All types of osteoarthritis occur with degenerative and dystrophic processes in the joint tissue. The disease always acquires a chronic character and is not completely cured, you can only slow down or stop its progression.
According to ICD-10, knee osteoarthritis (damage to the knee joints) belongs to the group under the code "M17". Treatment emphasizes drug therapy, surgical intervention 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, inflammatory processes are not observed, except in rare cases.
Joint degeneration and dystrophy initially have virtually no effect on the functionality of the knee. Over time, these processes lead to a violation of the structure of the joint, it stops "slipping", bumps appear on its surface (due to changes in deformation).
Blood circulation decreases, local metabolism (metabolic processes) worsens, which only increases the rate of progression of the disease. 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 does not end there: due to the exposure of the bone, it begins to thicken and bone growths appear on it (often in the form of thorns).
All this also leads to deformity of the affected limb, followed by its curvature. It is for this reason that the disease is also called "arthritis deformans". With an already 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 at all necessary to have congenital risk factors, the disease very often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Severe disorders of metabolic / metabolic processes in the body (any acute or chronic serious disease of the thyroid gland, adrenal glands).
- Circulatory disorders and presence of a tendency to capillary bleeding (due to their fragility).
- Overweight (obesity stage II-III) with a significant increase in the load on the entire musculoskeletal system.
- Injury to the knee joints (including direct injuries, penetrating wounds, ruptures of the ligamentous apparatus, meniscus injuries, fractures, dislocations and subluxations, cracks).
- Inflammatory pathologies that have occurred in the recent past (mainly arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, people playing tennis, football, basketball).
- The consequences of a long-standing and poorly treated knee injury.
- Congenital malformations and abnormalities in the structure of joint tissues, hereditary risk factors (genetic mutations).
There is a direct link between the cause and the severity of osteoarthritis. If metabolic disorders or serious injuries are the cause, the prognosis is worse than with the development of osteoarthritis on the background of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, osteoarthritis of the knee is very common, it occupies one of the first places among all forms of osteoarthritis in general. About 20% of patients who go to specialized medical institutions suffer from knee osteoarthritis.
If we consider all the 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 knee osteoarthritis among the population, especially in developed countries.
This is linked to an increase in average life expectancy (the older a person, 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 aren't able to completely cure knee osteoarthritis.
Why is knee osteoarthritis dangerous?
The main danger of knee osteoarthritis is disability due to the development of complications that do not lend themselves to conservative treatment. First of all, it is a deformation of the joint and bone of the affected limb. Disability is possible from the third stage of the disease.
The second danger is the development of severe chronic pain, which can disturb the patient so much that he will not be able to sleep normally. Constant arousal from knee pain is one of the most common problems in stage 3-4 of knee osteoarthritis.
Fatal consequences precisely because of knee osteoarthritis do not occur. In theory, a serious injury could occur due to a sudden blockage in the joint. This is the so-called symptom of joint blockage, most often seen in 3-4 stages of the disease.
The degree of knee osteoarthritis 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. In addition, each stage of osteoarthritis is treated in a unique way (although the differences in treatment regimens may seem small to a non-physician).
The degree of knee osteoarthritis:
- first degree: the disease practically does not manifest itself in any way, only slight discomfort is possible, but in general the patient feels good, and therefore it is very problematic to diagnose the disease at the first stage;
- second degree: severe painful sensations appear, especially after a long walk or standing; a characteristic tightening develops during physical activity, the process of atrophy of the quadriceps femoris muscle may already begin;
- third degree: the pains become excruciating, constantly disturb the patient, pronounced deforming changes in the joint appear, 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 is possible (complete immobilization of the affected joint).
The first two degrees of knee osteoarthritis are considered conditionally favorable, since they practically do not interfere with a person's normal life. The last two stages are very severe and lead to disability.
Symptoms of knee osteoarthritis at different stages
The clinical picture of knee osteoarthritis depends on the stage of the disease. At the first stage, there may be no symptoms, while at the fourth stage they are very pronounced and do not cease to bother the patient, even under strong drug therapy.
