All types of arthrosis occur with degenerative and dystrophic processes in the articular tissues. The disease is always a chronic disease and is not completely cured, you can only slow down or stop its progression.
According to ICD-10, gonarthrosis (damage to the knee joint) belongs to the group under the code "M17". The emphasis in treatment is on drug therapy, surgical intervention is only used when the course is already advanced.
What happens to the knee joint with arthrosis?
Arthrosis of the knee joint is accompanied by degenerative and dystrophic processes, which, if left untreated, develop stably. In these cases, the inflammatory process is not observed, except in rare cases.
Degeneration and dystrophy of the joints initially have practically no effect on knee function. Over time, this process causes a violation of the structure of the joint, it stops "sliding", bruises appear on its surface (due to changes in deformation).
Blood circulation decreases, local metabolism (metabolic processes) worsens, which only increases the rate of disease progression. The process of degeneration of hyaline cartilage begins very quickly, thinning, stratification, and then the appearance of cracks on it.
The end result of this disease is complete destruction (destruction) of hyaline cartilage with exposure to nearby bone. But the problem doesn’t end there: because of bone exposure, the latter begins to thicken and bone growth appears on it (often in the form of thorns).
All this also leads to deformation of the affected limb, followed by its curvature. For this reason the disease is also called "deforming arthrosis". With pre -existing limb deformities, the disease cannot be cured without surgery.
The causes of the development of this disease
Often, the development of knee arthrosis is preceded by the emergence of several predisposing factors. Absolutely no need to have congenital risk factors, the disease often develops with acquired factors (trauma, infection, inflammation).
Main reason:
- Severe disorders of metabolic / metabolic processes in the body (severe acute or chronic diseases of the thyroid gland, adrenal glands).
- Circulatory disorders and the presence of capillary bleeding tendency (due to its fragility).
- Overweight (obesity levels II-III) with weight gain on the musculoskeletal system as a whole.
- Knee joint injuries (including direct injuries, penetrating wounds, rupture of ligament apparatus, menisci injuries, fractures, dislocations and subluxations, cracks).
- Inflammatory pathology experienced in recent times (especially arthritis or rheumatism).
- Excessive physical activity (risk groups include athletes, gymnasts, people who play tennis, football, basketball).
- After a long and untreated knee injury.
- Congenital defects and anomalies in the structure of articular tissue, hereditary risk factors (genetic mutations).
There is a direct relationship between the cause and severity of arthrosis. If the cause is a metabolic disorder or severe injury, the prognosis is worse than in the development of arthrosis with a background of joint strain or age -related dystrophic changes.
Incident statistics
Statistically, arthrosis of the knee joint is very common; it occupies one of the leading places among all forms of arthrosis in general. About 20% of patients who apply to specialized medical institutions suffer from gonarthrosis.
If we consider all diseases of the knee joint, then among them the proportion of arthrosis falls on about 53% of cases. Recently, there has been an increase in the number of cases of gonarthrosis among the population, especially in developed countries.
This is associated with an increase in average life expectancy (the older a person is, the greater the risk of this form of arthrosis), and with the dominance of an unsteady lifestyle. And this is really a problem, because doctors still 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 unacceptable by conservative therapy. First of all, this is a deformation of the joints and bones of the affected limb. Defects may occur in the third stage of the disease.
The second danger is the development of chronic severe pain, which can disturb the patient until he is unable to sleep normally. Persistent awakening due to knee pain is one of the most common stage 3-4 gonarthrosis problems.
Fatal consequences precisely because gonarthrosis does not arise. Theoretically, serious injuries can occur due to sudden joint disruption. These are the so-called symptoms of joint blockage, which are most often observed at 3-4 stages of the disease.
The degree of gonarthrosis and the differences between them
The disease is divided into four stages, which differ in the severity of the course, the severity and number of symptoms, and the final prognosis. Also, each stage of arthrosis is treated in a special way (although differences in treatment regimens may seem small to non -physicians).
Stages of gonarthrosis:
- first stage: the disease practically does not manifest itself in any way, only slight discomfort may occur, but in general the patient feels well and is therefore very problematic to diagnose the disease in the first stage;
- second degree: severe painful sensations appear, especially after walking or standing; characteristic spasm develops during physical activity, the process of atrophy of the quadriceps femoral muscle may have already begun;
- third stage: the pain becomes painful, always bothers the patient, obvious joint deformation changes appear, it becomes hot when touched, normal walking or walking is more impossible;
- fourth degree: very difficult with severe deformity of the joints and persistent pain that does not even let the patient sleep; joint dysfunction is so obvious that ankylosis is possible (complete immobilization of the affected joint).
