Any type of arthrosis occurs with degenerative and dystrophic processes in the joint tissue. The disease always takes on a chronic nature and is not completely cured, you can only slow down or stop its progress.
According to ICD-10, gonarthrosis (damage to the knee joints) belongs to the group marked "M17". The emphasis in treatment is on drug therapy, surgical intervention is used only when the course progresses.
What happens to the knee joint in osteoarthritis?
Osteoarthritis of the knee joint is accompanied by degenerative and dystrophic processes, which, if left untreated, continue to progress. In this case, inflammatory processes are not noticed, with the exception of rare cases.
Joint degeneration and dystrophy initially have virtually no effect on knee functionality. Over time, these processes lead to a violation of the structure of the joint, it stops "slipping", protrusions appear on its surface (due to deformative changes).
Blood circulation decreases, local metabolism (metabolic processes) worsens, which only increases the speed of disease progression. The process of degeneration of hyaline cartilage begins very quickly, its thinning, stratification, and later the appearance of cracks on it.
The end result of the disease is the complete destruction (destruction) of hyaline cartilage with exposure of the adjacent bone. But the problem doesn't stop there: due to the exposure of the bone, it starts to thicken and bone growths (often in the shape of thorns) appear on it.
All this also leads to deformation of the affected limb, followed by its curvature. For that reason, the disease is also called "deforming arthrosis". With pre-existing limb deformity, the disease cannot be cured without surgery.
Reasons for disease development
Most often, the development of osteoarthritis of the knee is preceded by the appearance of several predisposing factors. It is not necessary to have congenital risk factors at all, the disease very often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Severe disturbances of metabolism / metabolic processes in the body (any acute or chronic severe diseases of the thyroid gland, adrenal glands).
- Circulatory disorders and the presence of a tendency to capillary bleeding (due to their fragility).
- Overweight (stage II-III obesity) with a serious increase in the load on the musculoskeletal system as a whole.
- Injuries to the knee joints (including direct injuries, penetrating wounds, ruptures of the ligament apparatus, meniscus injuries, fractures, dislocations and subluxations, cracks).
- Inflammatory pathologies in the recent past (primarily arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, people who play tennis, football, basketball).
- Consequences of long-term, poorly treated knee injury.
- Congenital defects and anomalies in the structure of joint tissue, hereditary risk factors (genetic mutations).
There is a direct link between the cause and severity of osteoarthritis. If the cause is metabolic disorders or severe injuries, the prognosis is worse than in the case of the development of arthrosis on the background of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, osteoarthritis of the knee joint is very common and occupies one of the leading positions among all forms of osteoarthritis in general. Approximately 20% of patients who turn to specialized medical institutions suffer from gonarthrosis.
If we take into account all diseases of the knee joints, then among them the proportion 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 higher the risk of this form of osteoarthritis) and with a predominance of a sedentary lifestyle. And this is really a problem, because doctors are still not able to completely cure gonarthrosis.
Why is gonarthrosis dangerous?
The main danger of gonarthrosis is disability due to the development of complications that are not subject to conservative therapy. First of all, this is a deformity of the joint and bone of the affected limb. Disability is possible already in the third phase of the disease.
Another danger is the development of chronic severe pain, which can upset 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.
The deadly consequences of gonarthrosis do not occur. In theory, a serious injury can occur due to a sudden jamming of the joints. This is the so-called symptom of joint blockage, which is 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 phases, which differ in severity of course, severity and number of symptoms, and the final prognosis. Also, each stage of osteoarthritis is treated in a special way (although differences in treatment regimens may seem small to doctors).
Degree of gonarthrosis:
- first degree: the disease practically does not manifest itself in any way, only mild 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: strong painful feelings appear, especially after a long walk or standing; during physical activity a characteristic crunch develops, the process of atrophy of the quadriceps femoris muscles can already begin;
- third degree: the pain becomes unbearable, constantly disturbs the patient, there are pronounced deformation changes in the joint, it becomes hot to the touch, it is impossible to walk normally or run even more;
- fourth degree: it is very difficult with severe joint deformities and constant pain that does not even allow the patient to sleep; joint dysfunctions are so pronounced that ankylosis (complete immobilization of the affected joint) is possible.
