Arthrosis of the knee jointDegenerative-dystrophic disease of the cartilage tissue, which leads to exposure of the bone heads and impairment of joint mobility. The disease is non-inflammatory in nature and progresses slowly - the transition from the initial stage to disability takes from several years to several decades. Knee arthritis is one of the top 5 causes of disability and disability worldwide.
Knee arthritis (gonarthrosis) affects more than 20% of people over the age of 55, but the disease is getting younger rapidly - its symptoms appear more and more often at the age of 25.
Signs of osteoarthritis of the knee
The wear of articular cartilage is accompanied by characteristic signs, the intensity of which depends on the stage of the disease.Most often, patients complain of:
- morning stiffness and reduced mobility in the joint (needs to warm up upon awakening);
- pain and discomfort in the knee, which increases after physical exertion (long walking, running or standing) and decreases with rest;
- at the 2nd stage - the so-calledstarting pain that occurs after a long stay in one position;
- increased fatigue, often attributed to age-related changes;
- a dry, harsh crunch that recurs regularly when bending and flexing the knee;
- edema and other inflammatory symptoms that appear in the 2nd stage of the disease due to trauma to the periarticular tissues;
- meteosensitivity, increased symptoms in the cold season.
When bending the knee affected by gonarthrosis to impact, there is a sharp pain and a feeling of physical obstruction. In the later stages, even in the treatment of knee arthrosis, the patient's gait is disturbed (he ducks, walks on stiff legs), the deformity of the lower limbs appears in the form of the letters "O" or "X". ".
The insidiousness of the disease lies in the fact that it takes place in a latent form for years, and the first significant symptoms often appear only in the 2nd stage - when complete restoration of the articular cartilage is no longer possible.
That's why it's important to see a doctor at the first sign of discomfort in the knee - for example, weak, pulling pains that occur when there is insufficient production of synovial fluid. Remember: knee pain is not normal regardless of age. Timely examination and treatment of grade I arthrosis of the knee joint can completely protect you from excruciating joint pain in old age.
What happens if knee arthritis is not treated?
With self-medication, failure to follow the doctor's recommendations or lack of treatment, arthrosis of the knee joint progresses 3-8 times faster on average than with complex therapy. If gonarthrosis progresses aggressively, the patient may lose normal mobility before reaching retirement age.
Effective treatment of knee arthrosis in the acute stage is particularly important. It can be triggered by damp cold weather, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in short, any shock to the body. Aggravation of arthrosis occurs with the destruction of a large number of chondrocytes. In response, the body produces enzymes to process and remove dead cells. However, if their concentration is too high, healthy cartilage areas also suffer - cell membranes become thinner, erosion foci appear on the synovial covering of the joint. This process, if not stopped by medication for knee arthrosis, can last for several weeks, and it can also be permanent with chronic stress, lack of sleep or insufficient nutrition.
Ultimately, without treatment, osteoarthritis of the knee leads to a complete reduction of the lumen of the joint space due to the growth of osteophytes. The gap necessary for normal movement is closed, and the patient cannot even bend the leg by 30-45 °. The difficulty is not only climbing stairs, but also getting up from the couch or moving normally. This condition is accompanied by pain, which is not helped by conventional pain relievers. In such cases, there is only one option for the treatment of arthrosis of the knee joint - surgery, complete replacement of the joint architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients do not return to a completely normal life.
Treatment of osteoarthritis of the knee
Depending on the stage of the disease and the state of the joint, conservative or surgical treatment of arthrosis of the knee joint is used.
The treatment of arthrosis of the 1st degree of the knee joint is always carried out with conservative methods - with a successful combination of circumstances and good self-discipline of the patient, the disease can be cured or have a stable remission.
The treatment of grade 2 arthrosis of the knee joint is usually based on all methods of conservative treatment, however, the doctor may decide on minor surgical interventions in the joint if the disease is aggressive or has complications.
Treatment for grade 3 knee arthritis almost always involves surgery.
