Any types of arthrosis occur with degenerative and dystrophic processes in the joint tissue. The disease always takes on a chronic character and is not completely cured, you can only slow down or stop its progress.
According to the ICD-10, gonarthrosis (injury to the knee joints) belongs to the group under the code "M17". The emphasis in treatment is on drug therapy, surgical intervention is used only when the course is advanced.
What happens to the knee joint with osteoarthritis?
Arthrosis of the knee joint is accompanied by degenerative and dystrophic processes that, if left untreated, progress steadily. In this case, no inflammatory processes are observed, with the exception of rare cases.
Degeneration and dystrophy of the joint at first practically do not affect the functionality of the knee. Over time, these processes lead to a violation of the structure of the joint, it stops "slipping", and bumps appear on its surface (due to deformative changes).
Blood circulation decreases, local metabolism (metabolic processes) worsens, which only increases the rate of disease progression. The hyaline cartilage degeneration process begins very quickly, its thinning, stratification and, later, the appearance of cracks.
The end result of the disease is the complete destruction (destruction) of the 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 nodules (often in the form of spines) appear.
All of this also leads to deformation of the affected limb, followed by its curvature. It is for this reason that the disease is also called "arthrosis deformans". With an existing limb deformity, the disease cannot be cured without surgery.
The reasons for the development of the disease
Most of the time, the development of knee arthrosis is preceded by the appearance of several predisposing factors. It is not necessary to have congenital risk factors, the disease often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Serious disturbances of the metabolic / metabolic processes of the body (any serious acute or chronic diseases of the thyroid gland, adrenal glands).
- Circulatory disorders and the presence of a tendency to capillary bleeding (due to its fragility).
- Overweight (stage II-III obesity) with a serious increase in the load on the musculoskeletal system as a whole.
- Injury to the knee joints (including direct injuries, penetrating wounds, torn ligaments, injuries to the menisci, fractures, dislocations and subluxations, fissures).
- Inflammatory pathologies suffered in the recent past (mainly arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, people who play tennis, football, basketball).
- The result of a long-standing and poorly treated knee injury.
- Congenital defects and anomalies in the structure of joint tissues, hereditary risk factors (genetic mutations).
There is a direct connection between the cause and severity of arthrosis. If metabolic disturbances or severe injuries are the cause, the prognosis is worse than in the case of the development of arthrosis in the context of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, arthrosis of the knee joint is very common, occupying one of the prominent places among all forms of arthrosis in general. Approximately 20% of patients who apply to specialized medical institutions suffer from gonarthrosis.
If we consider all the diseases of the knee joints, then, among them, the participation of arthrosis falls in about 53% of the cases. Recently, there has been an increase in the number of cases of gonarthrosis in the population, mainly in developed countries.
This is related to the increase in average life expectancy (the older the person, the greater the risk of this form of arthrosis) and the predominance of a sedentary lifestyle. And that's really a problem, as doctors haven't been 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 amenable to conservative therapy. First, it is a deformation of the joint and bone of the affected limb. Disability is possible in the third stage of the disease.
The second danger is the development of severe chronic pain, which can upset the patient so much that he will not be able to sleep normally. Constant awakening from knee pain is one of the most common problems in stage 3-4 of gonarthrosis.
Lethal consequences precisely because of gonarthrosis do not arise. In theory, serious injury can occur due to a sudden joint blockage. This is the so-called joint blockage symptom, most often seen in 3-4 stages of the disease.
The degree of gonarthrosis and the difference between them
The disease is divided into four stages, which differ in course severity, severity and number of symptoms, and final prognosis. In addition, each stage of osteoarthritis is treated in a special way (although differences in treatment regimens may seem small to non-physicians).
The degree of gonarthrosis:
- first degree: the disease is hardly manifest at all, 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 sensations appear, especially after a long walk or standing; during physical activity, a characteristic crunch develops, the process of atrophy of the quadriceps femoris muscle can already begin;
- third degree: the pain becomes unbearable, constantly bothers the patient, there are pronounced deforming changes in the joint, it becomes hot to the touch, it is impossible to walk normally or even run longer;
- fourth degree: it is very difficult with severe joint deformities and constant pain that does not even allow you to sleep; joint dysfunctions are so pronounced that ankylosis is possible (complete immobilization of the affected joint).
The first two degrees of gonarthrosis are considered conditionally favorable, as they practically do not interfere with the person's normal life. The last two stages are very serious and lead to disability.
