Any type of osteoarthritis occurs with degenerative and dystrophic processes in the joint tissue. The disease always acquires a chronic nature and is not completely cured, you can only slow down or stop its progress.
According to the ICD-10, gonarthrosis (damage to the knee joints) belongs to the group under the code "M17". The emphasis in treatment is on 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, no inflammatory processes are observed, except in rare cases.
Initial joint degeneration and dystrophy have virtually no effect on knee function. Over time, these processes lead to a violation of the structure of the joint, it stops "slipping", bumps appear on its surface (due to deformative changes).
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, layering 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, the latter begins to thicken and bony growths appear on it (often in the form of spines).
All this also leads to deformation of the affected limb, followed by its curvature. It is for this reason that the disease is also called "deforming osteoarthritis". 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 emergence of several predisposing factors. It is not at all necessary to have congenital risk factors, the disease most often develops with acquired factors (trauma, infections, inflammation).
Main reason:
- Severe disturbances of metabolic / metabolic processes in the body (any acute or chronic severe disease 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 severe increase in the load on the entire musculoskeletal system.
- Injuries of the knee joints (including direct injuries, penetrating wounds, ruptures of the ligament apparatus, injuries of the menisci, fractures, dislocations and subluxations, cracks).
- Inflammatory diseases suffered in the recent past (mainly arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, people who play tennis, football, basketball).
- The consequences of a longstanding and poorly treated knee injury.
- Congenital defects and anomalies in the structure of joint tissues, hereditary risk factors (genetic mutations).
There is a direct connection between the cause and severity of osteoarthritis. If the cause is metabolic disorders or severe injuries, the prognosis is worse than the development of arthrosis against the background of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, osteoarthritis of the knee joint is very common; 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 gonarthrosis.
If we consider all the diseases of the knee joints, among these the share of osteoarthritis falls on about 53% of cases. There has recently been an increase in the number of cases of gonarthrosis among the population, especially in developed countries.
This is linked to an increase in the average life expectancy (the older a person is, the greater the risk of this form of osteoarthritis) and the predominance of a sedentary lifestyle. And this is really a problem, since doctors are not yet able to completely cure gonarthrosis.
Why is gonarthrosis dangerous?
The main danger of gonarthrosis is disability due to the development of complications that are not amenable to conservative therapy. First of all, this is the deformation of the joint and bone of the affected limb. Disability is possible already at the third stage of the disease.
The second danger is the development of severe chronic pain, which can disturb the patient so much that it prevents him from sleeping normally. Constant awakening due to knee pain is one of the most common problems of stage 3-4 of gonarthrosis.
No lethal consequences occur precisely because of gonarthrosis. In theory, a serious injury could occur due to a sudden jamming of the joint. This is the so-called symptom of joint blockage, most often observed in the 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. In addition, each stage of osteoarthritis is treated in a special way (although the differences in treatment regimens may seem small to a non-doctor).
The degree of gonarthrosis:
- first degree - the disease practically does not manifest itself in any way, only a slight discomfort is possible, but in general the patient feels well and therefore it is very problematic to diagnose the disease at the first stage;
- second degree - strong painful sensations appear, especially after a long walk or standing; a characteristic crunch develops during physical activity, the process of atrophy of the quadriceps femoral muscle can already begin;
- third degree - the pains become excruciating, constantly bother the patient, pronounced deformative changes appear in the joint, it becomes hot to the touch, it is impossible to walk normally or even run more;
- fourth degree - it is very difficult with severe deformity 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, since they practically do not interfere with the normal life of a person. The last two stages are very serious and lead to disability.
Symptoms of gonarthrosis in 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 disturb the patient even under powerful drug therapy.
Symptoms of stage 1:
- Slight discomfort or pain with severe stress on the joint.
- Barely perceptible crunch.
- Slight increase in joint size.
Symptoms of stage 2:
- pain of moderate intensity, which usually occurs with a period of exacerbations and remissions;
- the joint becomes hot to the touch;
- redness 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 standing.
Symptoms of stage 3:
- severe pains that bother the patient 24 hours a day, but during periods of exacerbation (triggers of 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;
- possible curvature of the lower leg.
Symptoms of stage 4:
- the pains become excruciating, they do not allow the patient to do everyday things (including intellectual ones, since 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 already clearly visible not only in the joint, but also in the limb as a whole;
- a sensation of fluctuation 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 pain at 3-4 stages of osteoarthritis, doctors resort to analgesic blocks, but blocks cannot be performed daily.
Diagnostics
The emphasis in diagnosing osteoarthritis of the knee is on imaging techniques, while laboratory tests usually show nothing.
Diagnostic methods used:
- Visit by an orthopedist with palpation of the affected joint, linear measurements of the bones, angiometry.
- Clinical blood tests (total erythrocyte sedimentation / ESR), determination of fibrinogen levels in blood and urine and, above all, urea, as well as other biochemical parameters.
- Radiography (narrowing of the joint space, deformity, cartilage sclerosis, accumulation of salts and even bone osteophytes).
- Ultrasound examination (for differential diagnosis only).
