Deforming osteoarthritis of the knee (also known as osteoarthritis of the knee or DOA for short)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic, steadily progressive course, damage to all structural elements (hyaline cartilage, periarticular bone structures, synovial membrane, capsular and joint ligaments) and leads to joint deformities, reduced range of movement and often disability.
The disease begins with changes in the articular cartilage, which causes the articular surfaces of the bones to slip. Malnutrition and loss of elasticity lead to its dystrophy (thinning) and resorption, in the process the bone tissue of the joint surfaces is exposed, sliding is disturbed, the joint knees narrow, the biomechanics of the joint changes. The synovial membrane, which lines the joint and produces synovial fluid (which nourishes the cartilage and plays the role of the physiological lubricant), becomes irritated, causing an increase in its amount in the joint (synovitis). Against the background of the narrowing of the joint space, the joint volume decreases, the synovial fluid protrudes through the back wall of the joint capsule, and a Becker cyst forms (which, with large sizes, can cause pain in the hollow of the knee). The thin and sensitive tissue of the joint capsule is replaced by coarse connective tissue, and the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed. The blood flow to the periarticular tissue is impaired, under-oxidized metabolic products accumulate, which stimulate chemoreceptors, and a persistent pain syndrome develops. Against the background of changes in the anatomy of the joint, there is a violation of the surrounding muscles, hypotrophy and spasm appear, and the gait is disturbed. There is a persistent restriction of movement in the joint (contracture), which is sometimes so pronounced that only rocking movements (rigidity) or complete freedom of movement (ankylosis) are possible.
About osteoarthritis of the knee joint, we can say that it is a fairly common disease: it affects 10% of the total world population, and by the age of over 60, it affects one in three people.
Causes of osteoarthritis of the knee
- Bone and joint injuries.
- Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
- Violation of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
- Muscle disorders and neuropathy (Charcot's disease).
In addition to the main reasons, there are also unfavorable background factors for the development of osteoarthritis of the knee, including:
- obesity (literally puts pressure on the lower limbs);
- Old age (mainly the elderly are prone to the disease);
- female gender (according to statistics, women get sick more often);
- increased sport and professional physical activity.
Symptoms of osteoarthritis of the knee joints
- Pain that increases while walking and decreases at rest.
- Difficulty making habitual, physiological movements in the joints.
- The characteristic "crunch" in the joints.
- Joint enlargement and visible deformity.
Stages of osteoarthritis of the knee
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There are several stages of osteoarthritis:
- In the first stage, a person only experiences symptoms likeslight discomfortor "heaviness" in the knee, annoying when walking long distances or during increased physical exertion. The X-ray examination is not very meaningful: only a slight narrowing of the joint space can be seen, otherwise there are no changes. At the beginning of the defeat of osteoarthritis of the knee joint, a person does not turn to specialists without attaching special importance to the symptoms that have arisen.
- For the second stage of osteoarthritis of the knee joint,palpable pain, the severity of which decreases at rest. Movement difficulties arise in the joints, a characteristic "creak" can be heard when walking (you can hear a common phrase from the patient in everyday life - "knee crack"). The x-ray shows a clearly distinguishable narrowing of the joint space and individual osteophytes.
- With the transition of gonarthrosis to the next, third stage,Symptoms of pain will constantly bother the patient, even at rest, a violation of the joint configuration, d. H. Deformation aggravated by edema at the time of inflammation. X-rays show a moderate narrowing of the joint space and multiple osteophytes. In the third stage, many are already seeking medical help, because the quality of life is severely impaired by pain and difficulty walking normally.
- The fourth stage of osteoarthritis of the knee joint is accompanied byinsatiable, exhausting pain. . . Minimal attempts at movement become a difficult test for a person, deformity of the joints is visually noticeable, walking is extremely difficult. The x-ray shows significant changes: the joint gap is practically invisible in the images, several coarse osteophytes, "joint mice" (fragments of collapsing bone that fall into the joint cavity) become visible. This stage of osteoarthritis of the knee almost always involves a disability: often the result of the disease is complete fusion of the joint, its instability and the formation of a "false joint".
Who treats osteoarthritis of the knee joint?
