Knee arthrosis: causes, symptoms, methods of treatment

causes of arthrosis of the knee

One of the most common pathologies of the musculoskeletal system is arthrosis of the knee joint (also known as gonarthrosis) - a chronic disease accompanied by degeneration and destruction of the joint structure of the knee.

The result of destructive processes is a sharp restriction or complete loss of joint mobility, as a result - reduced performance, disability.

Adverse consequences can only be prevented by early diagnosis and timely therapy.

Causes

Knee arthrosis has primary and secondary origins. It develops as a primary independent disease, is more often diagnosed in the elderly, and in this case is due to age-related changes in the tissues. Secondary gonarthrosis results from other diseases and disorders of the body.

Promotes gonarthrosis:

  • injuries (displacements, fractures, meniscus damage);
  • musculoskeletal disorders (congenital deformity of the legs, knee dysplasia, chondrocalcinosis, arthritis, osteoporosis);
  • constant high load on the joint caused by professional activity, professional sports;
  • overweight, obesity;
  • endocrine diseases, including diabetes, hypothyroidism, acromegaly;
  • metabolic disorders;
  • genetic predisposition.

Symptoms

Inflammation of the arthrosis of the knee joint is accompanied by two main clinical manifestations - pain and edema. The intensity and frequency of the onset of pain syndrome depends on the depth of damage to the structures of the joint. In the initial stage, the pain is felt only with effort, and quickly disappears at rest. In advanced gonarthrosis, painful pain is constantly present, increasing during movement as the weather changes.

Other signs of knee arthrosis:

  • crunch when moving;
  • joint stiffness, impaired motor function;
  • knee deformity (in advanced gonarthrosis).

Gonarthrosis may be associated with synovitis (accumulation of fluid in the joint cavity) and subsequent Baker cyst formation (elastic formation in the back of the knee).

Extent of arthrosis

degree of development of knee arthrosis

The symptoms of knee arthrosis vary depending on the depth of damage to the knee structure, so the pathology has 3 stages.

  1. Grade I knee arthritismild pain during exertion (disappears immediately at rest), mild stiffness after sleep. X-ray shows an insignificant narrowing of the joint space (less than one-third) and the presence of individual osteophytes (bone outgrowths).
  2. Grade 2 knee arthrosisis ​​accompanied by pain and characteristic cracking during movement. The pain stays calm for a while. Morning stiffness, restriction of range of motion is observed. Diagnostic procedures reveal marked stenosis of the joint space (more than half) and multiple osteophytes.
  3. Grade 3 knee arthrosisis ​​associated with persistent painful pain that increases during exercise and at night. Morning stiffness persists for more than an hour as the inflammation worsens and for at least half an hour during remission. Joint mobility is severely restricted or completely lost. X-rays show several large osteophytes and cysts. The joint gap is narrowed by more than two-thirds of the norm.

Depending on the degree of arthrosis of the knee joint, the patient may require conservative or surgical treatment.

Diagnostics

Diagnosis of knee arthrosis includes visual examination, analysis of patient complaints, laboratory results (urine examination, general and biochemical blood tests), and instrumental examination methods.

The following diagnostic procedures allow you to confirm or reject a diagnosis:

methods for diagnosing knee arthrosis
  • radiography;
  • ultrasound (ultrasound);
  • MRI (magnetic resonance imaging);
  • CT (computed tomography);
  • arthroscopy and scintigraphy (if a tumor is suspected).

These methods can be used to identify the narrowing of the joint space, the degree of thinning and deformation of the cartilage, the presence of fluid in the joint cavity, structural changes in the synovium, the proliferation of osteophytes, and foci of cartilage.

Conservative treatment

Conservative treatments can reduce pain and inflammation, improve blood circulation and nutrition in periarticular tissues, and strengthen the muscular system.

To do this, do the following:

  • drug therapy;
  • blockade;
  • physiotherapy and manual therapy;
  • physiotherapy exercises.

Adherence to a therapeutic diet is also an important part of treating arthrosis.

Conservative treatment of knee arthrosis will be effective in the early stages of the disease, when there are minor degenerative changes in cartilage, inflammation, and synovial membrane dysfunction.

Preparations

medication date includes:

  • non-steroidal anti-inflammatory drugs (NSAIDs);
  • chondroprotectors;
  • hyaluronic acid.

NSAIDs

Nonsteroidal anti-inflammatory drugs relieve inflammation and reduce its main symptoms - swelling and pain.

The compositions are prescribed in the form of solutions (for intramuscular administration) or in the form of tablets, capsules (for oral administration). Capsules and tablets for osteoarthritis of the knee joint of the NSAID group are taken in short courses because the drugs are severely irritating to the gastric mucosa and can trigger the development of peptic ulcer disease, with many other side effects.

In addition, external medications (ointments, gels, creams) based on non-steroidal anti-inflammatory drugs are prescribed. Topical therapy is allowed for a longer period of time.

NSAIDs have a pronounced anti-inflammatory effect, but their long-term use contributes to further cartilage destruction.

NSAIDs are symptomatic medications. They help eliminate the unpleasant symptoms of the disease but do not affect the condition of the cartilage. In contrast to these agents, chondroprotectors and hyaluronic acid accelerate cartilage tissue regeneration and slow its destruction.

Chondroprotectors

The preparations of the chondroprotective group contain chondroitin and glucosamine (structural elements of cartilage) and help to restore the knee in case of osteoarthritis of the knee joint. Tablets, powder for oral administration, are available as a solution for injection.

