Osteoarthritis is a joint pathology accompanied by damage to the cartilaginous tissue. Synonyms of arthrosis are gonarthrosis, deforming osteoarthrosis, osteoarthritis: all these terms mean the development of degenerative processes in the cartilage covering the epiphyses of the articulated bones.
Despite the fact that the lesion affects only the cartilaginous structures, all joint elements are affected: the capsule, the synovial membrane, the subchondral bones, as well as the ligaments and muscles surrounding the joint. Osteoarthritis can affect one or more joints.
The most common localized forms of the disease have their own names: arthrosis of the hip joint is called coxarthrosis, arthrosis of the knee joint is called gonarthrosis.
Classification and reasons
Knee osteoarthritis can be primary or secondary. The first group includes pathologies whose cause has not been established, that is, they are idiopathic. Secondary arthrosis occurs after an injury, due to congenital anomalies and against the background of systemic diseases.
The following are the causes of arthrosis of the knee joint:
- autoimmune diseases – rheumatoid arthritis, lupus erythematosus, scleroderma, etc. ;
- joint inflammation caused by a specific infection (syphilis, gonorrhea, encephalitis);
- hereditary diseases of the musculoskeletal system and joints, mutations in type 2 collagen.
There are also a number of factors that negatively affect the joints and can provoke pathological changes in them:
- old age, overweight, osteoporosis;
- hormonal changes, including a decrease in estrogen synthesis during the postmenopausal period in women;
- metabolic disease;
- deficiency of microelements and vitamins in the diet;
- congenital and acquired deformities of skeletal bones;
- hypothermia and intoxication by toxic compounds;
- constant injuries to the joint during sports training or hard work;
- operations on the knee joint, for example to remove the meniscus.
Symptoms and phases
Deforming arthrosis of the knee joint is characterized by intracellular changes at the morphological, molecular, biochemical and biomechanical levels. The consequence of the pathological process is softening, fibrosity and reduction in the thickness of the articular cartilage. In addition, the surfaces of the bones that form the joints become denser, and bone spines appear on them - osteophytes.
DOA of the knee joints develops in 3 stages and in the initial stages may experience only mild pain and discomfort after prolonged physical activity. Sometimes one of the characteristic symptoms of arthrosis appears: morning stiffness. At this time, changes occur in the synovial membrane and the composition of the intraarticular fluid.
As a result, the cartilage tissue does not receive enough nutrients and its ability to withstand pressure begins to decline. Therefore, with strenuous exercise and long walking, pain occurs.
In the second stage of arthrosis, the destruction of cartilaginous tissue progresses, and part of the major load is taken on by the articular surfaces of the bones. Since there is not enough space for support, the edges of the bones increase due to osteophytes. The pain no longer disappears at rest, as before, and it bothers me even at night.
It also increases the time of morning stiffness and it takes a long time to "train" the leg so that you can walk normally. Also, when the limb is bent, creaking and clicking sounds are heard, accompanied by sharp pain. It is not always possible to bend the leg completely, it seems jammed, and further attempts end in a strong crunch and pain.
Due to pain during any movement, a person tends to move less, which negatively affects the muscles surrounding the joint. A change in the size of the epiphyses of the bones leads to a shift in the axis of the limbs and the development of deformities. The joint capsule becomes stiffer as the volume of fluid inside it decreases. When osteophytes compress the surrounding soft tissues, synovitis and chronic inflammation appear.
When moving to the 3rd stage, the signs of arthrosis of the knee joint become very serious: the pain does not go away even at night, the motor ability practically stops, the leg seems crooked and does not bend. The third degree of osteoarthritis is characterized by an X- or O-shaped deformity, which makes movement extremely difficult. An advanced form of deforming gonarthrosis can only be treated surgically.
Diagnostics
The diagnosis of arthrosis of the knee joint is not particularly difficult; the doctor can hypothesize gonarthrosis based on existing symptoms and characteristic visual signs. To confirm the diagnosis, x-rays are taken. The images will show narrowing of the inter-articular space, bony growths, and subchondral osteosclerosis of the bones.
X-rays are used to determine the cause of the disease. Bone deformations are especially clearly visible in post-traumatic arthrosis. If cartilage degeneration is caused by arthritis, defects are detected along the edges of the bones, as well as periarticular osteoporosis and atrophy of bone structures. With various congenital anomalies, a distortion of the axis of one of the bones is observed, which led to improper distribution of the load and the appearance of secondary osteoporosis.
Treatment
Treatment of gonarthrosis of the knee joint has 3 main objectives: restoration of cartilaginous tissue, improvement of joint mobility and slowing down the progression of the disease. Great importance is attached to eliminating or weakening symptoms, reducing the intensity of pain and inflammation. Medication, physiotherapy and physical therapy are used to solve these problems. To achieve the maximum effect of therapy, dosed physical activity and compliance with the orthopedic regimen are necessary.
Pharmacological treatment of knee osteoarthritis includes taking painkillers and anti-inflammatory drugs, as well as chondroprotectors that promote the regeneration of cartilage tissue. Medicines can be prescribed in the form of injections, tablets, ointments and gels.
If first-degree knee arthrosis is diagnosed, physiotherapeutic methods, physical therapy and massage are used in treatment. The early stages of the disease are much easier to treat and you can expect a full recovery. An important condition is to lose weight to reduce the load on the painful joint.