The patient can receive qualified medical care for osteoarthritis of the knee from a therapist, rheumatologist and family doctor (family doctor), but these specialists deal with the treatment of the knee joint in uncomplicated osteoarthritis.
If synovitis occurs or the treatment prescribed by the therapist does not have the desired effect, the help of an orthopedic surgeon cannot be dispensed with. In situations where surgical care is required, a patient with osteoarthritis of the knee is referred to a specialized orthopedic and accident department.
How and how do you treat osteoarthritis of the knee joint?
The currently known methods of treating patients with osteoarthritis of the knee joint are divided into non-drug conservative, medical and surgical.
Non-drug methods
Many patients ask the question, "How do you deal with osteoarthritis of the knee without pills? " In response, we regret to note that osteoarthritis of the knee is a chronic disease that can be eliminated forever. However, many of the currently existing non-pharmacological (i. e. , drug-free) methods of treating this disease can significantly slow the progression of the disease and improve the patient's quality of life, especially when used in the early stages of the disease.
With a timely visit to the doctor and sufficient motivation of the patient to cure, it is sometimes enough to eliminate negative factors. For example, it has been proven that reducing obesity reduces the manifestation of the main symptoms of the disease.
Elimination of pathological physical activity and, on the contrarytherapeutic gymnasticsby using rational physical programs, they reduce the intensity of pain. Exercises to strengthen the quadriceps femoris have been shown to have effects comparable to anti-inflammatory drugs.
If we treat osteoarthritis of the knee joint, then we should aimright nutrition: to improve the elastic properties of articular cartilage will help products rich in animal collagen (diet types of meat and fish) and cartilage components (shrimp, crab, krill), fresh vegetables and fruits saturated with vegetable collagen and antioxidants, and a passionfor smoked meat, marinades, preservatives, sweet and salty dishes, on the other hand, potentiates the disruption of metabolic processes in the body and the accumulation of overweight and even obesity.
When thinking about the most effective treatment for knee osteoarthritis, it is worth remembering such an effective method of treatment and prophylaxis asOrthotics: Fixation knee pads, orthotics, elastic bandages and orthopedic insoles reduce and distribute the stress on the joint correctly, thereby reducing the intensity of pain. The use of a walking stick is also recommended for effective relief of the knee joints. It should be in the hand opposite the affected limb.
Comprehensive treatment of osteoarthritis of the knee joint also requires the appointment of very effective, even with advanced forms of the diseasephysical therapy. . . With widespread use in different categories of patients with osteoarthritis of any degree, it has proven its effectivenessMagnetic Therapy: After several procedures, the pain intensity decreases, as a result of improved blood circulation, a decrease in edema and an elimination of muscle spasms, the mobility of the joint increases. The effect of magnetic field therapy is particularly pronounced in the development of active inflammation in the joint: the severity of the edema is significantly reduced, the symptoms of synovitis recede. Physiotherapy methods such asLaser therapyandCryotherapy(Exposure to cold), which have a pronounced analgesic effect.
Medication
In the schemes for the effective treatment of osteoarthritis of the knee joint, the following drugs are used.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), produced in forms for external (various gels, ointments) and systemic use (tablets, suppositories, solutions), have long proven themselves in the treatment of osteoarthritis and are often prescribed by doctors. By inhibiting inflammation at the enzymatic level, they eliminate joint pain and swelling and slow the progression of the disease. With early manifestations of the disease, the local use of these drugs in combination with non-drug methods (therapeutic exercises, magnetic therapy) is effective. But with advanced osteoarthritis of the knee joints, tablets and sometimes NSAID injections are indispensable. It must be remembered that prolonged systemic use of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract, and in addition, adversely affect the functioning of the kidneys and liver. Therefore, patients who have long used NSAIDs should also be prescribed drugs to protect the gastric mucosa, and the laboratory performance of internal organs should be regularly monitored.
