone - growth hormone - increases. Most often, a benign tumor of the anterior pituitary gland contributes to an increase in its amount. If such a disease develops in adolescence, the child develops a specific physique. The excessive growth rate of cartilage tissue leads to deformity of the knee joint.
- Diabetes.
- Hypothyroidism. This disease is also endocrine. It occurs due to a lack of thyroid hormones. A person's mass begins to increase, it moves little, and the cartilage in the knee joint wears out.
- Frostbite. In this case, ice crystals form in the soft tissues, which kill the living cells.
- Synovitis (inflammation localized in the synovial sac of the joint).
All these reasons are capable of causing knee osteoarthritis of the knee, while the person will not even notice when the disease has started to develop.
What stages does osteoarthritis go through in its development?
The effectiveness of knee treatment depends on the degree of development of the diagnosed osteoarthritis in the patient:
- Osteoarthritis of the knee of the first degree. Pain at this stage is little felt. The patient can endure discomfort for years, while he is in no hurry to contact specialists or carry out any kind of treatment. A person needs help during an exacerbation. The sudden onset of pain is not typical for osteoarthritis of the knee.
- Osteoarthritis of the knee joint of the 2nd degree. The intensity of the discomfort increases. Pain occurs not only after physical exertion on the knee joint, but also at rest. To get rid of unpleasant sensations, you need to rest more. At the level of the knee joint, swelling appears, the patient hears a cracking sound. The x-ray shows a narrowing of the joint space, a slight deformation of the knee joint.
- Third degree osteoarthritis of the knee joint. In this case, the mobility of the knee is severely limited, and sometimes the leg cannot fully straighten out. Joint pain becomes severe and constant, it appears as a response to changing weather conditions. The discomfort is painful in nature and it is difficult to get rid of even at rest. Often the patient's sleep is disturbed, and in order to alleviate his condition at least a little, he uses NSAIDs. A person develops lameness, and the deformation of the joint is very noticeable.
Treatment for osteoarthritis should be started as soon as possible, before the destruction of bone tissue becomes critical. In case of irreversible changes, only surgery can help the patient.
Symptoms of osteoarthritis of the knee
The development of osteoarthritis does not happen overnight. As it progresses, the symptoms become more intense. For knee osteoarthritis, the following manifestations are characteristic:
- Cracks and clicks that are heard with some movement. The patient may notice this symptom quite late. However, he says that the joint surfaces are damaged, furrows and bone growths have appeared there.
- Swelling and enlargement of the knee.
- Painful sensations. At the first stage of the development of osteoarthritis, they are invisible and can appear only after a large static load on the knee joint. Dynamic exercise, in turn, improves the condition of the joint, its nutrition and subsequent prognosis. Since the top layer of cartilage is erased in osteoarthritis, the nerve endings are exposed. After a while (after resting) the fibers are covered with a small layer of fibrin and become less sensitive - the knee pain goes away. If the knee joint continues to collapse, the discomfort does not leave the person even at rest. Edema appears in the bursa, which further compresses the nerves. The inflammatory process begins.
- Reduced mobility. This symptom makes it possible to differentiate osteoarthritis from other pathologies of the knee joint. Stiffness appears in the morning after sleep and disappears after half an hour. If this condition lasts longer, it indicates the presence of an inflammatory process.
- Decreased range of motion. The patient is not able to straighten the limb to the end. Since the patient is in constant pain, he tries to reduce the range of motion and the ligaments adapt to it. That is, they are shortened and do not allow the knee joint to fully perform its function.
- Blocked joints. It occurs as a result of a strong modification of the articular surfaces.
- Dislocations and subluxations. They appear at the last stage of the development of osteoarthritis, when the joint is severely deformed.
Over time, a person experiences muscle atrophy, overgrowth of osteophytes, and weakened lateral ligaments. The consequences of osteoarthritis are serious because a person becomes disabled.
How to correctly define osteoarthritis?
In order to begin the correct treatment of osteoarthritis, the patient must undergo a thorough examination. Diagnoses should be differential and include the following studies:
- X-ray of the knee joint. With knee osteoarthritis, it is performed in two projections. The specialist needs an x-ray of the damaged knee and the healthy knee. The x-ray can determine the following signs of osteoarthritis: narrowing of the joint space, osteophytes, subchondral sclerosis. Also, the presented study of the knee joint reveals subluxations, places of ossification of the cartilage tissue.
- Arthroscopy. This is a minimally invasive procedure that is used not only to diagnose osteoarthritis but also to treat it. It provides for the use of a special LED driver with a camera at the end. It is inserted through a small opening on the side of the knee. The entire image of the internal condition of the joint is reflected on the monitor. However, the procedure has one drawback - the joint is depressurized, and pathogenic microorganisms can enter it.
- Ultrasound. This diagnostic method is absolutely safe. The procedure examines the soft tissues of the knee, as well as the cartilage, synovium, and blood vessels.
