Any type of osteoarthritis occurs with degenerative and dystrophic processes in the articular tissue. The disease always takes on a chronic nature and is not completely cured, you can only slow down or stop its progression.
According to ICD-10, gonarthrosis (damage to the knee joints) belongs to the group under the code "M17". Emphasis on treatment is 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 associated with degenerative and dystrophic processes, which, if left untreated, progress steadily. In this case, inflammatory processes are not observed, except in rare cases.
Degeneration and dystrophy of the joint at first has virtually no effect on knee functionality. Over time, these processes lead to a violation of the structure of the joint, it stops "slipping", lumps 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 hyaline cartilage degeneration begins very quickly, its thinning, stratification, and later the appearance of cracks in it.
The end result of the disease is complete destruction (destruction) of the hyaline cartilage with exposure of the adjacent bone. But the problem does not end here: due to the exposure of the bone, the latter begins to thicken and bone growths appear on it (often in the form of thorns).
All this also leads to deformation of the affected limb, followed by its bending. Forst for this reason the disease is also called "deforming osteoarthritis". With an already existing deformity of the limbs, the disease cannot be cured without surgery.
Reasons for the development of the disease
Most often, the development of knee osteoarthritis is preceded by the appearance of several predisposing factors. It is not at all necessary to have innate 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 severe acute or chronic 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 serious increase in load on the musculoskeletal system as a whole.
- Injury of the knee joints (including direct injuries, penetrating wounds, ruptures of the ligament apparatus, meniscus injuries, 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).
- Consequences of a long, poorly treated knee injury.
- Congenital defects and abnormalities in the structure of articular tissue, hereditary risk factors (genetic mutations).
There is a direct link between the cause and severity of osteoarthritis. If metabolic disorders or severe damage are the cause, the prognosis is worse than in the case of the development of osteoarthritis against the background of joint overload or age-related dystrophic changes.
Incidence 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 the diseases of the knee joints, then among them the share of osteoarthritis falls in 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 average life expectancy (the older a person is, the greater the risk of this form of osteoarthritis), and with the predominance of a sedentary lifestyle. And this is really a problem, as doctors are still not able to completely cure gonarthrosis.
Why is gonarthrosis dangerous?
The main risk of gonarthrosis is disability due to the development of complications that do not undergo conservative therapy. First of all, this is deformity of the joint and bone of the affected limbs. Disability is already possible in the third stage of the disease.
The second risk is the development of severe chronic pain, which can bother the patient so much that he will not be able to sleep normally. Constant waking up due to knee pain is one of the most common problems of stage 3-4 gonarthrosis.
Fatal consequences precisely because of gonarthrosis do not arise. In theory, a serious injury can occur due to a sudden blockage of the joints. This is the so-called symptom of joint blockage, 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 vary in severity of course, severity and number of symptoms, and final prognosis. Also, each stage of osteoarthritis is treated in a different way (although changes in treatment regimens may seem small to a non-physician).
Degree of gonarthrosis:
- first degree: the disease practically does not appear 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: appear severe painful sensations, especially after a long walk or standing; a characteristic seizure develops during physical activity, the process of femoral thigh muscle atrophy may already begin;
- third degree: the pain becomes torturous, constantly disturbs the patient, pronounced deforming changes appear in the joints, 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 joints and constant pain that do not even allow the patient to sleep; joint dysfunctions are as pronounced as ankylosis is possible (complete immobilization of the affected joint).
The first two stages of gonarthrosis are considered favorable condition, as they practically do not interfere with a person's normal life. The last two stages are very severe 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 bother the patient even under vigorous drug therapy.
Stage 1 symptoms:
- Mild discomfort or pain with severe stress in the joints.
- Barely visible chewing.
- Delicate increase in knot size.
Stage 2 symptoms:
- pain of moderate intensity, usually occurring with a period of worsening and remission;
- the knot becomes warm 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 stay in a standing position.
Stage 3 symptoms:
- severe pain that bothers the patient all the time, but during periods of deterioration (causes deterioration for each patient), the pain intensifies several times;
- noticeable deforming changes in the knee, its increase in size;
- the affected joint heats up on palpation;
- normal movement is impossible due to partial immobilization of the node;
- perhaps the curvature of the lower leg.
Stage 4 symptoms:
- pains become torturous, do not allow the patient to do everyday things (including intellectual ones, as pain impairs cognitive functions);
- the appearance of synovitis due to the accumulation of leakage in the knee cartilage cavity;
- now the deforming changes are already clearly visible not only in the joints but also in the limbs as a whole;
- a feeling of fluctuation on palpation of the patella and surrounding tissues;
- almost complete or even complete immobilization of the knee joint (in this case, surgery alone will help restore limb function).
If it is not possible to eliminate or significantly reduce the pain in 3-4 stages of osteoarthritis, doctors use analgesic blockades, but blockages cannot be done every day.
diagnostic
The emphasis in the diagnosis of knee osteoarthritis 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 measurement, angiometry.