The minimum time to take tablets and powder is 3 months. After the break, the course is repeated 2-3 more times. The process of treatment with the solution involves 12-15 injections, repeated 2-3 times a year.

The first positive results of treatment with chondroprotectors are not seen until a few months after the start of therapy.

Hyaluronic acid

Hyaluronic acid is injected into the affected joint. The drug for osteoarthritis of the knee acts as a lubricant - covering the joint surfaces, thereby reducing friction between them.

Therapy with hyaluronic acid preparations helps to increase the elasticity of cartilage tissue, prevents further destruction of joint structures, thereby improving joint mobility and reducing the symptoms of inflammation. The drugs are well tolerated and do not cause side effects. Their only downside is their high cost.

Treatment with hyaluronic acid usually involves 3-4 injections given at 10-14 day intervals.

Blocking

knee seal in arthrosis

When nonsteroidal anti-inflammatory drugs are unable to relieve knee pain in arthrosis, they perform a blockade - a method of treatment in which drugs are injected directly into the affected tissues to relieve pain and inflammation. In the treatment of arthrosis, joint (injections into the joint cavity) and periarticular (into the periarticular cavity) blockade are used.

The main advantage of this method is immediate targeted action, as with such an introduction, the maximum concentration of the active ingredient is created just in the inflammatory zone. In addition, drugs do not enter the systemic circulation, which significantly reduces the risk of side effects.

In the late stages of gonarthrosis, the joint space narrows, osteophytes grow, joint surfaces are deformed, so only periarticular blockades are allowed.

Knee blockade in osteoarthritis can be done with anesthetics and corticosteroids.

Anesthetics are usually given in combination with steroid hormones to reduce the pain of the procedure.

Hyaluronic acid and chondroprotectors can also be injected directly into the joint. But in this case, we are not talking about blockade, but intraarticular injection, as these drugs do not block pain impulses, but initiate the processes of cartilage tissue regeneration.

Physiotherapy and manual therapy

The physiotherapy methods used to treat arthrosis are as follows:

  • laser treatment;
  • ultrasound therapy;
  • cryotherapy;
  • paraffin and ozokerite therapy;
  • mud therapy.

The main task of all physiotherapy procedures is to stimulate blood circulation in nearby tissues and to improve cartilage nutrition.

gym therapy

Pain syndrome forces the patient with gonarthrosis to limit physical activity, resulting in atrophy of nearby ligaments and muscles. This condition negatively affects the joint tissues as nutrients penetrate from the joint fluid into the cartilage during movement. If the joint is constantly at rest, the dystrophic processes worsen.

physiotherapy exercises for knee arthrosis

Therefore, physiotherapy practices are an integral part of conservative therapy. Moderate physical activity allows you to strengthen the muscular system, increase the nutrition of joint structures, eliminate stiffness, and improve knee motor function.

Physiotherapy exercises are developed by the physician individually for each patient, taking into account the depth of the injury and the functional condition of the joint structures.

General recommendations for exercise therapy for knee arthrosis:

  • Start training only after the signs of acute inflammation have subsided;
  • Perform all exercises smoothly, without sudden movements;
  • gradually increase the load;
  • eliminates high joint load (increased flexion / knee extension);
  • Stop training if you experience pain or discomfort.

Dieting

In the case of gonarthrosis, the patient's diet should include the following foods:

  • amino acids (dairy products, lean meats);
  • collagen (dishes with added gelatin);
  • essential fatty acids (vegetable oils, fish);
  • Sulfur and selenium (legumes, cereals, cabbage and apples, beef, chicken, eggs).

Also important:

  • excludes the use of smoked meats, pickles, pickles;
  • limits salt intake;
  • stick to the fivefold diet;
  • Observe your drinking system.

Being overweight is one of the main factors in the development of knee arthrosis. Therefore, it is the job of overweight patients to lose weight. In this case, the result can only be achieved with the help of diet, as intense exercise is harmful to the inflamed joint.

To reduce weight, we recommend that you exclude from the menu:

  • fatty meat and fish;
  • cream, homemade sour cream and other high-fat dairy products;
  • margarine, mayonnaise, various sauces;
  • confectionery;
  • fast food;
  • sugary drinks.

Surgical treatment

surgery for knee arthrosis

Grade 3 knee osteoarthritis does not respond to conservative therapy, so surgery is the only way out for the patient.

There are two surgical options:

  • corrective osteotomy- performed in the initial stage of the development of stage 3 gonarthrosis, if the cartilage tissue is partially destroyed, it is possible to remove the osteophytes;
  • endoprosthesis- the joint or its destroyed parts are replaced by the complete destruction of the cartilage.

Forecast

Abnormal changes in the structure of the joint are progressive, irreversible. However, with early diagnosis and proper treatment, it is possible to completely stop the inflammation and stop the dystrophic changes in the cartilage tissue - grade 1 knee arthrosis makes good use of conservative therapy.

In grade 2 arthrosis, which involves the destruction of cartilage and the formation of osteophytes, conservative techniques allow slowing or suspending cartilage deformation, stopping inflammation, and improving motor activity. However, doctors are often forced to resort to blockages, arthroscopy.

It is impossible to conservatively cure grade 3 knee arthrosis. The only way to restore knee mobility is surgery.

18.09.2020