Stage 1 symptoms:
- Slight discomfort or pain with significant stress on the joint.
- Barely noticeable crunch.
- Subtle increase in joint size.
Stage 2 symptoms:
- pain of moderate intensity, usually occurring with a period of exacerbations and remissions;
- the joint becomes hot to the touch;
- redness of the skin on the affected joint is possible;
- moderate knee dysfunction (walking and running are still possible, but with some difficulty);
- increased pain in the morning and after a long stay in a standing position.
Stage 3 symptoms:
- severe pains that bother the patient around the clock, but during periods of exacerbation (exacerbation triggers for each patient) the pain intensifies several times;
- visible deforming 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 curvature of the lower leg.
Stage 4 symptoms:
- the pains become excruciating, do 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 cartilage cavity of the knee;
- now the deformative changes are already clearly visible not only in the joint, but also in the limb as a whole;
- a feeling of fluctuation on palpation of the kneecap and surrounding tissues;
- almost complete or even complete immobilization of the knee joint (in this case, only surgery will 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 blockages, but the blockages cannot be performed on a daily basis.
Diagnostic
The emphasis in diagnosing osteoarthritis of the knee is on imaging techniques, while lab tests usually show nothing.
Diagnostic methods used:
- Examination by an orthopedist with palpation of the affected joint, linear measurements of the bones, angiometry.
- Clinical blood tests (total and erythrocyte sedimentation / ESR), determination of levels of fibrinogen in blood and urine and, above all, urea, as well as other biochemical parameters.
- Radiography (narrowing of the joint space, deformities, sclerosis of the cartilage, accumulation of salts and even bone osteophytes are revealed).
- Ultrasound examination (only for differential diagnosis).
- Magnetic resonance imaging or computed tomography (the most informative diagnostic methods in terms of imaging).
Usually, an x-ray is enough to make a diagnosis, especially if the disease is at an advanced stage. In relatively rare cases, magnetic resonance or computerized imaging is required.
Treatment of knee osteoarthritis: methods
Treatment of osteoarthritis of the knee is only complex, since no treatment method is isolated from others with a good effect (even drugs). The treatment is long, it can last for years, sometimes it is even prescribed for the rest of your life.
Treatment methods used:
- drug therapy - the basis of treatment;
- physiotherapy exercises;
- diet therapy;
- physiotherapy treatment;
- surgical intervention.
The main thing in the treatment of osteoarthritis is the systematic nature of the process and unconditional compliance with the recommendations of the attending physician. Attempts at independent treatment of knee osteoarthritis, including ignoring a doctor's prescription, usually end in disability.
Exercise therapy
Physiotherapy exercises are best suited for treating 1 to 2 stages of osteoarthritis of the knee joints. At such stages, it 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 of classical physical education, it can also be harmful. Therefore, the patient is prescribed special exercises and individually (since knee osteoarthritis can proceed differently in different patients).
There is no time limit for treatment with exercise therapy methods - ideally you should engage in prescribed exercises for life, occasionally consulting a doctor for dynamic monitoring of the joint. It is very useful to combine exercise therapy with exercises in the pool (there the load on the joints is much less).
Diet
Although nutritional correction can be very helpful, it is not a mandatory method of treatment. Only in 40% of cases, diet gives noticeable results, and usually in people in whom the onset of osteoarthritis was caused by endocrine pathologies.
The patient is advised to give up fatty, fried, salty and smoked foods. A ban is introduced on the consumption of alcoholic beverages, sometimes smoking is also prohibited. At the same time, the consumption of large amounts of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or smoked sausages can not be called meat products. The patient is advised to consume lean meats, boiled chicken is especially useful (due to its relatively low calorie content and high protein content).
Physiotherapy
Physiotherapy procedures are only helpful in relieving the symptoms of osteoarthritis, but they do not directly affect the disease. That is, it is impossible to cure even the first stage of osteoarthritis with the help of physiotherapy, no matter what some "specialists" say.