The first two stages of gonarthrosis are considered conditionally beneficial because they practically do not interfere with a person’s normal life. The last two phases are very difficult 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 phase there may be no symptoms, while in the fourth they are very pronounced and do not cease to disturb the patient even under strong drug therapy.
Symptoms of the first phase:
- Mild discomfort or pain with severe stress on the joint.
- Barely noticeable creak.
- Subtle increase in joint size.
Symptoms of the second phase:
- pain of moderate intensity, which usually occurs with a period of exacerbations and remissions;
- the joint becomes warm to the touch;
- redness of the skin on 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.
Symptoms of the third phase:
- severe pain that bothers the patient non-stop, but in periods of worsening (cause worsening in each patient), the pain intensifies several times;
- visible deformation changes in the knee, its increase in size;
- the affected joint becomes hot on palpation;
- normal movement is impossible due to partial immobilization of the joint;
- possible curvature of the lower leg.
Symptoms of the fourth stage:
- pain becomes unbearable, does not allow the patient to do everyday things (including intellectual, because the pain impairs cognitive functions);
- occurrence of synovitis due to accumulation of effusion in the cartilage cavity of the knee;
- now the deformation changes are already clearly visible not only in the joint but also in the limb as a whole;
- feeling of fluctuation on palpation of the patella and surrounding tissues;
- almost complete or even complete immobilization of the knee joint (in this case only surgery will help restore limb functionality).
If it is not possible to remove or significantly reduce pain in 3-4 stages of osteoarthritis, doctors resort to analgesic blockades, but blockades cannot be done on a daily basis.
Diagnosis
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 measurements, 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, salt accumulation, and even bone osteophytes).
- Ultrasound examination (for differential diagnosis only).
- Magnetic resonance imaging or computed tomography (the most informative, in terms of imaging, diagnostic methods).
An X-ray is usually sufficient to make a diagnosis, especially if the disease is in an advanced stage. In relatively rare cases, computerized or magnetic resonance imaging is required.
Treatment of gonarthrosis: methods
The treatment of osteoarthritis of the knee is only complex because no method of treatment is isolated from others with good effect (even drugs). Treatment is long, can last for years, sometimes even prescribed for the rest of your life.
Used treatment methods:
- drug therapy - the basis of treatment;
- physiotherapy exercises;
- dietary therapy;
- physiotherapy treatment;
- surgical intervention.
The main thing in the treatment of osteoarthritis is the systematic nature of the process and the unquestioning adherence to the recommendations of the attending physician. Attempts to treat gonarthrosis on their own, including neglecting 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, there is no special meaning from classical physical education, it can also be harmful. Therefore, the patient is prescribed special exercises and individually (since gonarthrosis in individual patients can take place differently).
There is no time frame for treatment with exercise methods - ideally you should do the prescribed exercises for life, visiting a doctor from time to time for dynamic monitoring of the joint. It is very useful to combine exercise therapy with exercises in the pool (there the load on the joints is much less).
Diet
Although dietary correction can be very helpful, it is not a mandatory method of treatment. Only in 40% of cases, diet therapy gives noticeable results, and usually in those people in whom the onset of osteoarthritis is caused 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 introduced, and sometimes smoking is also banned. At the same time, the consumption of large quantities of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or juices cannot be called meat products. The patient is instructed to consume lean meat, especially cooked chicken (due to its relatively low calorie content and high protein content).
Physiotherapy
Physiotherapy procedures are useful only in terms of relieving the symptoms of osteoarthritis, but do not directly affect the disease. That is, it is impossible to cure even the first stage of arthrosis with the help of physiotherapy, regardless of what some "specialists" there say.
Physiotherapy is good for relieving pain, but only if it is mild. In severe pain (stage 3-4 arthrosis) physiotherapy will not help, as will most medications (especially for oral administration).
