One of the most common pathologies of the musculoskeletal system is the arthrosis of the knee joint (otherwise gonartrosis) is a chronic disease, accompanied by the dystrophy and the destruction of the joint structures of the knee.
The result of destructive processes is a strong restriction or complete loss of joint mobility and, consequently, a decrease in performance, disability.
It is possible to prevent adverse consequences only if you are diagnosed early and therapy over time.
Reasons
By origin, the arthrosis of the knee is primary and secondary.Primary develops as an independent disease, it is more often diagnosed in the elderly and in this case it is due to changes related to the age that occur in the tissues.Secondary gonartrosis becomes the result of other diseases and disorders in the body.
The development of gonartrosis contributes to:
- lesions (dislocations, fractures, damage to meniscus);
- Diseases of the musculoskeletal system (congenital deformation of the legs, knee dysplasia, condrocalcinosis, arthritis, osteoporosis);
- High loads constant on the Municipality due to professional activities, professional sports;
- overweight, obesity;
- Endocrine diseases, including diabetes, hypothyroidism, acromigaly;
- metabolic disorders;
- Genetic predisposition.
Symptoms
The inflammation with arthrosis of the knee joint is accompanied by two main clinical manifestations: pain and edema.The intensity and frequency of the appearance of pain depend on the depth of damage to joint structures.In the initial phase, the pain is felt only with a load, it passes quickly to rest.With advanced gonartrosis, painful pain is constantly present, it intensifies during movements, with a change over time.
Other signs of arthrosis of the knee joint:
- crunch when it moves;
- rigidity in the joint, violation of the motor function;
- The deformation of the knee (with neglected gonartrosis).
Gonartrosis can be accompanied by a synovitis (accumulation of fluid in the joint cavity) and the subsequent formation of a baker cyst (elastic formation on the back of the knee).
Degree of arthrosis
The symptoms of arthrosis of the knee joint differ according to the depth of the damage to the knee structures and therefore the 3 phases of the pathology are distinguished.
- High arthrosis of the knee joint 1 degreeIt manifests itself from a weak pain in the loads (at rest it passes simultaneously), with a slight rigidity after sleep.In the radiographic framework, there is an insignificant narrowing of the joint gap (less than a third), the presence of individual osteophytes (bone extension) is noted.
- Osteoarthritis of the knee joint 2 degreesIt is accompanied by characteristic pain and crew during movements.The pain persists for some time at rest.The morning rigidity, the breadth of movements is bored.The diagnostic procedures reveal a pronounced narrowing of the joint gap (more than half) and multiple osteophytes.
- Osteoarthritis of the 3 -degree kneeIt is accompanied by a constant pain, which, during the movements and at night, intensifies.Morning rigidity remains longer than an hour with an exacerbation of inflammation and at least half an hour - during periods of remission.The mobility of the joint is abruptly limited or completely lost.In the radiographic picture, larger osteophytes, cysts are visible.The joint gap is reduced by over two thirds of the standard.
Depending on the degree of arthrosis of the knee joint, the patient is prescribed a conservative or surgical treatment.
Diagnostics
The diagnosis of arthrosis of the knee joint includes visual examination, analysis of the patient complaints, laboratory tests (urine analysis, general and biochemical blood test) and instrumental examination methods.
The following diagnostic procedures allow to confirm or refute the diagnosis:
- X -ray;
- Ultrasound (ultrasound);
- MRI (magnetic resonance imaging);
- CT (computerized tomography);
- Arthroscopy and scintigraphy (with suspicion of a tumor).
Using these methods, it is possible to detect the narrowing of the joint gap, the degree of thinning and deformation of the cartilage, the presence of fluid in the joint cavity, the structural changes in the synovial membrane, the growth of osteophyte and the outbreaks of ossification of the folder.
Conservative treatment
Conservative treatment methods can reduce pain and inflammation, improve blood circulation and nutrition of periastrated tissues, strengthen the muscle system.
To this end, they are held:
- drug therapy;
- block;
- physiotherapy and manual therapy;
- Medical physical education.
An important component of the treatment of arthrosis is the observance of a therapeutic diet.
The conservative treatment of arthrosis of the knee joint will be effective in the initial phase of the disease, when minor cartilage dystrophic cartridges are detected, inflammation and altered functions of the synovial shell.
Drugs
Pharmacological treatment includes the appointment:
- Non -pounding anti -inflammatory drugs (NSAIDs);
- chondroprotectors;
- hyaluronic acid.
Fans
Anti -inflammatory drugs non -pounds help to relieve inflammation, to reduce its main symptoms: edema and pain.
Preparations are prescribed in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration).The capsules and tablets from the arthrosis of the knee joint of the fans group have followed in short courses, since the drugs have a strong irritating effect on the gastric mucosa and can cause the development of the peptic ulcer, have many other side effects.
In addition, prescribed external drugs (ointments, gels, creams) based on non -pounded anti -inflammatory components.Local therapy can be carried out for a longer time.
Fans have a pronounced anti -inflammatory effect, but with prolonged use it contributes to the further destruction of the cartilage.
Fans are symptomatic therapy.They help to eliminate the unpleasant symptoms of the disease, but do not affect the condition of the cartilage.Contrary to these products, chondroprotectors and hyaluronic acid accelerate the processes of the regeneration of the cartilage tissue and slow down its destruction.