Symptoms of gonarthrosis at different stages
The clinical picture of gonarthrosis depends on the stage of the disease. In the first stage, there may be no symptoms, whereas in the fourth stage they are very pronounced and keep bothering the patient even under potent drug therapy.
Stage 1 symptoms:
- Mild discomfort or pain with strong stress on the joint.
- Almost imperceptible crunch.
- Subtle increase in joint size.
Stage 2 symptoms:
- moderate pain, usually occurring with a period of exacerbations and remissions;
- the joint is hot to the touch;
- redness of the skin over the affected joint is possible;
- moderate knee disorders (it is still possible to walk and run, but with some difficulty);
- increased pain in the morning and after standing for a long time.
Stage 3 symptoms:
- severe pain that bothers the patient 24 hours a day, but during periods of exacerbation (triggers the exacerbation for each patient), the pain intensifies several times;
- visible deformative changes in the knee, its increase in size;
- the affected joint becomes warm on palpation;
- normal movement is impossible due to partial joint immobilization;
- possibly leg curvature.
Stage 4 symptoms:
- the pain becomes unbearable, does not allow the patient to do everyday things (including intellectual ones, as the pain impairs cognitive functions);
- the appearance of synovitis due to the accumulation of effusion in the cartilage cavity of the knee;
- now the deformative changes are already clearly visible not only in the articulation 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 eliminate or significantly reduce the pain in 3-4 stages of osteoarthritis, doctors resort to analgesic blocks, but the blocks cannot be done daily.
Diagnosis
The emphasis in diagnosing arthrosis of the knee is on imaging techniques, whereas 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 / ESR), determination of fibrinogen levels in blood and urine, and especially urea, in addition to other biochemical parameters.
- Radiography (narrowing of the joint space, deformities, cartilage sclerosis, accumulation of salts and even bone osteophytes are revealed).
- Ultrasound exam (only for differential diagnosis).
- Magnetic resonance imaging or computed tomography (the most informative, in terms of imaging, diagnostic methods).
An X-ray is usually sufficient to make the diagnosis, especially if the disease is at an advanced stage. In relatively rare cases, magnetic resonance imaging or computerized imaging is required.
Treatment of gonarthrosis: methods
The treatment of arthrosis of the knee is just complex, as no treatment method is isolated from another with good effect (even medications). The treatment is long, can last for years, sometimes even prescribed for life.
Treatment methods used:
- drug therapy - the mainstay of treatment;
- physiotherapy exercises;
- dietary therapy;
- physiotherapeutic treatment;
- surgical intervention.
The main thing about the treatment of arthrosis is the systematic nature of the process and the unquestionable adherence to the recommendations of the treating physician. Attempts to treat gonarthrosis independently, including ignoring the doctor's prescription, often end in failure.
exercise therapy
Physical therapy exercises are best suited for treating 1-2 stages of arthrosis of the knee joints. At these stages, this is almost the main method of treatment, as physical education can slow the progression of the disease and eliminate most symptoms.
However, there is no special sense of classical physical education, it can also be harmful. Therefore, special exercises are prescribed to the patient and individually (since gonarthrosis can occur differently in each patient).
There is no timeframe for treatment with exercise therapy methods - ideally, you need to engage in prescribed exercises for life, visiting a doctor from time to time for dynamic joint monitoring. It is very useful to combine exercise therapy with exercises in the pool (there the load on the joints is much less).
Diet
While nutritional correction can be very helpful, it is not a mandatory treatment method. Only in 40% of cases, diet therapy gives noticeable results and generally in those people in whom the onset of arthrosis was caused by endocrine pathologies.
The patient is advised to give up fatty, fried, salty and smoked foods. A ban on the use of alcoholic beverages is introduced, sometimes tobacco smoking is also banned. At the same time, the consumption of large amounts of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or sausages cannot be called meat products. The patient is instructed to consume lean meats, cooked chicken is especially helpful (due to the relatively low calorie content and high protein content).
Physiotherapy
Physical therapy procedures are only useful for relieving the symptoms of arthrosis, but they do not directly affect the disease. In other words, it is impossible to cure even the first stage of osteoarthritis with the help of physical therapy, no matter what some "experts" say there.
Physical therapy is good for relieving pain, but only if it is mild. With severe pain (stage 3-4 of osteoarthritis), physical therapy will not help, as will most medications (especially for oral use).