Physiotherapy is good for relieving pain, but only if it is mild. With severe pain (stage 3-4 of osteoarthritis), physiotherapy will not help, as will most medicines (especially for oral use).
The most preferred for the treatment of osteoarthritis are magnetotherapy, quantum therapy, mud therapy, acupuncture, and hirudotherapy (leech therapy). Shock physiotherapy techniques are prohibited due to the threat of further joint damage.
Surgery
Surgical intervention is required only in 3-4 stages of the disease, when conservative methods are no longer required. Different types of interventions can be used: drainage of the joint cavity, removal of bone osteophytes, (prosthetic) joint replacement.
To restore the functionality of the joint, its transplant is the best, but the problem is that it 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 replace the gasket.
The fact is that such a procedure is contraindicated in patients in severe condition, or in patients over 65-70 years of age. Keep in mind that any knee surgery comes with its own risks of complications (even fatal complications are possible, but they are very rare).
Medication
Along with physiotherapy exercises are the basis of treatment and its obligatory component. If other procedures still cannot be used, then it is impossible to do without drug therapy in combination with exercise therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed analgesics (with severe pain - blockage), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid (replacing physiological lubrication of the joints) are possible.
Drugs can only really affect the disease in stages 1-2 of osteoarthritis. At 3-4 stages of the disease, drug therapy only plays a role in treating symptoms, while nothing other than an operation can affect the disease.
The nuances of treatment at the stage of exacerbation and remission
The approaches to treating osteoarthritis of the knee during exacerbation and remission are somewhat different. At the stage of exacerbation, aggressive therapy is used, aimed at restoring joint function as quickly as possible and eliminating symptoms.
The pain reaches its peak precisely at the stage of exacerbation of the disease. Therefore, in such cases, drug blockages may be prescribed.
Nonsteroidal anti-inflammatory drugs may be prescribed. Despite the fact that osteoarthritis usually proceeds 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, at the stage of remission, physical exercises are prescribed, and in general, an increase in physical activity is prescribed. The reason is that it is in the remission stage that normal walking is possible, as the function of the joint 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. You cannot do without medication at this stage.
Most often, chondroprotectors, oral pain relievers are prescribed (at the discretion of the patient, since if the pain is barely noticeable, it is not necessary to take them). Ointments, gels and creams, including those with a warming effect, may be prescribed (which are better not to use during an exacerbation).
In addition, massage can 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 managed by the doctor and not by the patient. Ultimately, if necessary, during remission, injections of hyaluronic acid preparations can be administered.
With an exacerbation of osteoarthritis, hyaluronic acid is not prescribed, since against the background of inflammation, such injections will lead to serious consequences. Please note: injections should only be administered by a qualified person.
Ordinary doctors, and even more so mid-level medical personnel (paramedics, nurses) are not allowed to perform such injections. Self-injections into the joint lead not only to disability, but also to death (due to the threat of anaphylactic shock or a blood clot if the needle accidentally enters the vessel).
Treatment prognosis
The prognosis for the treatment of knee osteoarthritis differs depending on the stage of the disease and the general state of 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.
With stage 3-4 osteoarthritis, the prognosis is extremely poor, both in young and old patients. Although it has been noticed that young people tolerate osteoarthritis much more easily at such stages, it still inevitably leads to disability.
However, having stage 3-4 osteoarthritis does not equal a sentence. In fact, with the help of surgery, you can try to restore, if not all, the functionality of the knee, at least most of it. The 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 avoided 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 those at risk).
Preventive measures:
- It is necessary to avoid unnecessary stress 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 mass - more stress on the joints of the body).
- Preventive treatment with chondroprotectors after 45 years (only after consultation with a doctor).
- Adequate daily fluid intake (about 1. 5 liters of water per day), minimizing salt intake.
The main thing is not to overdo it with physical activity, as it is useful only in moderation (if there is no wear and tear on the musculoskeletal system). Physical education is useful, sport is not, especially for the joints and the cardiovascular system.