The first two stages of gonarthrosis are considered conditionally good, as they practically do not interfere with a person’s normal life. The last two stages are very severe 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, while in the fourth stage they are very obvious and do not stop bothering the patient despite undergoing intense drug therapy.
Stage 1 symptoms:
- Discomfort or pain with severe pressure on the joints.
- The shortcomings are almost invisible.
- Subtle increase in joint size.
Stage 2 symptoms:
- pain of moderate intensity, usually occurring with periods of exacerbation and depression;
- joints become warm to the touch;
- redness of the skin on the affected joints is possible;
- moderate knee dysfunction (walking and running are still possible, but with some difficulty);
- increased pain in the morning and after a long stay in a standing position.
Stage 3 symptoms:
- severe pain that bothers the patient all the time, but during the period of exacerbation (triggering exacerbation for each patient), the pain intensifies several times;
- visible deformity changes of the knee, increase in its size;
- the affected joint becomes hot on palpation;
- normal movement is unlikely to occur due to partial movement of the joint;
- possible curvature of the lower leg.
Stage 4 symptoms:
- pain becomes painful, do not let the patient do everyday things (including intellectual ones, because pain interferes with cognitive function);
- the appearance of synovitis due to accumulation of effusions in the cartilage cavity of the knee;
- now the deformation changes are already clearly visible not only on the joints, but also on the limbs as a whole;
- feeling of fluctuations 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 function).
If it is not possible to relieve or reduce pain in stage 3-4 arthrosis, doctors use analgesic blockade, but blockage can not be done every day.
Diagnostics
The emphasis in the diagnosis of knee arthrosis is on imaging techniques, while laboratory tests usually show nothing.
Diagnostic methods used:
- Examination by an orthopedist with palpation of the affected joint, linear measurement of bone, angiometry.
- Clinical blood tests (total deposition and erythrocytes / ESR), determination of fibrinogen levels in blood and urine and, especially, urea, as well as other biochemical parameters.
- Radiography (joint space narrowing, deformities, cartilage sclerosis, salt accumulation and even bone osteophytes are noted).
- Ultrasound examination (only for differential diagnosis).
- Magnetic resonance imaging or computed tomography (the most informative method, in terms of imaging, diagnostics).
Usually, X-rays are enough to make a diagnosis, especially if the disease is at an advanced stage. In relatively rare cases, computerized or magnetic resonance imaging is required.
Treatment of gonarthrosis: methods
The treatment of knee arthrosis is simply complex, as there is no method of treatment that is isolated from others with good effect (even medication). The treatment is long, can last for years, sometimes it is even prescribed for your lifetime.
Treatment methods used:
- drug therapy - the basis of treatment;
- physiotherapy training;
- diet therapy;
- physiotherapy treatment;
- surgical intervention.
The main thing in the treatment of arthrosis is the nature of the systematic process and unwavering adherence to the recommendations of the attending physician. Attempts to treat gonarthrosis independently, including ignoring a doctor’s prescription, usually end in disability.
Exercise therapy
Physiotherapy training is ideal for the treatment of 1-2 stage arthrosis of the knee joint. At such a stage, this is the most important method of treatment, as physical education can slow the progression of the disease and eliminate most of the symptoms.
However, there is no specific meaning of classical physical education, it can also be detrimental. Therefore, patients are given special training, and individually (because gonarthrosis can run differently in each patient).
There is no time frame for treatment with exercise therapy methods - ideally, you should undergo a lifelong prescribed exercise, from time to time see a doctor for dynamic joint monitoring. It is very useful to combine exercise therapy with exercise in the pool (there the load on the joints is much less).
Diet
Although dietary correction is very useful, this is not a mandatory method of treatment. Only in 40% of cases, dietary therapy gives significant results, and usually in people where the onset of arthrosis is provoked by endocrine pathology.
Patients are instructed to avoid fatty, fried, salty and smoked foods. Prohibition is imposed on the use of alcoholic beverages, sometimes smoking is also prohibited. At the same time, consumption of vegetables, fruits and meat products in large quantities.
In this case, sausages, sausages or wieners can not be called meat products. Patients are instructed to eat lean meat, boiled chicken is very useful (because of its high calorie content and protein content).
Physiotherapy
Physiotherapy procedures are only useful for relieving the symptoms of arthrosis, but do not directly affect the disease. That is, it is impossible to cure even first -degree arthrosis with the help of physiotherapy, no matter what the "experts" there say.
