Osteoarthritis of the knee joint is understood as a decrease in cartilage performance due to its bending and destruction. Other terms used to refer to this disease -gonarthrosisANDdeforming osteoarthritis. Currently, several methods of treating the disease are used: a specific option is chosen taking into account the individual characteristics of the patient.
Disease specification
Knee osteoarthritis usually develops progressively. It usually occurs in women and older people who are overweight or have venous defects. The disease can occur on one or both knees at the same time.
The main stages of the development of osteoarthritis of the knee:
- Beginners. There is a decrease in the amortization parameters of the joint due to the mutual friction of the cartilage and the increase of their roughness. Sometimes the formation of cracks is observed.
- Secondly. At this stage, the bone begins to grow (osteophytes). Bending is fixed on the inner surface of the articular bag, stiffness is observed in the work of the limb. As a result, the knee joint gradually reduces its functionality. Due to the reduction in the thickness of the intercartilaginous lining, a decrease in the distance between the tibia and the femur is observed.
- Third. If nothing is done, the pain in the knee area becomes permanent due to irreversible damage to the cartilage tissue. The patient at this stage is no longer able to move normally.
The first symptoms of osteoarthritis of the knee joint are a sufficient reason to consult a specialist. Otherwise, there is a real risk of becoming disabled.
Why osteoarthritis occurs
The main causes of the development of osteoarthritis of the knee joint:
- hereditary tendencies;
- temporary immobility of the knee joint as a result of an injury;
- surgical removal of the meniscus;
- high physical activity, persistent hypothermia;
- obesity, problems with overweight;
- ligament rupture (weakening);
- other joint diseases (arthritis, swelling, various inflammations);
- failures of normal metabolism, lack of calcium in the body;
- flat feet (failure of the center of gravity increases the pressure on the joints);
- stress, general fatigue, lack of sleep.
Symptoms
Signs of the possible presence of osteoarthritis of the knee:
- Pain in the knee joint. The pain appears suddenly, against the background of physical exertion. In the first stage, we are talking about almost invisible lumbago, later the disease becomes more serious.
- Visual violation of the shape of the knee. This happens in the later stages.
- Fluid accumulation, Baker cyst. These are palpable seals in the posterior region of the knee joint.
- The appearance of a cartilage crackle, against the background of a sharp pain. This indicates the second or third stage of gonarthrosis.
- Inflammation of the inner area of the articular sac. Appears with edema and increased cartilage.
- Knee stiffness due to severe pain, up to complete immobilization. This occurs in the advanced stages of the disease.
Treatment
Effective treatment of osteoarthritis of the knee joint is possible only with the use of an integrated approach. Modern medicine can not yet offer a specific medicine that can eliminate this disorder. The success of treatment procedures depends on the time of detection of the problem, which allows you to start the fight against gonarthrosis in the early stages.
When starting treatment, the specialist pursues several goals:
- reduce pain symptoms as much as possible;
- to resume the normal flow of nutrients to the joints;
- increases the intensity of blood circulation in the knee area;
- restore the functionality of the supporting muscles in the problem area;
- make the knee as mobile as possible;
- expand the space between the connected bones.
The exact treatment algorithm is determined on an individual basis. Distinguish between conservative and surgical techniques.
conservative method
This approach is used in the early stages of disease onset, and is the use of various medications and therapeutic exercises.
Painkillers, anti-inflammatory
To eliminate or reduce pain in the knee joint, the doctor usually prescribes the use of non-steroidal anti-inflammatory drugs. In pharmacies, they are represented by tablets, ointments and injections. Heat and anesthetic gels, ointments and patches demonstrate good efficacy for pain relief.
A positive result in this case is usually achieved in 3-4 days. It should be understood that these medications do not eliminate the disease, but only reduce the pain. It is recommended to take pain medication only with the advice of a specialist and only when adjusting unbearable pain. The fact is that NSAIDs provoke the appearance of various side effects (especially the gastrointestinal tract suffers).
Hormonal drugs
In some cases, to relieve pain in osteoarthritis of the knee, the doctor may prescribe hormonal injections. This approach is used when the effectiveness of NSAIDs is weak against the background of a progressive disease.
Hormones are prescribed for a short period (1-10 days) during exacerbations of osteoarthritis and accumulation of fluid in the knee joint.
Chondroprotectors
To restore and nourish the cartilage layer at the beginning of the development of the disease, the so-called. chondroprotectors (glucosamine, chondroitin sulfate). Glucosamine starts the process of cartilage regeneration, corrects metabolism, blocks destructive processes. Chondroitin sulfate disarms dangerous enzymes, increases the amount of collagen (this protein nourishes moist cartilage). According to leading doctors, these drugs currently demonstrate the greatest positive effect in the treatment of gonarthrosis.
In particularly critical cases, when cartilage tissue has suffered severe abnormalities, chondroprotectors are ineffective. When prescribing glucosamine and chondroitin sulfate, the doctor indicates specific daily doses. Only a systematic approach to taking these drugs gives a chance for positive results. On sale they are represented by tablets, capsules, injections, gels.
Vasodilators
To remove spasms of the vascular system, to optimize blood flow and metabolism in the knee area, the doctor prescribes funds for vasodilation. As a rule, they are prescribed in combination with chondroprotectors. If, on the background of osteoarthritis, fluid in the knee does not accumulate, it is allowed to rub the joint with a warming ointment and attend therapeutic massage sessions.
Hyaluronic acid
In its chemical composition, this substance is very close to intra-articular fluid. Once inserted into the joint, the acid generates a film that protects the cartilage from mutual friction. The use of the drug is allowed after the cessation of irritation.
