Arthrosis is a joint pathology that is associated with cartilage tissue damage. Synonyms of arthrosis are gonarthrosis, deforming osteoarthrosis, osteoarthritis - all these terms mean the development of degenerative processes in the cartilage that covers the epiphyses of articulating bones.
Despite the fact that the lesion affects only cartilaginous structures, all articular elements are affected - capsule, synovial membrane, subchondral bones, as well as ligaments and muscles surrounding 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 reasons
Knee arthrosis can be primary or secondary. The first group includes pathologies whose cause has not been proven, that is, they are idiopathic. Secondary arthrosis appears after injury, due to congenital anomalies and against the background of systemic diseases.
Below 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, obesity, osteoporosis;
- hormonal changes, including a decrease in estrogen synthesis during the postmenopausal period in women;
- metabolic disease;
- lack of microelements and vitamins in the diet;
- congenital and acquired deformities of skeletal bones;
- hypothermia and intoxication with toxic compounds;
- persistent joint injury during sports training or hard 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 the softening, fibrosis and reduction of the thickness of the articular cartilage. In addition, the surfaces of the bones that form joints become denser and bone spines appear on them - osteophytes.
DOA of the knee joints develops in 3 stages, and in the early stages only pain and minor discomfort may be manifested after prolonged physical activity. Sometimes one of the characteristic symptoms of arthrosis appears - stiffness in the morning. 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 walks, pain appears.
In the second stage of arthrosis, the destruction of the cartilage tissue progresses and part of the increased load is taken by the articular surfaces of the bones. Since there is not enough area for support, the edges of the bones grow due to osteophytes. The pain doesn't go away at rest like it used to, and it bothers me even at night.
The morning stiffness time 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, sounds of crackling and clicking are heard, accompanied by sharp pains. It is not always possible to fully bend the leg; it seems to be stuck and further attempts end 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 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 more rigid as the volume of fluid in it decreases. When osteophytes compress the surrounding soft tissues, synovitis and chronic inflammation occur.
When you move 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 skills practically stop, 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. An advanced form of deforming gonarthrosis can only be treated surgically.
Diagnosing
The diagnosis of osteoarthritis of the knee joint is not particularly difficult; a doctor can assume gonarthrosis based on existing symptoms and characteristic visual signs. To confirm the diagnosis, x-rays are performed. The images will show narrowing of the inter-articular space, bone growth and subchondral osteosclerosis of the bones.
X-rays are used to determine the cause of the disease. Bone deformities are particularly evident 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 appearance 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 get the maximum effect of the therapy, dosed physical activity and compliance with the orthopedic regime is necessary.
Medical 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, 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 weight loss to reduce the load on the injured joint.
Treatment of second-stage knee arthrosis necessarily includes exercise therapy, wearing orthopedic devices and following a diet. To relieve pain, non-steroidal anti-inflammatory drugs, chondroprotectors and intra-articular injections 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 (replacement of a joint with a prosthesis).
The deforming arthrosis of the knee joint of the third stage is characterized by the complete absence of the inter-articular space, replaced by a bony structure. This condition requires surgical intervention, as other methods are ineffective 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 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 NSAID treatment is limited to two weeks, as longer use increases the risk of side effects. Special care should be taken by people who have problems with the gastrointestinal tract, as well as those who suffer from high blood pressure.
If there is no result, hormonal drugs are prescribed to relieve inflammation. In the case of gonarthrosis of the left side, drugs are injected into the left knee, on the right side - 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. With the removal of symptoms, they switch to tablet forms of drugs.
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, nourishes the cartilage and protects pain receptors from irritation.
As a result, the destruction of cartilage structures and, therefore, the progression of the disease slows down. After a course of taking drugs, the 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 oil or gel. However, intra-articular injections are more 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 elasticity, elasticity and strength to the cartilage.
With the development of joint pathologies, the volume of hyaluronic acid can decrease by 2-4 times, which inevitably leads to excessive bone friction. With the intra-articular injection of hyaluronic, 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 may be different and depends on the stage of arthrosis. The mildest operation is arthroscopy - the rehabilitation period after its implementation is less 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 damages that are inaccessible to other studies.
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 goes away, resistance to stress increases and motor activity returns.
In case of pronounced deformations, osteotomy is indicated - the creation of an artificial bone fracture in a certain 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 complete replacement of a diseased joint with a prosthesis. As a result, knee function is fully restored in more than 90% of cases, significantly improving 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. A course of physical therapy accelerates regeneration processes, eliminates pain and muscle spasms. In addition, some procedures allow the administration of drugs through the skin, thereby reducing the dose of oral drugs.
For damaged joints, the following techniques are recommended:
- magnetic therapy;
- mid-wave ultraviolet (WUV);
- infrared laser;
- UHF;
- ultrasound;
- modulated diadem and sinusoidal currents (amplipulse therapy);
- Darsonval.
Effective procedures for arthrosis are also therapeutic baths - radon, hydrogen sulfide, biscofit, mineral and sage. They have an anti-inflammatory, analgesic and restorative effect on the joints.
Finally
If you suspect knee arthrosis, you should consult an orthopedic doctor or traumatologist who diagnoses and treats these pathologies. In order not to worsen 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 osteoarthritis, but it is recommended to avoid concentrated meat and fish juices, fatty meat and smoked meat, as well as reducing the consumption of kitchen 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 organize a fasting day - kefir, cottage cheese or fruits and vegetables.
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 exercises are what will definitely help a patient with arthrosis. And to avoid traumatic surgery, you should seek medical help as soon as possible. Be healthy!