- CT. This is an X-ray examination method, however, it allows you to see not only bone structures, but soft tissue as well. Using computer equipment, the specialist can build a three-dimensional model of the knee. However, to get accurate information, the patient must receive a large dose of radiation.
- Scintigraphy. This is an x-ray examination using a contrast agent.
- MRI. In this case, magnetic beams are used to obtain information. The image shows the soft tissue more clearly.
- Thermography. The procedure is based on recording thermal radiation from the surface of the patient's body. So you can identify tumors, foci of inflammation. One study is assigned for differential diagnosis.
- General blood test. It helps to determine the severity of inflammation, to determine its nature.
- General urine test. Thanks to him, it is possible to determine the systemic nature of the pathology.
- Blood chemistry.
With these diagnostic measures, specialists can accurately determine osteoarthritis of the knee and prescribe truly effective treatment.
Treatment of osteoarthritis of the knee
The treatment of osteoarthritis should be versatile and long-term. Since it will not be possible to completely stop the destruction of the joint, therapy will have to be carried out continuously in order to improve the patient's quality of life.
Drugs for the treatment of osteoarthritis
The doctor may prescribe the following medications:
- Non-hormonal anti-inflammatory drugs. They are used in the form of tablets and ointments. However, with severe pain syndrome, which cannot be ruled out by standard methods, an injection is used. It helps calm pain quickly, relieve swelling, and reduce the intensity of inflammation. These remedies can only eliminate the symptom, but cannot cure osteoarthritis. Only a doctor should prescribe these funds. The treatment lasts no more than 14 days, and relief comes already in 2-3 days.
- Chondroprotectors for osteoarthritis of the knee. Each of these drugs contains useful substances that can regenerate cartilage. However, it will only be effective if its application is started on time. If the cartilage is completely erased, the use of chondroprotectors will be unnecessary. Treatment with such means will be long-term (at least 6 months). Pills and topical medications are the most commonly used, although injections are possible.
- Vasodilators. They help relieve spasms and pain syndrome, restore normal blood circulation, and improve the nutrition of the knee joint.
- Glucocorticoids. Most often they are used in the most difficult cases, when other drugs do not give a positive effect. Intra-articular injections into the knee are used for osteoarthritis. They can only be used once a year.
- Enzymes. They ensure the regeneration of the cartilage structure in the initial stages of the development of osteoarthritis of the knee. They are also prescribed for injection into the joint.
- Hyaluronic acid. It allows smooth movement of the knee joint because it is able to replace synovial fluid.
- Local preparations - ointments, creams, gels. They also only relieve symptoms.
- Compresses of medicines. In this case, a drug is used that can penetrate the skin, helps remove muscle clamps and has a resorbing effect. The compress can be made with the help of medical bile.
Pharmacotherapy in the treatment of osteoarthritis is essential. However, drugs should be used strictly in the dosage prescribed by the doctor. It is impossible to independently increase or decrease the rate, to change the daily rate without the knowledge of a specialist.
Features of physiotherapy treatment and exercise therapy
You can also treat osteoarthritis of the knee joint using physiotherapy procedures:
- Massage. It helps restore normal blood circulation in the tissues, eliminate muscle spasms.
- Electrophoresis with drugs allows you to remove inflammation from the joint, and also produces an analgesic effect.
- Magnetic therapy. With the help of specific radiation, the tissues surrounding the affected right or left joint are stimulated. Metabolic processes in cells are improved.
- UHF. The waves promote the production of synovial fluid, which lubricates the knee.
- Phonophoresis with corticosteroids.
- Electrotherapy helps to remove not only the pain, but also the swelling.
- Mud therapy.
- Hirudotherapy.
- Shock wave therapy.
- Heat treatment. This includes paraffin therapy. Thanks to this procedure, the local blood circulation is improved.
- VMS therapy. This physiotherapy stimulates blood circulation, relieves swelling and helps improve the nutrition of cartilage tissue.
Physiotherapy is extremely helpful. It is necessary to restore the elasticity of muscle tissues and ligaments, to improve the mobility of the knee joint. The following exercises will be useful:
- Lying on your stomach, you need to take turns lifting your legs. In this case, they should not be bent at the knee. The lifting height is about 20cm.
- Lying on your left side, you need to bend your left leg and lift it 30 degrees. It is necessary to keep the limb in this position for up to 30 seconds. The same exercise should be done with the right leg.
- Sitting on a chair, the legs should be straightened and raised in turn as high as possible.
The set of exercises is selected individually by the attending physician. Gymnastics is best performed after a small massage with medicated ointments. Physiotherapy is an additional effective method of treating osteoarthritis, which enhances the effect of drugs.
Is surgery necessary?
In the most difficult cases, when the joint is severely destroyed by osteoarthritis, the patient is prescribed an operation. There are several types of interventions:
- Articulated traction. This involves stretching the joint damaged by osteoarthritis in order to increase the gap between the cartilages. This will prevent further destruction of the tissues and their gradual recovery.