Glucocorticosteroids (GCS)- hormonal preparations with a pronounced anti-inflammatory effect. They are recommended when the NSAIDs previously prescribed to the patient cannot cope with the elimination of the symptoms of inflammation. As a powerful anti-inflammatory agent, GCS have certain contraindications in the treatment of osteoarthritis as they can cause a number of significant side effects. With systemic forms with osteoarthritis of the knee, they are practically not prescribed. The effective treatment of osteoarthritis usually means GCS injections into the periarticular pain points, which increases the intensity of the inflammation control and minimizes the risk of undesirable side effects of the drug. This manipulation can be performed by a rheumatologist or trauma specialist. If you have synovitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single administration of GCS, the effects of such treatment last up to 1 month. According to national guidelines for the treatment of osteoarthritis, do not give more than three injections of the drug into the same joint per year.
In advanced, "neglected" osteoarthritis, when a person experiences excruciating pain that does not subside even at rest, disrupts normal sleep, and is not eliminated by NSAIDs, GCS, and non-drug methods, it is possible to prescribeOpioid pain relievers. . . These drugs are used only with a doctor's prescription, taking into account the appropriateness of their appointment in each case.
Chondroprotectors(literally translated as "protection of the cartilage"). This name refers to various drugs that are united by one property - a structure-changing effect, i. H. the ability to slow down degenerative changes in cartilage and the narrowing of the joint space. They are made in forms for both oral administration and for insertion into the joint cavity. Of course, these drugs don't work miracles or "grow" new cartilage, but they can stop its destruction. In order to achieve a lasting effect, they must be used several times a year over a long period of time with regular courses.
Surgical treatment of osteoarthritis of the knee joints
There are frequent cases when, despite adequate complex treatment, the disease progresses and steadily reduces the quality of life of the person. In such situations, the patient begins to ask questions: "What to do if prescribed medication does not help with osteoarthritis of the knee joint? "" Is surgical treatment indicated for knee osteoarthritis? "To answer these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are persistent pain syndrome and significant dysfunction of the joint, which are associated with the use of a complex conservativeTherapy that is possible with the latter cannot be eliminated. fourth degree of the disease.
The most popular type of surgical care for third and fourth degree osteoarthritis isEndoprosthetics, d. H. Removal of one's own joint while at the same time inserting a metal replacement prosthesis, the structure of which is similar to the anatomy of the human knee joint. The prerequisites for this type of surgical treatment in this case are: the absence of gross joint deformities, formed "false joints", muscle contractures and severe muscle atrophy. In the case of severe osteoporosis (a significant decrease in bone mineral density), endoprosthetics are also not indicated: "sugar" bones do not withstand the introduction of metal pins, and rapid resorption (resorption) of bone tissue begins at their place of installation. pathological fractures can occur. That is why a timely decision about the need to install an endoprosthesis seems so important - it should be made when the age and general condition of the human body still allow the operation to be performed. According to the results of long-term studies, the duration of effect of endoprostheses in patients with advanced osteoarthritis, i. H. the temporary duration of the absence of significant motor impairments and the maintenance of an adequate quality of life is about ten years. The best results of surgical treatment are observed in people aged 45-75 years with low body weight (less than 70 kg) and a relatively high standard of living.
Despite the widespread use of knee arthroplasty, the results of such operations are often unsatisfactory and the complication rate is high. This is due to the design features of endoprostheses and the complexity of the surgical procedure itself (hip replacement is technically much easier). This makes it necessary to carry out organ-preserving operations (preservation of the joint). This includes arthromedullary bypass surgery and corrective osteotomy.
Arthromedullary bypass- Connection of the medullary canal of the femur with the cavity of the knee joint with a shunt - a hollow metal tube. This allows the fatty bone marrow from the lower third of the thigh bone to penetrate the knee joint, nourishing and lubricating the cartilage, which significantly reduces pain.
It is effective when changing the axis of the lower extremity (but under the condition of a slight restriction in the range of motion)Corrective Osteotomy- Division of the tibia with correction of its axis, followed by fixation with a plate and screws in the desired position. At the same time, two goals are achieved - the normalization of the biomechanics through the restoration of the extremity axis and the activation of blood flow and metabolism during bone fusion.
In summary, I would like to state that the treatment of osteoarthritis of the knee is a complex social task. And although medicine today cannot offer a drug that will get rid of it forever, or other options for a complete cure for this disease, a healthy lifestyle, timely seeking medical help, and following doctor's recommendations can stop the progression.