- MRI or computed tomography (the most informative, in terms of imaging, diagnostic methods).
Usually, an x-ray is sufficient to make a diagnosis, especially if the disease is in an advanced stage. In relatively rare cases, MRI or computerized resonance imaging is required.
Treatment of gonarthrosis: methods
Treatment of osteoarthritis of the knee is only complex, since no method of treatment is isolated from the 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 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 arthrosis is the systematic nature of the process and unconditional adherence to the recommendations of the attending physician. Attempts to independently treat gonarthrosis, including ignoring a doctor's prescription, usually end in disability.
Physical therapy
Physiotherapy exercises are best suited for the treatment of 1-2 stages of osteoarthritis of the knee joints. In such stages, this is almost the main method of treatment, since physical education can slow down the progression of the disease and eliminate most of the symptoms.
However, there is no special sense from classical physical education, it can also be harmful. Therefore, the patient is prescribed special exercises and individually (since gonarthrosis can proceed differently in individual patients).
There is no time frame for treatment with physical therapy methods - ideally, it is necessary to engage in the exercises prescribed for life, from time to time by visiting a doctor for dynamic joint monitoring. It is very useful to combine physical 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 treatment method. Only in 40% of cases, diet therapy gives evident results, and usually in those people in whom the onset of osteoarthritis has been caused 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, sometimes tobacco smoking is also banned. At the same time, the consumption of large quantities of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or sausages can not be called meat products. The patient is instructed to consume lean meats, boiled chicken is especially useful (due to the relatively low calorie and high protein content).
Physiotherapy
Physiotherapeutic procedures are only useful in terms of 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 arthrosis with the help of physiotherapy, regardless of what some "specialists" say.
Physiotherapy is fine for pain relief, but only if it is mild. With severe pain (stage 3-4 of arthrosis), physiotherapy does not help, as well as most drugs (especially for oral use).
The most preferred for the treatment of osteoarthritis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Shock physical therapy techniques are prohibited due to the threat of further damage to the joints.
operation
Surgical intervention is required only at 3-4 stages of the disease, when conservative methods are no longer needed. Several types of procedures can be used: drainage of the joint cavity, removal of bone osteophytes, replacement (prosthesis) of the joint.
To restore the function 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 joint.
The fact is that such a procedure is contraindicated in patients in serious condition or in patients over the age of 65-70. Keep in mind that any knee surgery has its own risks of complications (life-threatening complications are also possible, but they are very rare).
Drug
Together with physiotherapy exercises they are the basis of treatment and its mandatory component. If it is still not possible to use other procedures, it is impossible to do without drug therapy in combination with physical therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed painkillers (with severe pain - blockage), decongestants, muscle relaxants, antihistamines. Often chondroprotectors are prescribed, injections of hyaluronic acid are possible (as a replacement for physiological lubrication of the joints).
Drugs can really affect the disease only in stages 1-2 of osteoarthritis. At 3-4 stages of the disease, drug therapy plays only the role of a way to cope with the symptoms, while nothing but an operation can affect the disease.
The nuances of treatment in the stage of exacerbation and in remission
The approaches to treating osteoarthritis of the knee during exacerbation and remission are slightly different. In the phase of exacerbation, aggressive therapy is used, aimed at the fastest possible restoration of joint function and elimination of symptoms.
The pain reaches its peak precisely in the phase of exacerbation of the disease, therefore, in such cases, pharmacological blocks can be prescribed.
Non-steroidal 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, in the phase 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 phase that it is possible to walk normally, 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 period when classes in the pool, classes with a rehabilitation therapist and attempts to restore the functionality of the joint are possible. You can't do without drugs at this stage.
Most often, chondroprotectors, oral painkillers 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 can be prescribed, including those with a warming effect (which is better not to use during an exacerbation).
In addition, massage can be prescribed, including manual therapy (only if the disease is at stages 1-2). With the doctor's permission, special gymnastic techniques can be used.
Remission is the ideal time for physiotherapy, but the choice of specific physiotherapy should be managed by the physician, not the patient. Finally, if necessary, during remission, injections of hyaluronic acid preparations can be given.
With an exacerbation of arthrosis, hyaluronic acid is not prescribed, since against the background of inflammation, such injections will lead to serious consequences. Note: Injections should only be administered by a suitably qualified person.
Ordinary doctors, and even more so middle-level medical personnel (paramedics, nurses), are not allowed to perform such injections. Self-injections into the joint are fraught not only with disability, but also with 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 gonarthrosis varies according to 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.
With stage 3-4 of osteoarthritis, the prognosis is extremely poor, in both young and elderly patients. Although it has been noted that young people tolerate osteoarthritis in such stages much more easily, this inevitably leads to disability.
However, having stage 3-4 osteoarthritis is not the same as a sentence. In fact, with the help of surgery, you can try to restore, if not all the functionality of the knee, 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 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).
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 of age (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 it with physical activity, as it is useful only in moderation (if there is no wear and tear of the musculoskeletal system). Physical education is useful, sport is not, especially for the joints and the cardiovascular system.