Arthrosis is a joint pathology accompanied by damage to cartilage 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 joint bones.
Despite the fact that the lesion affects only cartilaginous structures, all joint elements are affected - the capsule, synovial membrane, subchondral bones, as well as ligaments and muscles around the joint. Arthritis can affect one or several 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 causes
Knee arthrosis can be primary and secondary. The first group includes pathologies whose cause has not been established, i. e. they are idiopathic. Secondary arthrosis occurs after an injury, due to congenital anomalies and against the background of systemic diseases.
The causes of arthrosis of the knee joint are:
- autoimmune pathologies - rheumatoid arthritis, lupus erythematosus, scleroderma, etc. ;
- inflammation of the joints caused by a specific infection (syphilis, gonorrhea, encephalitis);
- hereditary diseases of the musculoskeletal system and joints, type 2 collagen mutations.
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 trace elements and vitamins in the diet;
- congenital and acquired deformations of the bones of the skeleton;
- hypothermia and intoxication with toxic compounds;
- permanent injury to the joint during sports training or heavy work;
- operations on the knee joint - for example, to remove the meniscus.
Symptoms and stages
The deforming arthrosis of the knee joint is characterized by intracellular changes at the morphological, molecular, biochemical and biomechanical level. The consequence of the pathological process is softening, fibrillation and reduction of the thickness of the articular cartilage. In addition, the surfaces of the bones forming the joints become denser and bone spikes appear on them - osteophytes.
DOA of the knee joints develops in 3 stages, and in the early stages only mild pain and discomfort may occur 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 intra-articular fluid.
As a result, the cartilage tissue does not receive enough nutrients and its ability to withstand pressure begins to decrease. Therefore, with intense exercise and long walking, pain appears.
In the second stage of arthrosis, the destruction of the cartilage tissue progresses and part of the increased load is taken over by the articular surfaces of the bones. Since there is not enough area for support, the edges of the bones increase due to osteophytes. The pain no longer goes away at rest like before and bothers me even at night.
The time of morning stiffness also increases, and it takes a long time to "work out" the leg so that you can walk normally. In addition, when the limb is bent, popping and clicking sounds are heard, accompanied by sharp pain. It is not alwaysit is possible for the leg to fully bend, it appears to be stuck, and further attempts result in a harsh crunch and pain.
Due to the occurrence of pain during every movement, a person tends to move less, which negatively affects the muscles around the joint. The change in the size of the epiphyses of the bones leads to displacement of the axis of the limb and the development of deformity. The joint capsule becomes harder as the volume of fluid in it decreases. When osteophytes compress the surrounding soft tissues, synovitis and chronic inflammation occur.
When moving to the 3rd stage, the signs of arthrosis of the knee joint become very severe - the pain does not go away even at night, motor ability practically stops, the leg looks crooked and does not bend. The third degree of arthrosis is characterized by an X- or O-shaped deformity, which makes movement extremely difficult. The advanced form of deforming gonarthrosis can only be treated surgically.
Diagnosis
The diagnosis of arthrosis of the knee joint is not particularly difficult, the doctor can assume gonarthrosis based on the existing symptoms and characteristic visual signs. X-rays are taken to confirm the diagnosis. The images will show narrowing of the inter-articular space, bone spurs and subchondral osteosclerosis of the bones.
X-rays are used to determine the cause of the disease. Bone deformations are particularly clearly visible in post-traumatic arthrosis. If cartilage degeneration is caused by arthritis, then defects are found at the edges of the bones, as well as periarticular osteoporosis and atrophy of bone structures. In various congenital anomalies, a distortion of the axis of one of the bones is observed, which leads to an incorrect distribution of the load and the occurrence of secondary osteoporosis.
Treatment
The treatment of gonarthrosis of the knee joint has 3 main goals - restoration of cartilage tissue, improvement of mobility in the joint and slowing down the progression of the disease. Great importance is attached to the elimination or weakening of symptoms - a reduction in the intensity of pain and inflammation. Medicines, physiotherapy and therapeutic exercises are used to solve these problems. To achieve the maximum effect of the therapy, dosed physical activity and compliance with the orthopedic regime is necessary.
Medical treatment of knee arthrosis includes taking pain-relieving and anti-inflammatory drugs, as well as chondroprotectors, which promote the regeneration of cartilage tissue. Medicines can be prescribed in the form of injections, tablets, ointments and gels.
If knee arthrosis of the first degree is diagnosed, then physiotherapy methods, physiotherapy and massage are used in the 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 in order to reduce the load on the diseased joint.