- The stent is a complete replacement of a joint destroyed by osteoarthritis. It is performed as a last resort. The replacement can be full or partial. The prosthesis will need to be changed in 10-15 years.
- Osteotomy. Such treatment of osteoarthritis makes it possible to mechanically correct deviations of severely deformed bones. In this case, the solid elements break in a strictly defined place. Then the bones are positioned correctly and fused together.
- Arthroscopy. With its help, the restoration of the cartilage surface destroyed by osteoarthritis is carried out. In addition, by means of an arthroscope, foreign bodies and bone fragments can be removed from the joint. Such an operation is used for hypermobility of the joint. Arthroscopy is considered a minimally traumatic procedure, so rehabilitation after it does not last long.
It is better not to bring him for surgery. Treatment should be started at the first stage of development of osteoarthritis. Orthopedic devices will consolidate the result: a cane, an orthosis to reduce the load, knee pads with infrared radiation.
The use of folk remedies
It is impossible to completely cure osteoarthritis, because the degenerative process will gradually progress. However, you can eliminate the symptoms and stop the destruction of the knee joint in osteoarthritis. Folk remedies can be used during an exacerbation, as well as during relative calm. But first you need a specialist consultation. The following recipes will be useful for osteoarthritis:
- Chopped horseradish root should be boiled in a small amount of water over low heat. After that, the oatmeal should be filtered and put around the knee with osteoarthritis. The compress should be fixed with a bandage. You need to do the procedure every day for a month. The compress improves blood circulation and tissue repair.
- Rubbing any vegetable oil into the area of the knee joint for osteoarthritis will help remove the pain. However, it needs to be warmed up a bit.
- The mummy gives a good effect. Mix 3-4 g of raw materials with 100 g of honey and mix everything well. You should rub the medicine on the sore spot in the evening, before going to bed. Then wrap the affected area with a warm scarf. The welcome of the mummy inside is also welcome. You can use it at the rate of 0. 2 g per day.
- Fresh dandelion flowers can be washed thoroughly and eaten 5-6 pieces per day. Also dry the raw materials at the rate of 1 tbsp. you need to pour a glass of boiling water, insist and drink 1/3 cup three times a day.
- Rub the aloe leaves. It is necessary to twist 10 leaves of the plant and squeeze them through cheesecloth. The juice is mixed with half a glass of honey and 150 ml of red wine. The resulting product is poured into a dark glass container and applied every day for a month.
Cabbage and burdock leaves will help relieve inflammation in osteoarthritis. Folk remedies cannot be considered a panacea, but they increase the effectiveness of other types of therapy.
Nutritional rules for osteoarthritis
The treatment of osteoarthritis does not require a particularly strict diet, but it is still necessary to respect some nutritional rules:
- Reduce your salt intake. Its total amount per day should not exceed 2 g. It is best to salt the dish just before use, and not during cooking.
- The amount of spices used in the treatment of osteoarthritis should also be reduced. The same goes for fermented foods, pickles. Marinades and preserves are generally best to be excluded from the diet.
- Animal fats are not recommended.
- The menu should not contain sweets, pastries and bread made from wheat flour.
- With osteoarthritis, alcohol and nicotine are strictly prohibited.
- Dishes with gelatin are useful: aspic, jelly meat, beef bone broths.
- It is important for osteoarthritis to consume milk proteins (the products should not be fatty), fish, seafood.
- The diet should contain vegetable oils, vegetables and fruits, freshly squeezed fruit juices.
- A person should consume a sufficient amount of fluids per day.
The proper diet for osteoarthritis should be developed by a specialist. You cannot go to extremes even if the patient is overweight. Dramatic and inappropriate weight loss will only make your health worse. In this case, the processing will be significantly delayed.
Prevention of osteoarthritis
To avoid the possibility of developing osteoarthritis, as well as not to lose the ability to walk, you should follow the following expert advice:
- We must not forget the movement. Better to go to the swimming pool, to cycle, to hike in the great outdoors. You can also go to balls.
- It is advisable to avoid injury and hypothermia of the knee joint, as this causes post-traumatic arthritis.
- It is best to use protective knee pads or other braces for prolonged exertion.
- It is advisable to wear comfortable shoes.
- It is important to eat well - osteoarthritis will not stand a chance if all the necessary nutrients are supplied to the joint on a regular basis.
- If you are overweight, you should get rid of it.
- It is better to avoid stress, as well as to properly organize the routine of work and rest.
- It is necessary to strengthen the body's defenses.
- All inflammatory or infectious pathologies that can provoke the development of osteoarthritis must be eliminated in time.
Proper prevention can significantly delay the destruction of joints, which under normal conditions is a natural aging process in the body.
Osteoarthritis of the knee is an incurable disease, but its progression can be slowed or even stopped by improving the quality of life.