The most preferred for the treatment of arthrosis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Shock physiotherapy techniques are prohibited due to the threat of further joint damage.
Operation
Surgical intervention is only necessary at 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 (prosthesis) of the joint.
To restore the functionality of the joint, it is best to transplant it, but the problem is that it is a very expensive procedure. As a result, only 10-15% of patients can afford such an operation. But even with the necessary amount, it is not always possible to replace the gasket.
The fact is that this procedure is contraindicated in critically ill patients or in patients over 65-70 years. Remember that any knee surgery has its own risk of complications (even lethal complications are possible, but very rare).
medicine
Along with physiotherapy exercises they are the basis of treatment and its mandatory component. If other procedures still cannot be used, then it is impossible to dispense with drug therapy in conjunction with exercise therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed analgesics (with strong pain blockage), decongestants, muscle relaxants, antihistamines. Chondroprotectives are often prescribed, and injections of hyaluronic acid (replacing the physiological lubrication of the joints) are possible.
Drugs can actually affect the disease only in stages 1-2 of osteoarthritis. In 3-4 stages of the disease, drug therapy plays only the role of a way to deal with the symptoms, whereas nothing more than an operation can affect the disease.
The nuances of treatment at the stage of exacerbation and in remission
Approaches to treating knee arthrosis during exacerbation and remission are somewhat different. In the exacerbation phase, aggressive therapy is used, with the aim of restoring joint function as quickly as possible and eliminating symptoms.
Pain reaches its peak precisely in the phase of disease exacerbation, therefore, in these cases, drug blockade may be prescribed.
Nonsteroidal anti-inflammatory drugs may be prescribed. Although arthrosis usually proceeds without inflammation, it can occur in the acute phase. The patient is prescribed bed rest, minimal stress on the affected joint, and avoidance of limb overheating.
On the contrary, in the remission phase, physical exercise is prescribed and, in general, an increase in physical activity is prescribed. The reason is that it is in the remission phase that normal walking is possible, as joint function improves and the pain is usually of moderate intensity.
It is necessary to use remission skillfully - this is the time when pool classes, classes with a rehabilitation therapist, and attempts to restore joint functionality are possible. You cannot go without medication at this stage.
Most of the time, chondroprotectors, oral analgesics are prescribed (at the patient's discretion, because if the pain is barely noticeable, there is no need to take them). Ointments, gels and creams, including those with a warming effect, may be prescribed (which is best not to use during an exacerbation).
In addition, massage may be prescribed, including manual therapy (only if the illness is in stages 1-2). With the doctor's permission, special gymnastic techniques may be used.
Remission is the ideal time for physical therapy, but the choice of specific physical therapy should be made by the physician, not the patient. At the end, if necessary, during remission, injections of hyaluronic acid preparations can be given.
With the exacerbation of arthrosis, hyaluronic acid is not prescribed, because, in a context of inflammation, such injections have serious consequences. Note: Injections should only be administered by an appropriately qualified person.
Ordinary doctors, and even more so mid-level medical personnel (paramedics, nurses), are not allowed to give these injections. Joint self-injections are fraught not only with 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 differs depending on the stage of the disease and the patient's general health status. 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 arthrosis, the prognosis is extremely poor, both in young and elderly patients. Although it has been noted that young people tolerate arthrosis much more easily at these stages, it still inevitably leads to disability.
However, having osteoarthritis in stage 3-4 is not equivalent to a sentence. In fact, with the help of surgical intervention, you can try to restore, if not all the functionality of the knee, then most of it. The implantation of an artificial joint can give an excellent result.
Prevention of arthrosis of the knee joint
Arthrosis is a group of diseases that can be completely prevented by following very simple preventive measures. Of course, such measures do not guarantee 100% protection, but they can reduce the risk of illness (especially for people at risk).
Preventive measures:
- It is necessary to avoid unnecessary strain on the joints (such loads include professional sports).
- Rational nutrition, with a predominance of fruits and vegetables in the daily diet.
- Keep in good physical shape, regular gymnastics.
- Prevention or elimination of obesity (more body mass - more stress on the body's joints).
- Preventive treatment with chondroprotectors from 45 years of age (only after consultation with the doctor).
- Adequate daily fluid intake (about 1. 5 liters of water per day), minimizing salt intake.
The main thing is not to overdo the physical activity, as it only serves in moderation (if there is no wear and tear on the musculoskeletal system). Physical education is helpful, sports are not, especially for the joints and cardiovascular system.