Arthrosis is a joint pathology that is accompanied by damage to cartilage tissue. Synonyms for arthrosis are gonarthrosis, deforming osteoarthrosis, osteoarthritis - all these terms mean the development of degenerative processes in the cartilage covering the epiphyses of articulating bones.
Despite the fact that the lesion affects only the cartilaginous structures, all articular elements are affected - the capsule, synovial membrane, subchondral bones, as well as the ligaments and muscles surrounding the joint. Arthrosis can affect one joint or several.
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 reasons
Knee arthrosis can be primary or secondary. The first group includes pathologies whose cause has not been established, that is, they are idiopathic. Secondary arthrosis occurs after injury, due to congenital anomalies and against the background of systemic diseases.
The following are the causes of arthrosis of the knee joint:
- 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, excess weight, osteoporosis;
- hormonal changes, including a decrease in estrogen synthesis during the postmenopausal period in women;
- metabolic disease;
- deficiency of microelements and vitamins in the diet;
- congenital and acquired deformities of skeletal bones;
- hypothermia and intoxication with toxic compounds;
- constant injury to the joint during sports training or hard work;
- operations on the knee joint - for example, to remove the meniscus.
Symptoms and stages
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, fibering and reduction in the thickness of articular cartilage. In addition, the surfaces of the joint-forming bones become denser, and bone spines - osteophytes - appear on them.
DOA of the knee joints develops in 3 stages, and in the early stages may manifest only minor pain and discomfort 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 decline. Therefore, with intense exercise and long walking, pain occurs.
In the second stage of arthrosis, the destruction of cartilage tissue progresses, and part of the increased load is taken on 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, as it did 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, cracking and clicking sounds are heard, accompanied by sharp pain. It is not always possible to bend the leg completely; it seems to be jammed, and further attempts end in a rough crunch and pain.
Due to the occurrence of pain during any movement, a person tends to move less, which negatively affects the muscles surrounding the joint. A change in the size of the epiphyses of the bones leads to a displacement of the limb axis and the development of deformity. The joint capsule becomes stiffer as the volume of fluid in it decreases. When osteophytes compress the surrounding soft tissues, synovitis and chronic inflammation appear.
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 it extremely difficult to move. An advanced form of deforming gonarthrosis can only be treated surgically.
Diagnostics
Diagnosis of osteoarthritis of the knee joint is not particularly difficult; a doctor can assume gonarthrosis based on the existing symptoms and characteristic visual signs. To confirm the diagnosis, x-rays are performed. The images will show narrowing of the interarticular space, bone growths and subchondral osteosclerosis of the bones.
X-rays are used to determine the cause of the disease. Bone deformations are especially clearly visible in post-traumatic arthrosis. If cartilage degeneration is caused by arthritis, then defects along the edges of the bones are detected, as well as periarticular osteoporosis and atrophy of bone structures. With various congenital anomalies, a distortion of the axis of one of the bones is observed, which led to improper distribution of the load and the occurrence of secondary osteoporosis.
Treatment
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 - reducing the intensity of pain and inflammation. To solve these problems, medications, physiotherapy, and exercise therapy are used. To obtain the maximum effect of therapy, dosed physical activity and compliance with the orthopedic regimen are necessary.
Drug treatment of knee arthrosis includes taking painkillers and anti-inflammatory drugs, as well as chondroprotectors that 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 physiotherapeutic methods, physical therapy and massage are used in 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 to reduce the load on the sore joint.
Treatment of arthrosis of the knee joint of the second stage necessarily includes exercise therapy, wearing orthopedic devices and following a diet. To relieve pain, non-steroidal 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 enough. 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 either corrective or radical (replacing a joint with a prosthesis).
Deforming arthrosis of the knee joint of the third stage is characterized by the complete absence of the interarticular space, replaced by a bone structure. This condition requires surgical intervention, since other methods are powerless in this case.
NSAIDs and corticosteroids
To save patients from physical and mental suffering, therapy for acute arthrosis begins with pain relief. Drugs that are part of the NSAID group and can be used in tablets or topically have proven themselves to be effective.
The analgesic effect does not always occur immediately, but after two or three days it reaches its peak, and the pain goes away. The course of treatment with NSAIDs is limited to two weeks, since longer use increases the risk of side effects. Particular caution should be exercised by people who have problems with the gastrointestinal tract, as well as those suffering from high blood pressure.
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-sided - into the right.
Hormonal injections can be given once every 10 days, not more often. The indication for such treatment is a large accumulation of fluid in the joint due to inflammation. As the symptoms subside, they switch to tablet forms of medications.
Chondroprotectors and hyaluronic acid
Chondroprotective agents work in three directions - they restore damaged cartilage tissue, reduce pain and eliminate inflammatory reactions. Taking chondroprotectors helps normalize the composition and properties of synovial fluid, nourish cartilage and protect pain receptors from irritation.
As a result, the destruction of cartilage structures and, consequently, the progression of the disease slows down. After a course of taking the drugs, the shock-absorbing 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, intra-articular injections are most effective. Modern methods of treating arthrosis include the use of combined agents, which 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. This is, in fact, a biological lubricant that provides cartilage with elasticity, elasticity and strength.
With the development of joint pathologies, the volume of hyaluronic acid can decrease by 2-4 times, which necessarily leads to excessive friction of the bones. With intra-articular injection of hyaluron, the function of the knee is normalized, and the person can move normally.
Surgery
Surgery 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 implementation is the least painful for the patient.
Important:arthroscopy can be performed not only for treatment, but also for diagnosing articular pathology. This procedure allows you to identify damage that is inaccessible to other studies.
The goal of arthroscopy is to extend the life of the joint by removing dead and damaged tissue from the joint cavity. As a result, pain goes away, resistance to stress increases, and motor activity returns.
In case of significant deformities, osteotomy is indicated - creating an artificial bone fracture in a specific area. Knee osteotomy 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 bone graft. During the healing period, the structure is secured with special clamps.
Endoprosthesis replacement is an alternative method to the outdated arthrodesis procedure, the essence of which is the partial or total replacement of a diseased joint with a prosthesis. As a result, knee function is completely restored in more than 90% of cases, significantly improving the quality of life of patients.
Physiotherapy
Physiotherapeutic procedures play an important role in the treatment of arthrosis, due to their beneficial effect on damaged joints. A course of physical therapy accelerates regeneration processes, eliminates pain and muscle spasms. In addition, certain 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;
- mid-wave ultraviolet (WUV);
- infrared laser;
- UHF;
- ultrasound;
- diademic and sinusoidal modulated currents (amplipulse therapy);
- Darsonval.
Effective procedures for arthrosis are also therapeutic baths - radon, hydrogen sulfide, bischofite, mineral and sage. They have an anti-inflammatory, analgesic and restorative effect on joints.
Finally
If you suspect arthrosis of the knee, you should consult an orthopedic doctor or traumatologist who diagnoses and treats these pathologies. In order not to aggravate the disease, it is necessary to avoid excessive physical activity 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, and also reduce the consumption of table salt. The diet should be dominated by foods rich in vitamins and minerals and vegetable oils. In addition, once a week it is advisable to arrange a fasting day - kefir, cottage cheese or fruit and vegetable.
To strengthen the muscular corset of the lower extremities and increase blood flow, it is necessary to regularly perform therapeutic exercises, which are selected individually by a physical therapy instructor.
Thus, taking medications, physical procedures, a balanced diet and physical exercise are what will definitely help a patient with arthrosis. And to avoid traumatic surgery, you should seek medical help as early as possible. Be healthy!