Therapeutic exercises
For osteoarthritis of the knee,turn to exercise therapy, but only under the strict supervision of the attending physician or an experienced trainer. Self-medication is strictly prohibited, given the great risks of any careless movement and load. Proper use of physiotherapy exercises helps to keep the joint in working condition, removes muscle spasms and alleviates unpleasant symptoms. It is strictly forbidden to perform physiotherapy exercises during irritations or in inappropriate conditions.
Physiotherapy
By properly applying physiotherapy techniques, you can significantly reduce pain in the knee area, relieve inflammation, and improve the flow of nutrients to the joint tissues. Before prescribing physiotherapy, the orthopedist conducts a detailed diagnosis of the problem area, prescribes general and special tests, sends an ultrasound or X-ray. This approach allows you to create an actual picture of the problem and choose the best methods.
The following types of physiotherapy have a good analgesic effect:
- UV radiation. Due to exposure to ultraviolet rays, there is a decrease in the sensitivity of nerve endings and a decrease in pain. As a rule, it is prescribed in the later stages of the disease. The standard duration of treatment is 7-8 sessions.
- Local magnetotherapy. Improves the overall health of the patient by reducing pain, inflammation, muscle spasms. Magnetotherapy is usually prescribed at the first fixation of the symptoms of knee osteoarthritis. The standard number of procedures is 20-25 sessions of 30 minutes each.
- Infrared laser therapy, UHF devices, SMW, ultrasound, therapeutic baths, etc.
If the disease has passed to the stage of dystrophic and deforming changes, the doctor recommends sanitary-resort treatment. A specific list of procedures is compiled after a careful study of the patient's history.
Surgery
This approach, with proper implementation, is able to partially or completely resume the work of the knee joint. The formation of the surgical intervention algorithm takes into account the level of destruction of cartilage tissue, the degree of inflammation, the amount of fluid collected, etc. Surgical intervention is usually practiced in the late stages of gonarthrosis. This approach implies a fragmentary or complete replacement of the affected wrist with an endoprosthesis.
Main approaches to surgical treatment:
- Ankle arthrodesis. During surgery, the surgeon adjusts the leg to the most comfortable position for the patient, followed by immobilization of the knee joint. The damaged cartilage is completely eliminated. Such a radical approach is important only in extreme cases.
- Arthroscopic debridement. Used in the second stage of development of knee osteoarthritis. A surgical removal of damaged cartilage tissue is performed, which allows you to save a person from pain for several years (usually for 2-3 years).
- Endoprosthetics. In this case, the knee joint or its special part is replaced with a plastic, ceramic or metal implant that completely repeats the anatomical configuration of the natural joint. Endoprosthetics today are considered the most effective way to bring back a complete lifestyle to the knee suffering from osteoarthritis for the next 15-20 years.
Competent planning and implementation of surgical treatment makes it possible to improve the patient's well-being and restore his mobility (partially or completely). At the same time, it should be understood that after the operation, a long period of recovery will be required, following the exercises of physiotherapy, mechanotherapy, diet, etc.
reHabiLitatiON
On average, the rehabilitation period after surgical treatment lasts 90 days:
Main rehabilitation tasks:
- resumption of the patient's ability to move normally;
- optimizing muscle and joint function;
- creating a protective block for the prosthesis.
Drainage is removed 2-3 days after surgery, after which you can try to walk carefully. To relieve the pain, the doctor prescribes medication with a cooling effect. Minor pain symptoms sometimes persist for a year after surgery: this is due to the fact that the prosthesis needs time to heal. Elderly patients recover longer: to alleviate their condition, they are prescribed NSAIDs. In some situations, the attending physician prescribes hormonal agents that have a pronounced effect.
One week later, the patient enters the rehabilitation center under the care of an experienced physiotherapist. When developing a course of exercise therapy, the individual characteristics of the body are taken into account. Classes are held regularly (daily), with a gradual increase in loads: this protects against tissue damage and rupture.
Period after discharge
At the end of the stay in the rehabilitation center, the patient is discharged from the hospital, giving detailed recommendations regarding his future lifestyle. Jumping and light gymnastics are allowed after 6 months from the date of surgery. As for serious loads (sprinting, jumping, sports games, heavy weight gathering), they should be completely excluded. Otherwise, the prosthesis will fail quickly.
Do not lift heavy objects weighing more than 25 kg. Inside the apartment, it is necessary to place support railings: they are placed on the stairs, in the shower room and in the bathroom. All pieces of furniture should be fully functional (especially chairs). These and other measures will maximize the life of the prosthesis. You should also be prepared for postoperative osteoarthritis of the knee, which can last up to 3 years.
Prevention of disease onset
The best way to deal with any disease is to prevent its occurrence.
Effective waysprevention of knee osteoarthritis:
- Proper nutrition, maintaining a normal weight. It is better to remove from your diet fatty and fried foods, alcohol, coffee, etc. . An experienced nutritionist can give detailed advice on this.
- Be careful when playing sports. It is desirable to reduce the load on the joints as much as possible.
- Be alert to any diseases (especially infectious ones), treat them correctly and avoid chronic stages.
- Watch your attitude, do not be negligent about bone and spine diseases.
- Include gentle physical activity in your daily routine (cycling, swimming, walking, joint strengthening exercises).
- Avoid any self-medication option for knee arthritis. At the first symptoms of the disease, you should immediately contact the clinic.
- Live a quiet lifestyle without stress and lack of sleep.
- Take measures to strengthen immunity (strengthening, taking vitamins).
- Dress warmly in the cold season.
By applying the principles of a healthy lifestyle in your life and seeking medical help in a timely manner, you can minimize the risks of developing osteoarthritis of the knee joints. When choosing a clinic, priority should be given to proven treatment centers equipped with modern equipment.