Comprehensive conservative treatment of arthrosis of the knee joint includes the elimination of pain and inflammation, the restoration of cartilage tissue and the increase of joint range of motion. For this, the patient is prescribed an orthopedic load and rest regimen, systemic and local drugs (hormonal and non-hormonal anti-inflammatory drugs, pain relievers, chondroprotectors and others). Innovative biological methods are also becoming more and more popular - the injection of drugs for the treatment of arthrosis of the knee joint directly into the joint bag. In this case, PRP injections (platelet-rich plasma) are used, as well as stem cell injections obtained from the patient's own fat tissue. In parallel, auxiliary and rehabilitation methods are connected to each other - physiotherapy, massage, manual therapy, therapeutic exercises.
Surgical treatment of osteoarthritis of the knee joint is performed in cases where drugs are ineffective.With this pathology, the doctor may prescribe the following interventions:
- Arthroscopy of the knee. The collective name of the group of minimally invasive surgeries, the aim of which is to remove a broken piece of joint tissue or osteophyte, or to partially cut out the joint membrane. It makes it possible to delay or exclude prostheses and to eliminate discomfort in the early stages of the disease. It is primarily used to treat knee arthrosis in patients under 60 years of age.
- Osteotomy. Surgery to cut off part of the bone and correct the load axis of the affected knee, which allows to slow down the degenerative changes. It is usually performed in the treatment of 2nd degree arthrosis of the knee joint.
- Endoprosthesis. Partial or total replacement of the knee joint with a titanium implant that lasts 15-20 years. This technique is the last resort because it involves certain risks. Recommended for patients over 55 years of age.
All these operations require a period of recovery and have many contraindications, so the best solution is to prevent knee arthrosis in the early stages (exercise therapy, chondroprotectors) and treat it.
In addition to the main treatment methods, diet therapy and other weight reduction methods are used. Bandages and other orthoses (walking sticks, orthopedic insoles, etc. ) are used to relieve the load on the diseased joint.
Treatment of arthrosis of the knee is prescribed by a rheumatologist or orthopedist. At the first appointment, he palpates the joint, performs motor tests, and then refers the patient to tomography or radiography.
Therapeutic exercises for knee arthrosis
Physiotherapy performed on the limbs of the lower belt is the most effective method for reducing pain and treating 1st degree arthrosis of the knee joint. The first results of therapeutic exercises appear after 2-4 weeks of continuous training. Continuity in the treatment of arthrosis of the knee joint is one of the main factors affecting the effectiveness of exercise therapy. The full-value lesson is held once a day every day, and it is also recommended to do at least 3-4 training sessions during the day.
In the treatment of arthrosis of the knee joint, the main task of physical exercises is to strengthen the muscles of the thigh and lower leg, to preserve the flexibility of the ligaments and tendons, and to overcome the muscle atrophy characteristic of arthrosis. This allows the load to be transferred from the joint to the periarticular structures - and thus slows down the mechanical wear of the cartilage and reduces inflammation.
Exercises for the treatment of knee arthrosis are performed on both legs! If a sharp pain occurs, the session should be stopped or continued at a gentler pace.
- Starting position - lying on your back. One leg is extended on the floor, the other is bent at 90° and raised (lower leg parallel to the floor). We perform up and down movements with the leg, as far as the joint range of motion allows.
- Starting position - lying on your back. Let's do the cycling exercise.
- Starting position - lying on your stomach. We alternately swing our legs, trying to bring the heels as close to the bottom as possible.
- Starting position - lying on the side with the arm bent under the head or extended above the head in line with the body. The other hand rests on his side. We swing upwards with a straight leg. We switched sides.
- Starting position - lying on your back. The feet are pulled along the floor with the heel forward (moving away from you), the socks "look inside".
- Starting position - lying on your stomach. Let's do the exercise "boat". If your physical fitness does not allow, place your palms on both sides of your chest and take your legs back one by one, experiencing tension on the back of the thigh and the lower leg.
- Starting position - lying on your back. We alternately rotate the legs, trying to describe the entire circle with the socks.
- Starting position - leaning against the wall. We squat slowly and evenly without lifting our backs from the wall to distribute the load. When the legs are bent at the knees by 90 °, we begin a smooth upward movement.