Treatment of arthrosis of the knee joint in the second stage necessarily includes exercise therapy, wearing orthopedic devices and following a diet. To relieve pain, nonsteroidal anti-inflammatory drugs, chondroprotectors and intra-articular 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 injection of glucocorticosteroids into the joint cavity are used.
If conservative methods are ineffective, an operation is performed, which can be corrective or radical (joint replacement with a prosthesis).
The deforming arthrosis of the knee joint of the third stage is characterized by a complete absence of inter-articular space, replaced by bone structure. This condition requires surgical intervention, as other methods are powerless in this case.
NSAIDs and corticosteroids
In order to save patients from physical and mental suffering, therapy for acute arthrosis begins with anesthesia. Medicines that are part of the NSAID group and can be used in the form of tablets or topically have proven their effectiveness.
The analgesic effect does not always occur 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 longer use increases the risk of side effects. People who have problems with the gastrointestinal tract, as well as those suffering from high blood pressure, should be especially careful.
If there is no result, hormonal drugs are prescribed to relieve inflammation. In the case of left-sided gonarthrosis, drugs are injected into the left knee, right - into the right.
Hormonal injections can be given once every 10 days, no more often. The indication for such treatment is a large accumulation of fluid in the joint due to inflammation. When symptoms subside, they switch to tablet forms of medication.
Chondroprotectors and hyaluronic acid
Chondroprotectors 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, nourishes cartilage and protects pain receptors from irritation.
As a result, the destruction of cartilaginous structures and, accordingly, the progression of the disease is delayed. After a course of medication, the cushioning and lubricating function of the joint is restored.
In the early stages of the disease, chondroprotectors can be used in the form of an ointment or gel. However, the most effective are intra-articular injections. Modern methods of treating arthrosis include the use of combined agents that 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. It is actually a biological lubricant that provides cartilage elasticity, elasticity and strength.
With the development of joint pathologies, the volume of hyaluronic acid can decrease 2-4 times, which necessarily leads to excessive bone friction. With intra-articular injection of hyaluronan, the function of the knee is normalized and a person can move normally.
surgery
The operation 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 gentle operation is arthroscopy - the rehabilitation period after its application is the least painful for the patient.
Important:arthroscopy can be performed not only for treatment, but also for the diagnosis of joint pathology. This procedure allows you to identify damage that is inaccessible to other research.
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, resistance to stress increases and motor activity returns.
In case of significant deformations, osteotomy is indicated - creation of an artificial bone fracture in a certain area. Osteotomy of the knee literally means "cutting the bones" - during the operation, the surgeon removes a wedge-shaped segment of the femur or tibia, then combines the bones in the most physiological position. If necessary, the resulting gap is filled with a bone graft. Duringduring the healing period, the structure is fixed with special clamps.
Endoprosthesis is an alternative method to the outdated procedure of arthrodesis, the essence of which is the partial or complete replacement of a diseased joint with a prosthesis. As a result, knee function is fully restored in more than 90% of cases, which significantly improves the quality of life of patients.
Physiotherapy
Physiotherapy procedures play an important role in the treatment of arthrosis, due to their beneficial effect on damaged joints. The course of physiotherapy accelerates regeneration processes, removes pain and muscle spasms. In addition, some procedures allow the administration of drugs through the skin, thereby reducing the dosage of oral drugs.
For damaged joints, the following techniques are recommended:
- magnetic therapy;
- medium wave ultraviolet (WUV);
- infrared laser;
- UHF;
- ultrasound;
- diademic and sinusoidal modulated currents (amplipulse therapy);
- Darsonval.
Effective procedures for arthrosis are also medicinal baths - radon, hydrogen sulphide, bischofite, mineral and sage. They have an anti-inflammatory, analgesic and joint-restoring effect.
Finally
If you suspect arthrosis of the knee, you should consult an orthopedist or traumatologist who diagnoses and treats these pathologies. In order not to worsen the disease, it is necessary to avoid excessive physical load 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 meats and smoked meats, as well as to reduce the consumption of table salt. Foods rich in vitamins and minerals and vegetable oils should prevail in the diet. In addition, once a week it is recommended to organize a fasting day - kefir, cottage cheese or fruits and vegetables.
To strengthen the muscle corset of the lower limbs and increase blood flow, it is necessary to regularly perform therapeutic exercises, which are selected individually by a physical therapy instructor.
Thus, taking medication, physical procedures, balanced diet and exercise are what will definitely help a patient with osteoarthritis. And to avoid a traumatic operation, you should seek medical help as early as possible. Be healthy!