The most desirable for the treatment of osteoarthritis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Shock physical therapy techniques are prohibited due to the threat of additional joint damage.
Operation
Surgical intervention is needed 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 joint cavity, removal of bone osteophytes, replacement (prosthetics) of the joint.
To restore the functionality of the joint, its transplant 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 surgery. But even with the required amount of money, the compound cannot always be replaced.
The fact is that such a procedure is contraindicated in patients in a serious condition or in patients older than 65-70 years. Keep in mind that each knee surgery carries its own risk of complications (even fatal complications are possible, but they are very rare).
Medications
In addition to physiotherapy, exercises are the basis of treatment and its obligatory component. If other procedures still cannot be used, then it is impossible without drug therapy along with exercise therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed painkillers (with severe pain - blockade), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid are possible (replacing the physiological lubrication of the joints).
Medications can really affect the disease only in stage 1-2 osteoarthritis. In 3-4 stages of the disease, drug therapy only plays the role of a way of resolving the symptoms, while nothing but surgery can affect the disease.
Shades of treatment in the exacerbation phase and in remission
Approaches to treating knee osteoarthritis during exacerbation and remission are somewhat different. In the worsening phase, aggressive therapy is used, which aims to restore joint function as quickly as possible and eliminate symptoms.
The pain reaches its peak precisely in the phase of exacerbation of the disease, so in such cases, drug blockades may be prescribed.
Nonsteroidal anti-inflammatory drugs may be prescribed. Despite the fact that osteoarthritis usually passes without inflammation, it can occur in the acute phase. The patient is prescribed bed rest, minimal stress on the affected joint and avoiding overheating of the limbs.
On the contrary, in the remission phase, physical exercises are prescribed and an increase in physical activity is generally prescribed. The reason is that in the remission phase, normal walking is possible, because the function of the joint improves, and the pain is usually of moderate intensity.
It is necessary to skillfully use remission - this is exactly the period when classes in swimming pools, classes with a rehabilitation therapist and attempts to restore joint functionality are possible. You can’t do without medication at this stage.
Chondroprotectors, oral painkillers, are most often prescribed (according to the patient's assessment, because if the pain is barely noticeable, there is no need to take it). Ointments, gels and creams may be prescribed, including those with a warming effect (which is better not to use during exacerbations).
In addition, massage may be prescribed, including manual therapy (only if the disease is in stage 1-2). With the permission of a doctor, special gymnastic techniques can be used.
Remission is an ideal time for physiotherapy, but choosing a particular physiotherapy should be addressed by the physician, not the patient. Finally, if necessary, injections of hyaluronic acid preparations may be given during remission.
With the worsening of arthrosis, hyaluronic acid is not prescribed, because in the background of inflammation, such injections will lead to serious consequences. Note: injections should only be given by a suitably qualified person.
Ordinary doctors, and even more so paramedics (nurses, nurses) are not allowed to perform such injections. Self-injections into the joint bring not only disability, but also death (due to the threat of anaphylactic shock or blood clot if the needle accidentally enters the vessel).
Treatment prognosis
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 is started 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 at such stages tolerate osteoarthritis much more easily, it still inevitably leads to disability.
However, having 3-4 stages of osteoarthritis is not straightforward. In fact, with the help of surgery you can try to restore, if not all the functionality of the knee, then most. The installation of an artificial joint can give a great 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 risk of disease (especially in people at risk).
Preventive measures:
- Unnecessary stress on the joints should be avoided (such loads include professional sports).
- Rational diet, with the predominance of fruits and vegetables in the daily diet.
- Maintaining good physical shape, regular gymnastics.
- Prevention or elimination of obesity (higher body weight - higher stress on the joints in the body).
- Preventive treatment with chondroprotectors after the age of 45 (only after consulting a doctor).
- Adequate 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, because it is useful only in moderation (if there is no wear and tear of the musculoskeletal system). Physical education is useful, sport is not, especially for the joints and cardiovascular system.