- Starting position - standing position. We alternately swing our legs forward, backward and sideways.
Please note: therapeutic exercises after joint surgery have their own characteristics and depending on how many days have passed since the operation. This is prescribed by a doctor - a surgeon or a rehabilitation specialist.
Massage for knee arthritis
Therapeutic massage for knee arthrosis is performed on both legs. At first, at least 10-12 sessions are usually required by a masseur-rehabilitator or with the help of hydromassage equipment, but a simple restorative massage can also be performed at home. This includes the following types of movements:
- superficial stroking and rubbing (up and down, clockwise and counterclockwise);
- fingertip palpation and stretching of deeper tissues;
- pinching and tapping on the skin.
Self-massage can be combined with medical treatment of arthrosis of the knee joint: there will be no need to apply a warming ointment or balm before or during the session. You can also take a warm bath before the procedure.
Important: massage is contraindicated in patients with inflammatory symptoms (exacerbation of osteoarthritis or arthrosis). In this case, acute phase therapy is required.
Diet therapy for arthritis
A standard nutritional protocol for the treatment of osteoarthritis of the knee requires:
- limit foods and foods rich in simple carbohydrates (white bread, sweets, snacks, sweets, potatoes, sugar);
- exclude processed (ready-to-eat) and salt-rich foods - fast food, semi-finished products, sausage;
- avoid alcohol, decaffeinated coffee and fatty meats.
Add it to the menu instead:
- sprouted and whole grain foods;
- fatty fish from the northern seas and dietary poultry;
- cartilage (ears, nyushki, legs and other collagen-rich parts of farm animals), aspic and jelly;
- fruits and vegetables rich in vitamins and antioxidants (especially vitamins A, B12, C, E);
- nuts and other sources of omega fatty acids and valuable minerals.
It is also recommended to treat arthrosis of the knee joint with drugs - vitamin-mineral complexes (2 courses per year).
Physiotherapy for the treatment of osteoarthritis of the knee
The following physiotherapy procedures are used to effectively treat knee arthrosis and enhance the effect of medications:
- magnetotherapy;
- laser therapy;
- UHF;
- ultrasound therapy;
- amplipulse;
- electrophoresis (including medication - with analgin, novocaine or chymotrypsin);
- ozokerite and paraffin applications;
- thermotherapy (cryotherapy, inductothermy);
- phonophoresis (especially with hydrocortisone);
- balneological therapy (sulfur, hydrogen sulphide baths).
Acupuncture is not usually used in the treatment of 2nd degree arthrosis of the knee joint.
Before visiting the procedures, you should consult your doctor - many types of physiotherapy are contraindicated in case of exacerbation of the disease.
Medicines for the treatment of arthrosis of the knee joint
Drug treatment of arthrosis of the knee joint symptomatically and taking into account the patient's individual reaction to the selected drugs. Drug therapy - injections, ointments or tablets for the treatment of arthrosis of the knee - is usually prescribed in courses or as needed.
The medical treatment of arthrosis of the knee joint has several directions: making the patient's life easier, improving the nutrition of the cartilage, regenerating the cartilage tissue, and maintaining the normal musculoskeletal system.
Nonsteroidal anti-inflammatory drugs
To relieve exacerbations, NSAIDs in tablets or capsules are taken in courses (about 12 days) or as needed, depending on the intensity of the pain syndrome. Uncontrolled intake of NSAIDs, in violation of the doctor's instructions or recommendations, causes stomach or intestinal ulcers. They should be taken with extreme caution in combination with glucocorticosteroids and drugs affecting blood coagulation. Additional risk factors are age over 65, smoking, alcohol consumption during the course. In these cases, doctors usually recommend drug injection, bypassing the gastrointestinal tract. Together with NSAIDs, it is desirable to take stomach-protecting drugs.
The maximum effect is achieved by a combination of systemic NSAIDs (for internal use) and external - ointments, creams or gels. The second option provides a point effect on the affected joint and at the same time minimally affects digestion.
Corticosteroids (steroid medicines used to treat osteoarthritis of the knee)
Hormonal drugs (HA) are usually the so-calledsteroid blockade of the knee in cases where NSAIDs are insufficient to relieve pain and inflammation.
