Arthrosis is a joint pathology that is accompanied by damage to the cartilage tissue. Synonyms for arthrosis are gonarthrosis, deforming osteoarthrosis, osteoarthritis - all these terms mean the development of degenerative processes in the cartilage that covers the epiphyses of the joint bones.
Despite the fact that the lesion affects only cartilaginous structures, all joint elements are affected - capsule, synovial membrane, subchondral bones, as well as ligaments and muscles surrounding the joint. Arthrosis can affect one or more 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 determined, that is, they are idiopathic. Secondary arthrosis occurs after an injury, due to congenital anomalies and on the background of systemic diseases.
The following are the causes of arthrosis of the knee joint:
- autoimmune pathologies - rheumatoid arthritis, lupus erythematosus, scleroderma, etc. ;
- joint inflammation 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 cause 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;
- lack of microelements and vitamins in the diet;
- congenital and acquired deformities of skeletal bones;
- hypothermia and intoxication with toxic compounds;
- constant joint injuries 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 the softening, fibrous and reduction of the thickness of the articular cartilage. In addition, the surfaces of the bones that form the joint become denser, and bone spines - osteophytes - appear on them.
DOA of the knee joints develops in 3 stages, and in the early stages it can be manifested only by minor pain and discomfort after prolonged physical activity. Sometimes one of the characteristic symptoms of arthrosis occurs - morning stiffness. At this moment, there are changes 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, pain occurs during intense exercise and long walking.
In the second stage of arthrosis, the destruction of cartilaginous tissue progresses, and part of the increased load is taken over by the articular surfaces of the bones. Because there is not enough space for support, the edges of the bones increase due to osteophytes. The pain doesn't go away at rest, like before, and it bothers me even at night.
The time of morning stiffness also increases, and it takes a long time to "unbend" the leg to be able to walk normally. In addition, when the limb is bent, there are popping and clicking sounds, accompanied by sharp pain. It is not always possible to fully bend the leg, it seems to be stuck, and further attempts end in harsh grinding and pain.
Due to the appearance of pain during any movement, the person moves less, which negatively affects the muscles surrounding the joint. The change in the size of the epiphyses of the bones leads to the displacement of the limb axis and the development of deformities. The joint capsule becomes firmer as the volume of fluid within 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 pronounced - the pain does not go away even at night, the motor ability practically ceases, the leg looks crooked and does not bend. The third degree of arthrosis is characterized by a deformity in the shape of the letter X or O, which makes movement difficult. An advanced form of deforming gonarthrosis can only be treated surgically.
Diagnostics
The diagnosis of osteoarthritis of the knee joint is not particularly difficult, the doctor can assume gonarthrosis based on existing symptoms and characteristic visual signs. To confirm the diagnosis, an X-ray is taken. The images will show narrowing of the interarticular space, bony growths and subchondral osteosclerosis of the bones.
X-ray is 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, periarticular osteoporosis and atrophy of bone structures are detected. In the case of various congenital anomalies, distortion of the axis of one of the bones is observed, which led to improper load distribution 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 eliminating or weakening symptoms - reducing the intensity of pain and inflammation. Medicines, physiotherapy and exercise therapy are used to solve these problems. To achieve the maximum effect of the therapy, dosed physical activity and compliance with the orthopedic regimen are necessary.
Treatment of knee arthrosis with drugs 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 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 painful joint.
Treatment of arthrosis of the knee joint of the second stage necessarily includes exercise therapy, wearing orthopedic devices and following a diet. Non-steroidal anti-inflammatory drugs, chondroprotectors and intra-articular injection of hyaluronic acid are prescribed for pain relief.
Acute arthrosis is characterized by severe pain, for which conventional NSAIDs are not sufficient. In this case, strong analgesics and injections of glucocorticosteroids into the joint cavity are used.
If conservative methods are ineffective, surgery 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 lack of interarticular 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 psychological suffering, acute arthrosis therapy begins with pain relief. Medicines that are part of the NSAID group and can be used in tablets or topically have been shown to be effective.
The analgesic effect does not always appear immediately, but after two or three days it reaches its peak, and the pain disappears. The course of treatment with nonsteroidal anti-inflammatory drugs is limited to two weeks, because longer use increases the risk of side effects. People who have problems with the gastrointestinal tract, as well as people who suffer from high blood pressure, should be especially careful.
If there are no results, 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.
Hormone 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 symptoms subside, switch to tablets.
Chondroprotectors and hyaluronic acid
Chondroprotective agents work in three directions - restore damaged cartilage tissue, reduce pain and eliminate inflammatory reactions. Taking chondroprotectors helps normalize the composition and properties of synovial fluid, nourishes cartilage and protects 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 medication, the cushioning and lubrication function of the joint is restored.
In the early stage of the disease, chondroprotectors can be used in the form of ointment or gel. However, intra-articular injections are the most effective. 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. This is, in fact, a biological lubricant that gives cartilage 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 bone friction. With an intra-articular injection of hyaluronan, knee function is normalized and the person can move normally.
Operation
The operation is a radical method that partially or completely restores the functionality of the joint. 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 joint pathology. This procedure allows you to identify damage that is 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 disappears, resistance to stress increases, and motor activity returns.
In the case of significant deformities, 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, and then joins the bones in the most physiological position. If necessary, the resulting gap is filled with a bone graft. During the healing period, the structure is attached with special clamps.
Endoprosthesis replacement is an alternative method to the outdated arthrodesis procedure, the essence of which is partial or complete replacement of the 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
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, certain procedures allow the application of drugs through the skin, which reduces the dose of oral drugs.
The following techniques are recommended for damaged joints:
- magnetic therapy;
- medium wave ultraviolet radiation (WUV);
- infrared laser;
- UHF;
- ultrasound;
- diadem 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 regenerative effect on the joints.
Finally
If you suspect knee arthrosis, you should contact an orthopedist or traumatologist who diagnoses and treats these pathologies. In order not to make the disease worse, 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 meat and smoked meat, as well as to reduce the consumption of table salt. The diet should be dominated by foods rich in vitamins and minerals and vegetable oils. In addition, it is recommended to organize a fasting day once a week - 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 that are individually selected by the physical therapy instructor.
So, taking medicines, physical procedures, balanced diet and physical activity are what will definitely help a patient with arthrosis. And to avoid a traumatic operation, you should seek medical help as soon as possible. Be healthy!