One of the most common pathologies in the musculoskeletal system is arthrosis of the knee joint (otherwise gonar rose) is a chronic disease accompanied by dystrophy and destruction of the knee's articular structures.
The result of destructive processes is a sharp restriction or complete loss of common mobility, and as a result - a decrease in performance, disability.
It is only possible to prevent negative consequences if you are early diagnosed and therapy in time.
Causes
In origin, the knee rose is primary and secondary.Primary develops as an independent disease, more often diagnosed in the elderly, and in this case due to age -related changes that occur in the tissue.Secondary gonarthrosis is the result of other diseases and disorders of the body.
The development of gonarthrosis contributes to:
- damage (dislocations, fractures, meniscus damage);
- Diseases of the musculoskeletal system (congenital deformation of the legs, knee plasia, chondrocalcinosis, arthritis, osteoporosis);
- Constant high stresses on the collection due to professional activities, professional sports;
- overweight, obesity;
- Endocrine diseases including diabetes, hypothyroidism, acromigaly;
- Metabolic disorders;
- Genetic disposal.
Symptoms
Inflammation of arthrosis of the knee joint is accompanied by two most important clinical manifestations - pain and edema.The intensity and frequency of the appearance of pain depends on the depth of damage to joint structures.At the initial step, pain is felt only with a load, passes quickly at rest.With advanced gonarthrosis, sore pain is constantly present, intensified during movements with a change in weather.
Other signs of arthrosis of the knee joint:
- crunch when you move;
- Stiffness of the joint, violation of the motor function;
- The deformation of the knee (with neglected gonarthrosis).
Gonarthrosis can be accompanied by a synovitis (accumulation of fluid in the joint cavity) and the subsequent formation of a bakery cyst (elastic formation on the back of the knee).
Degree of arthrosis
Symptoms of arthosis in the knee joint vary depending on the depth of damage to the knee structures and therefore the 3 pathology stages are separated.
- Osteoarthritis in the knee joint 1 degreeIt is manifested by slight tenderness by loads (at rest passes at once) with a slight stiffness after sleep.In the radiographic image, a negligible narrowing of the common hole (less than one -third) is noted, the presence of single osteophytes (bone growth).
- Osteoarthritis of the knee joint 2 degreesIt is accompanied by pain and characteristic crunch during movements.The pain persists for some time at rest.Morning stiffness, restriction of the amplitude of movements is noted.Diagnostic procedures reveal a marked narrowing of the common hole (more than half) and more osteophytes.
- Osteoarthritis of the knee 3 degreesIt is accompanied by constant sore pain which intensifies during movements and at night.Morning stiffness stays longer than an hour with a worsening of inflammation and at least half an hour - during periods of remission.Common mobility is sharply limited or completely lost.In the radiographic image, several large osteophytes, cysts are visible.The common gap is narrowed by more than two -thirds from the norm.
Depending on the degree of arthosis in the knee joint, the patient is prescribed conservative or surgical treatment.
Diagnostics
Diagnosis of arthrosis of the knee joint includes visual examination, analysis of the patient's complaints, laboratory examinations (urine analysis, general and biochemical blood tests) and instrumental examination methods.
The following diagnostic procedures allow you to confirm or refute the diagnosis:
- Radiography;
- Ultrasound (ultrasound);
- MRI (magnetic resonance image);
- CT (computed tomography);
- Arthroscopy and scintigraphy (with suspicion of a tumor).
Using these methods, it is possible to detect narrowing of the joint gap, the degree of thinning and deformation of the cartilage, the presence of fluid in the joint cavity, structural changes in the synovial membrane, the growth of osteofitis and the foci of the cartilage of cartilage.
Conservative treatment
Conservative treatment methods can reduce pain and inflammation, improve the blood circulation and nutrition of periasta tissue, strengthen the muscle apparatus.
For this purpose they are held:
- Drug therapy;
- blockade;
- Physiotherapy and manual therapy;
- Medical physical exercise.
An important component of the treatment of arthrosis is adhering to a therapeutic diet.
Conservative treatment of arthrosis of the knee joint will be effective in the initial steps of the disease when less dystrophic cartridges of cartilage, inflammation and impaired functions in the synovial scale are noted.
Medicine
Drug treatment includes the agreement:
- Non -steroidal anti -inflammatory drugs (NSAIDs);
- Chondroprotectors;
- Hyaluronic acid.
NSAID
Non -steroidal anti -inflammatory drugs help relieve inflammation, reduce its main symptoms -edema and pain.
Preparations are prescribed in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration).Capsules and tablets from the arthrosis of the knee joint in the NSAID group are taken in short courses, as the drugs have a strong irritating effect on gastric mucosa and can provoke the development of stomach ulcers, have a lot of other side effects.
In addition, prescribed external drugs (ointments, gels, creams) based on non -steroidal anti -inflammatory components.Local therapy is allowed to be performed for a longer period of time.
NSAIDs have a pronounced anti -inflammatory effect, but with prolonged use contributes to the additional destruction of cartilage.
NSAIDs are symptomatic therapy.They help eliminate unpleasant symptoms of the disease but do not affect the condition of the cartilage.Unlike these products, chondroprotectors and hyaluronic acid accelerate the processes for regenerating cartilage tissue and slowing its destruction.