Glucocorticoid injections are considered a last resort in the medical treatment of osteoarthritis of the knee. They provide relief as early as 20 minutes after administration, but can lead to hormonal imbalance and cartilage damage if not taken properly. Because of the side effects, many orthopedists prefer knee surgery over long-term HA therapy.
Chondroprotectors in the treatment of arthrosis of the knee joint
Chondroprotective agents based on extracts from the veins and cartilages of cattle, sea fish and shellfish contribute to the restoration of joint cartilage and are therefore indispensable in the effective treatment of knee arthrosis. Chondroprotectors contain a large number of glycosaminoglycans - natural polymers from which cartilage tissue is built. Therefore, they make chondrocytes (cartilage cells) more stable, promote their growth, and enrich synovial fluid.
Unlike anti-inflammatory drugs, chondroprotectors have practically no contraindications. They provide a cumulative, prolonged effect - the first improvement occurs after 1-3 months of admission, and the duration of the course is 3-6 months.
Skin irritants
External preparations with a local irritant effect for the treatment of arthrosis of the knee improve the blood circulation and nutrition of the joint, and distract the patient from the pain. For this purpose, ointments, gels, creams and balms are used from natural ingredients - bee venom, strong pepper extract.
It is better to avoid warming ointments for the treatment of arthrosis of the knee joint in case of an allergic reaction (persistent skin redness and pain, rash), during pregnancy and breastfeeding, as well as other contraindications. and limit yourself to warm baths, applications, and external anti-inflammatory.
Synovial fluid prostheses
If there is too little synovial fluid in the joint, the sliding of the joint surfaces causes discomfort. And most importantly, the cartilage begins to starve, because the synovial fluid that nourishes it like a sponge normally provides nutrients for the growth and maintenance of cartilage tissue. In order to prevent cell death and mechanical wear of the knee cartilage, the doctor may prescribe injections of high molecular weight hyaluronic derivatives. In the treatment of arthrosis of the knee joint (viscosupplementation), injections of the drug are given directly into the joint capsule, which results in rapid relief that lasts for 3-12 months after the end of the course. However, with the introduction of prostheses, the risk of necrotic lesions or infection of the joint remains.
Antispasmodics, pain relievers, muscle relaxants
In cases where spasms and muscle tension prevent the patient from falling asleep, or cause pain during movement, the doctor prescribes antispasmodics and muscle relaxants.
Simple painkillers are not used to treat arthrosis of the knee joint, as they mask the pain but do not relieve the inflammation. You can use them or over-the-counter NSAIDs for up to 10 days without a doctor's prescription, after which a test is required.
Release form of drugs for the treatment of arthrosis of the knee joint
For the convenience of patients, drugs for the treatment of arthrosis of the knee joint are produced in various forms. Is there a difference between them and which one should I choose?
Capsules, sachets and tablets for the treatment of knee arthrosis
Nonsteroidal anti-inflammatory drugs, corticosteroids, chondroprotectors, and muscle relaxants are available orally. In such cases, they can be easily administered, the reception is also possible without the assistance of a healthcare worker, and it is easy to check which part of the course has already been completed. When taken orally, chondroprotectors and NSAIDs have a fairly high bioavailability (especially in the form of sachets).
Injection solutions
You can take the already mentioned NSAIDs, HA, chondroprotectors and muscle relaxants, as well as synovial fluid prostheses, in the form of injections. This method of drug treatment of arthrosis of the knee joint shows maximum bioavailability.
This method of drug treatment of knee arthrosis is safe for digestion, but it is desirable that the injections (intravenously, intramuscularly into the joint area or intra-articularly) are administered by qualified medical personnel. Intramuscular injections can be given independently in the buttocks or thighs.
Products for external use
Locally irritating, anti-inflammatory and chondroprotective ointments are applied externally to treat arthrosis of the knee joint. The advantage of such administration of drugs is the direct effect on the affected tissue. But the skin barrier blocks the active ingredients - unfortunately, often only 5% of the active ingredients reach the desired tissue layers.