Condroprotectors
The drugs of the Condroprotectors group contain chondroitin and glucosamine (elements of the structural cartilage) and help to restore the knee with arthrosis of the knee joint.A solution for injection are available in the form of tablets, dust for oral administration.
The minimum preparation course of tablets and dust is 3 months.After a break, the course repeats itself 2-3 times.The course of treatment with a solution includes 12-15 injections, repeats itself 2-3 times a year.
The first positive results of the treatment with chondroprotectors are evident only a few months after the start of therapy.
Hyaluronic acid
Hyaluronic acid is introduced injected into the affected articulation.The cure for the arthrosis of the knee joint plays the role of lubrication: it envelops the joint surfaces, thus reducing the friction with each other.
Drugs with hyaluronic acid therapy help to increase the elasticity of the cartilage tissue, prevent further destruction of joint structures, which improves the mobility of the joint, the symptoms of inflammation are reduced.The medicines are well tolerated, they do not cause side effects.Their only disadvantage is the high cost.
The course of treatment with hyaluronic acid usually includes 3-4 injections, which are performed with 10-14 days breaks.
Block
If non -pounded anti -anti -inflammatory drugs cannot alleviate knee pain with arthrosis, a block is performed -a treatment method in which the drugs are injected directly into the tissues concerned to relieve pain and inflammation.In illegal therapy, the joint block (injections in the joint cavity) and periarticular (in the periarticular cavity) are used.
The main advantage of the method is a targeted instant action, since with this introduction the maximum concentration of the active substance is created precisely in the inflammation area.In addition, the drugs do not fall into the systemic blood flow, which significantly reduces the risk of adverse reactions.
In the subsequent stages of Gonartrosi, the joint gap is narrowed, the osteophytes grow, the joint surfaces are deformed, therefore only a perirtic block is allowed.
The blocking of the knee joint for arthrosis can be performed using anesthetics and corticosteroids.
The anesthetics are generally 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 blockage, but intra -articular injection, since these drugs do not block pain impulses, but trigger the processes of the regeneration of the cartilage tissue.
Physiotherapy and manual therapy
The main methods of physiotherapy effects used in the treatment of arthrosis include:
- laser treatment;
- ultrasound therapy;
- Criotherapy;
- paraffin therapy and ozokrete;
- Mud.
The main task of all physiotherapy procedures is to stimulate blood circulation in nearby tissues, improve cartilage nutrition.
Operating therapy
Pain syndrome forces a patient with gonartrosis to limit motor activity, due to which the ligaments and muscles close atrophy.This condition negatively affects joint tissues, since it is during the movement that nutrients penetrate the synovial fluid in the cartilage.If the joint is constantly at rest, the dystrophic processes are aggravated.
That's why physiotherapy exercises are an full component of conservative therapy.Moderate physical activity allows you to strengthen the muscle system, improve the power of joint structures, eliminate rigidity and improve the motor function of the knee.
The therapeutic exercises are developed individually by the doctor for each patient, taking into account the depth of the injury and the functional state of the joint structures.
General recommendations to conduct operating therapy for the arthrosis of the knee joint:
- Start the lessons only after interrupting the signs of acute inflammation;
- Perform all the exercises without hitches, without sudden movements;
- The load is gradually increased;
- Eliminates high loads on the joint (improved knee -improved flexion/extension);
- If pain or discomfort appears, stop training.
Diet
With gonartrosis, products containing: containing:
- amino acids (dairy products -caseari, variety with low meat fat);
- collagen (dishes with gelatin);
- irreplaceable fatty acids (vegetable oils, fish);
- sulfur and selenium (legumes, cereals, cabbage and apples, beef, chicken, eggs).
It is also important:
- Eliminates the use of smoked meats, pickles, marinated;
- limit the consumption of salt;
- adhere to a diet 5 times;
- Observe the mode of drinking.
Excess body weight is one of the main factors that cause the development of arthrosis of the knee joint.Therefore, the task of patients with excess weight is a decrease in body weight.In this case, it is possible to obtain the result only with the help of a diet, since intensive sports are harmful to the inflamed articulation.
To reduce body weight, it is recommended to exclude from the menu:
- fatty varieties of meat and fish;
- Cream, homemade sour cream and other dairy products -caseari with a high percentage of fat content;
- Margarina, mayonnaise, various sauces;
- confectionery;
- fast food;
- Sweet drinks.
Surgical treatment
The arthrosis of the 3rd degree knee joint is not susceptible to conservative therapy, so the operation is the only way out for the patient.
There are two options for surgery:
- Corrective osteotomy- is carried out in the initial phase of the development of the third phase of gonartrosis, if the cartilage is partially destroyed, it is possible to remove osteophytes;
- Endopropostetic- The replacement of the joint or its destroyed parts is performed with the complete destruction of the cartilage.
Forecast
Pathological changes in joint structures are progressive, irreversible.However, with an early diagnosis and adequate treatment, it is possible to completely stop inflammation and stop dystrophic changes in the cartilage tissue - the arthrosis of the 1st degree knee joint is well suitable for conservative therapy.
With the osteoarthritis of the 2nd degree, which is accompanied by the destruction of cartilage and the formation of osteophytes, the conservative methods allow you to slow down or suspend the deformation of the cartilage, stop inflammation and improve motor activity.However, doctors are often forced to resort to blocking, arthroscopy.
It is impossible to take care of the arthrosis of the 3 -degree knee joint in a conservative way.The only way to restore knee mobility is surgery.