Physiotherapy is good for relieving pain, but only if mild. With severe pain (stage 3-4 arthrosis), physiotherapy 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 physical therapy techniques are prohibited because of the threat of additional joint damage.
Operation
Surgical intervention is only required at 3-4 stages of the disease, when conservative methods are no longer needed. Various types of procedures can be used: articular cavity drainage, bone osteophyte removal, joint (prosthetic) replacement.
To restore joint function, transplantation is best, but the problem is that it is a very expensive procedure. As a result, only 10-15% of patients are able to undergo such surgery. But even with the amount of money required, it is not always possible to replace the joint.
The fact is that such a procedure is contraindicated in patients in serious condition, or in patients older than 65-70 years. Keep in mind that any knee surgery has its own risk of complications (although fatal complications are possible, but very rare).
Medicine
Along with physiotherapy training is the basis of treatment and its mandatory components. If other procedures are still not feasible, then it is impossible to do without drug therapy equivalent to exercise therapy (traditional medicine cannot replace drug therapy).
Patients are given painkillers (with severe pain - blockage), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid (replacing the physiological lubrication of the joints) are possible.
Medications can affect the disease only at stage 1-2 of arthrosis. At 3-4 stages of the disease, drug therapy only plays a role as a way to relieve symptoms, while surgery can only affect the disease.
Nuances of treatment at the stage of exacerbation and remission
Approaches to the treatment of knee arthrosis during exacerbation and remission are quite different. At the stage of exacerbation, aggressive therapy is used, which aims at the restoration of joint function as soon as possible and the elimination of symptoms.
The pain reaches its peak precisely at the stage of exacerbation of the disease, therefore, in such cases, drug restriction may be prescribed.
Non-steroidal anti-inflammatory drugs can be prescribed. Although arthrosis usually occurs without inflammation, it can occur in an acute stage. Patients are given bed rest, minimal pressure on the affected joints and avoid limb overheating.
On the other hand, at the remission level, physical exercise is prescribed and in general, increased physical activity is prescribed. The reason is at the stage of remission that normal walking is possible, as joint function improves, and the pain is usually of moderate intensity.
It is necessary to use forgiveness skillfully - this is the period when classes in the pool, classes with rehabilitation therapists and efforts to restore joint function are possible. You can't do without medication at this stage.
Often, chondroprotectors, mouth pain relievers are prescribed (at the discretion of the patient, because if the pain is almost invisible, there is no need to take it). Ointments, gels and creams, including those with a warming effect, can be prescribed (which are better not used during exacerbations).
In addition, massage can be prescribed, including manual therapy (only if the disease is at stage 1-2). With a doctor's permission, special gymnastic techniques can be used.
Remission is an appropriate time for physiotherapy, but certain physiotherapy options should be addressed by the physician, not the patient. Finally, if necessary, during remission, an injection of hyaluronic acid preparation can be given.
With the increase of arthrosis, hyaluronic acid is not prescribed, because against the background of inflammation, such injections will lead to serious consequences. Please note: injections can only be given by qualified people.
Ordinary doctors, and even more so middle-level medical officers (paramedics, nurses), are not allowed to perform such injections. Self -injection into the joint not only results in disability, but also death (due to the threat of anaphylactic shock or blood clots if the needle enters the vessel accidentally).
Treatment prognosis
The prognosis for the treatment of gonarthrosis varies depending on the stage of the disease and the general health of the patient. 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 very poor, both in young patients and the elderly. Although it has been observed that young people tolerate arthrosis much more easily at such levels, it certainly causes deformity.
However, having stage 3-4 arthrosis is not the same as punishment. In fact, with the help of surgical intervention, you can try to restore, if not all the function of the knee, then for the most part. Artificial joint implants can provide excellent results.
Prevention of arthrosis of the knee joint
Arthrosis is a group of diseases that can be completely prevented by following fairly simple preventative measures. Of course, such measures do not guarantee 100%protection, but can reduce the risk of disease (especially in people at risk).
Preventive measures:
- It is necessary to avoid unnecessary stress on the joints (such loads include professional sports).
- Rational nutrition, with preference of fruits and vegetables in the daily diet.
- Maintain good physical shape, regular gymnastics.
- Prevention or elimination of obesity (more body mass - more pressure on the joints in the body).
- Preventive treatment with chondroprotectors after reaching the age of 45 years (only after consulting a doctor).
- Adequate daily fluid intake (about 1. 5 liters of water per day), minimizes salt intake.
The main thing is not to overdo it with physical activity, because it is useful only in moderation (if not wearing the musculoskeletal system). Physical education is useful, sports are not, especially for the joints and cardiovascular system.