Chondroprotectors
The drugs in the Chondroprotectors group contain chondroitin and glucosamine (structural cartilage elements) and help restore the knee with arthrosis in the knee joint.They are available in the form of tablets, powder for oral administration, a solution for injection.
The smallest course to take tablets and powder is 3 months.After a break, the course is repeated 2-3 times.The course of a solution includes 12-15 injections, repeated 2-3 times a year.
The first positive results of treatment with chondroprotectors are only noticeable a few months after the start of treatment.
Hyaluronic acid
Hyaluronic acid is injected into the affected joint.The cure for arthrosis of the knee joint performs the role of lubrication - enclosing the articular surfaces, thereby reducing friction between them.
Hyaluronic acid therapy medicine helps increase the elasticity of cartilage tissue, preventing the further destruction of the articular structures, which improves the mobility of the joint, the symptoms of inflammation are reduced.Medication is tolerated well, does not cause side effects.Their only downside is the high cost.
The course of treatment with hyaluronic acid usually includes 3-4 injections performed with breaks of 10-14 days.
Blockade
If, with non -steroidal anti -inflammatory drugs, it is not possible to relieve knee pain with arthrosis, a blockade -a treatment method is performed in which the drugs are injected directly into the affected tissue to relieve pain and inflammation.For therapy of arthosis, articular (injections in the articular cavity) and periarticular (in the periarticular cavity) are used.
The main advantage of the method is an immediate targeted action as the maximum concentration of the active substance with such an introduction is created exactly in the inflammatory zone.In addition, medications do not fall into the systemic bloodstream, reducing the risk of side effects.
In the later stages of gonarthrosis, the articular gap, which is narrowed, osteophytes grow, joint surfaces are deformed, therefore only perirticular blockade is allowed.
The blockade of the knee joint for arthrosis can be performed using anesthetics and corticosteroids.
Anesthetics are usually introduced in combination with steroid hormones to reduce the pain of the procedure.
Hyaluronic acid and chondroprotectors can also be introduced directly in the joint.But in this case we are not talking about blockade, but about intra -articular injection as these drugs do not block pain impulses but trigger the processes for regeneration of cartilage tissue.
Physiotherapy and manual therapy
The main methods of physiotherapeutic effects used to treat arthrosis include:
- laser treatment;
- Ultrasonic treatment;
- Cryotherapy;
- Therapy with paraffin and ozokerite;
- Mud.
The main task of all physiotherapeutic procedures is to stimulate blood circulation in the nearby tissue, improve the nutrition of cartilage.
Exercise therapy
Pain syndrome forces a patient with gonarthrosis to limit motor activity, as a result of which nearby ligaments and muscles atrophy.This condition affects the joint tissue negatively as it is while moving that the nutrients penetrate from the synovial fluid into the cartilage.If the joint is constantly at rest, dystrophic processes worsen.
Therefore, physiotherapy exercises are an integrated component of conservative therapy.Moderate physical activity allows you to strengthen the muscle apparatus, improve the power of articular structures, eliminate stiffness and improve the motor function of the knee.
The exercises with therapeutic exercises are developed by the doctor individually for each patient, taking into account the depth of the lesion and the functional state of the articular structures.
General recommendations for performing training therapy for arthrosis of the knee joint:
- Start classes only after stopping signs of acute inflammation;
- Complete all exercises smoothly without sudden movements;
- The load gradually increases;
- Eliminate high loads on the joint (improved flexion/extension of the knee);
- If pain or discomfort appears, stop training.
Diet
With gonarthrosis, products containing: containing:
- amino acids (dairy products, low -poor varieties of meat);
- Collagen (washing up with gelatin);
- Irreplaceable fatty acids (vegetable oils, fish);
- Sulfur and selenium (legumes, grains, cabbage and apples, beef, chicken, eggs).
It is also important:
- Remove the use of smoked meat, pickles, marinades;
- limit salt consumption;
- Observe a 5 times diet;
- Observe drinking mode.
Excess body weight is one of the most important factors that provides 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, you can only achieve the result by means of a diet as intensive sports are harmful to the inflamed joint.
To reduce body weight it is recommended to exclude from the menu:
- fat variants of meat and fish;
- cream, homemade cream fraiche and other dairy products with a high percentage of fat content;
- Margarine, mayonnaise, various sauces;
- confectionery;
- fast food;
- Sweet drinks.
Surgical treatment
The osteoarthritis of the knee joint in the 3rd degree is not available for conservative therapy, so the operation is the only way off the patient.
There are two options for surgical intervention:
- Corrective osteotomy- Performed in the initial step in the development of the 3rd phase of gonarthrosis, whose cartilage is partially destroyed, it is possible to remove osteophytes;
- Endoprotetics- The replacement of the joint or its broken parts is performed with the complete destruction of cartilage.
Forecast
Pathological changes in joint structures are progressive, irreversible.However, with early diagnosis and proper treatment you can completely stop the inflammation and stop dystrophic changes in cartilage tissue - Arthrosis in the knee joint in 1. Degree is well suited for conservative therapy.
With osteoarthritis of 2nd degree, accompanied by the destruction of cartilage and formation of osteophytes, conservative methods allow you to slow down or suspend the deformation of cartilage, stop inflammation and improve motor activity.However, doctors are often forced to resort to blockade, arthroscopy.
It is impossible to cure arthrosis of the knee joint at 3 degrees in a conservative way.The only way to restore the mobility of the knee is surgical intervention.