- Clinical blood tests (total and erythrocyte sedimentation rate / ESR), determination of fibrinogen levels in blood and urine and, above all, urea, as well as other biochemical parameters.
- Radiography (reveals narrowing of the joint space, deformities, cartilage sclerosis, accumulation of salts and even bone osteophytes).
- Ultrasound examination (for differential diagnosis only).
- 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, computer or magnetic resonance imaging is required.
Treatment of gonarthrosis: methods
Treatment of knee osteoarthritis is only complex, as no treatment method is isolated from others with a good effect (even medication). 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 the indisputable observance of the recommendations of the attending physician. Attempts to treat gonarthrosis independently, including ignoring a 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, it has no special meaning from classical physical education, it can also be harmful. Therefore, the patient is prescribed special exercises, and individually (as gonarthrosis may proceed differently in individual patients).
There is no timeline for treatment with exercise therapy methods - ideally, you should engage in life-prescribed exercises, occasionally visiting a physician for dynamic joint monitoring. Summer very useful to combine exercise therapy with exercises in the pool (there the load on the joints is much less).
Diet
Although correction of nutrition can be very helpful, it is not a mandatory treatment method. Only in 40% of cases, diet therapy gives visible results, and usually in those people in whom the onset of osteoarthritis was 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 imposed, sometimes smoking is also prohibited. At the same time, it is recommended to consume large amounts of vegetables, fruits and meat products.
In this case, sausages, sausages or wieners can not be called meat products. The patient is instructed to consume 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 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, despite what some "specialists" there 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 well as most medications (especially for oral use).
The most preferred for the treatment of osteoarthritis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (caterpillar therapy). Shock physical therapy techniques are banned because of the threat of additional joint damage.
Operation
Surgical intervention is required only in 3-4 stages of the disease, when conservative methods are no longer needed. Different types of procedures can be used: drainage of the articular cavity, removal of bone osteophytes, replacement (prosthetics) of the joint.
To restore the functionality of the node, its transplantation 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 knot.
The fact is that such a procedure is contraindicated in patients in serious condition, or in patients over 65-70 years. Keep in mind that every knee surgery has its own risks of complications (even fatal complications are possible, but they are very rare).
treatment
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 in conjunction with exercise therapy (traditional medicine can not replace drug therapy).
The patient is prescribed pain relievers (with severe pain - blockage), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid (replacing physiological lubrication of the joints) are possible.
Medications can really affect the disease only in stages 1-2 of osteoarthritis. In 3-4 stages of the disease, drug therapy only plays the role of a way to deal with the symptoms, while nothing but an operation can affect the disease.
The nuances of treatment in the stage of deterioration and in remission
Approaches to treating osteoarthritis of the knee during exacerbation and remission are somewhat different. In the deterioration phase, aggressive therapy is used, which aims to restore joint function as soon as possible and eliminate the symptoms.
The pain peaks precisely at the stage of disease exacerbation, therefore, in such cases, medication blockades may be prescribed.
Non-steroidal anti-inflammatory drugs may be prescribed. Despite the fact that osteoarthritis usually continues without inflammation, it can occur in the acute phase. The patient is prescribed bed rest, minimal stress on the affected joint, and avoidance of overheating of the limbs.
On the contrary, in the forgiveness phase, physical exercises are prescribed and, in general, an increase in physical activity is predicted. The reason is that it is in the remission phase that normal walking is possible, as joint function improves, and the pain is usually of moderate intensity.
It is often necessary to use forgiveness skillfully - this is the period when pool classes, classes with a rehabilitation therapist, and efforts to restore joint function are possible. You can not do without medication at this stage.
Most often, chondroprotectants, oral pain relievers are prescribed (at the patient's discretion, as if the pain is barely noticeable, there is no need to take them). Oils, gels and creams can be prescribed, including those with a warming effect (which is best not to use during a deterioration).
Furthermore, 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.
Forgiveness is the ideal time for physiotherapy, but the choice of specific physiotherapy should be made by the doctor, not the patient. Finally, if necessary, injections of hyaluronic acid preparations may be given during remission.
With a worsening of osteoarthritis, hyaluronic acid is not prescribed, as against the background of inflammation, such injections will lead to severe consequences. Please note: injections should only be given by a qualified person.
Ordinary doctors, and even more so mid-level medical staff (paramedics, nurses), are not allowed to perform such injections. Self-injections into the joints are fraught not only with disability but also with death (due to the threat of anaphylactic shock or blood clot if the needle accidentally enters the vessel).
Prognosis of 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 starts 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 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 disability.
However, having stage 3-4 osteoarthritis is not equal to one sentence. In fact, with the help of surgical intervention, 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 risks 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 diet, 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 in the body).
- Preventive treatment with chondroprotectors after you have reached the age of 45 (only after consulting your doctor).
- Proper 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 of the musculoskeletal system). Physical education is beneficial, sports are not, especially for the joints and the cardiovascular system.