Treatment of arthrosis of the knee joint of the second stage necessarily includes physical therapy, the use of orthopedic devices and compliance with the diet. To relieve pain, nonsteroidal anti-inflammatory drugs, chondroprotectors and intraarticular injection of hyaluronic acid are prescribed.
Acute arthrosis is characterized by severe pain, for which conventional NSAIDs are not sufficient. In this case, strong analgesics and glucocorticosteroid injections into the joint cavity are used.
If conservative methods are ineffective, an operation is performed which can be both corrective and radical (replacement of a joint with a prosthesis).
Deforming arthrosis of the knee joint of the third stage is characterized by the complete absence of the interarticular space, replaced by a bone structure. This condition requires surgical intervention, since in this case other methods are powerless.
NSAIDs and corticosteroids
To save patients from physical and mental suffering, therapy for acute osteoarthritis begins with pain relief. Drugs that are part of the NSAID group and which can be used in tablets or topically have proven effective.
The analgesic effect does not always appear immediately, but after two or three days it reaches its peak and the pain disappears. The course of treatment with NSAIDs is limited to two weeks, since prolonged use increases the risk of side effects. Particular caution should be exercised by people who have problems with the gastrointestinal tract, as well as those who suffer from high blood pressure.
If there is no result, hormonal drugs are prescribed to relieve inflammation. In case of left-sided gonarthrosis, drugs are injected into the left knee, into the right side - into the right one.
Hormone injections can be given once every 10 days, not more often. The indication for such treatment is a large accumulation of fluid in the joint due to inflammation. When the symptoms subside, the drug is switched to tablet form.
Chondroprotectors and hyaluronic acid
Chondroprotective agents act in three directions: they restore damaged cartilage tissue, reduce pain and eliminate inflammatory reactions. Taking chondroprotectors helps to normalize the composition and properties of synovial fluid, nourish cartilage and protect pain receptors from irritation.
As a result, the destruction of cartilaginous structures and, as a result, the progression of the disease slows down. After a course of taking the drugs, the shock-absorbing and lubricating function of the joint is restored.
In the initial stages of the disease, chondroprotectors can be used in the form of an ointment or gel. However, intra-articular injections are the most effective. Modern methods of treating arthrosis include the use of combined agents, which contain not only chondroprotective substances, but also anti-inflammatory components and vitamins.
Hyaluronic acid is the main component of synovial fluid, responsible for its viscosity and consistency. This is, in fact, a biological lubricant that provides cartilage with elasticity, elasticity and resistance.
With the development of joint pathologies, the volume of hyaluronic acid can decrease by 2-4 times, which necessarily leads to excessive friction of the bones. With intra-articular injection of hyaluronic acid, knee function is normalized and the person can move normally.
Surgery
Surgery is a radical method by which the functionality of the joint is partially or completely restored. The degree of intervention can be different and depends on the stage of arthrosis. The most delicate operation is arthroscopy: the rehabilitation period after its implementation is the least painful for the patient.
Important:arthroscopy can be performed not only for treatment, but also to diagnose joint pathology. This procedure allows you to identify damage that is inaccessible to other studies.
The goal of arthroscopy is to prolong the life of the joint by removing dead and damaged tissue from the joint cavity. As a result, pain disappears, stress resistance increases and motor activity returns.
In case of significant deformities, osteotomy is indicated, creating an artificial bone fracture in a specific area. Knee osteotomy literally means "cutting bones": during the operation, the surgeon removes a wedge-shaped segment of the femur or tibia, then joins the bones in the most physiological position. If necessary, the resulting space is filled with bone graft. During the healing period, the structure is fixed with special clamps.
Endoprosthesis replacement is an alternative method to the outdated procedure of arthrodesis, the essence of which is the partial or total replacement of a diseased joint with a prosthesis. As a result, knee function is fully restored in more than 90% of cases, significantly improving patients' quality of life.
Physiotherapy
Physiotherapy procedures play an important role in the treatment of osteoarthritis, due to their beneficial effect on damaged joints. A course of physical therapy accelerates regeneration processes, eliminates pain and muscle spasms. Additionally, some procedures allow the administration of medications through the skin, thus reducing the dosage of oral medications.
For damaged joints, the following techniques are recommended:
- magnetotherapy;
- medium wave ultraviolet (WUV);
- infrared laser;
- UHF;
- ultrasound;
- diademic and sinusoidal modulated currents (amplipulse therapy);
- Darsonval.
Effective procedures for arthrosis are also therapeutic baths: radon, hydrogen sulfide, bischofite, mineral and sage. They have an anti-inflammatory, analgesic and repairing effect on joints.
Finally
If you suspect knee osteoarthritis, you should see an orthopedic doctor or trauma surgeon who diagnoses and treats these conditions. In order not to aggravate the disease, it is necessary to avoid excessive physical activity on the legs and get rid of excess weight.
There is no special diet for arthrosis, but it is recommended to avoid concentrated meat and fish broths, fatty and smoked meats, as well as reduce the consumption of table salt. The diet should be dominated by foods rich in vitamins and minerals and vegetable oils. In addition, once a week it is advisable to organize a fasting day: kefir, cottage cheese or fruits and vegetables.
To strengthen the muscle corset of the lower extremities and increase blood flow, it is necessary to regularly perform therapeutic exercises, individually selected by a physiotherapy instructor.
Therefore, taking medications, physical procedures, a balanced diet and exercise are what will definitely help a patient suffering from osteoarthritis. And to avoid traumatic surgery, you should seek medical help as soon as possible. Be healthy!