Knee osteoarthritis

Have you ever had knee painIt is extremely uncomfortable if you suddenly start limping or cannot go down without pain in your knee. Osteoarthritis of the knee joint is not life-threatening, but the quality deteriorates dramatically.

Knee osteoarthritis

What is knee osteoarthritis?

Knee osteoarthritis(Gonarthrosis, osteoarthritis, osteoarthritis of the knee joint). Gonarthrosis is osteoarthritis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing helps but an operation. You need it? Then don't run into that state.

Causes of osteoarthritis of the knee joint.Differentiate between primary and secondary osteoarthritis of the knee joint. If the cause of the disease is not known, then such osteoarthritis is called primary and is inherited through the maternal line. If the grandmother has osteoarthritis of the knee joints, the daughter and granddaughter may have the disease at a younger age.

Secondary osteoarthritis is caused by trauma, congenital abnormalities of the knee joint, physical overload (sport, work) and endocrine disorders.

Risk factors are obesity, female gender, age. Cartilage is very sensitive to a decrease in female sex hormones. During menopause, all joints begin to "crumble". Overweight older women therefore suffer more and more often from osteoarthritis of the knee joint.

Knee anatomy.The knee joint consists of the femur, tibia and patella. The articular surfaces of the bones are covered with a layer of cartilage. The extra cartilaginous spacers between the bones are called menisci and they dampen. The knee joint has the largest synovia, which forms large coils and bursa.

The joint cavity is filled with synovial fluid that nourishes the articular cartilage. The synovial fluid contains hyaluronic acid, which is necessary for the smooth gliding of the joint surfaces. Ligaments, muscles, and their tendons guide and restrict movement in the joint.

General description.In the case of osteoarthritis of the knee joint, the articular cartilage is destroyed. There are three stages of knee osteoarthritis. In the first stage, the nutrition of the articular cartilage and menisci is disturbed. Cartilage loses its elasticity and cracks. Abnormal friction occurs between the bones. Joint overload is accompanied by inflammation and pain in the knee.

In the second phase, the destruction of the articular cartilage and menisci begins. The bone reacts to the load with marginal growth - osteophytes ("thorns"). The amount of intra-articular fluid decreases, the narrowing of the joint space increases. As a result, knee pain already occurs during normal exercise while walking.

In the third stage, there is a pronounced bone deformity of the knee joint with a severe restriction in natural movements.

Symptoms of osteoarthritis of the knee joint.The main symptoms of osteoarthritis are pain, restricted mobility and deformity of the knee joints. Knee osteoarthritis is long-term with a slow, irreversible increase in symptoms. If it was the first time suddenly and suddenly there was pain in the knee, then most likely it is not osteoarthritis.

Osteoarthritis of the knee joint begins gradually with discomfort or slight pain in the knee during overload, long walking as you go down the stairs and get up from a squatting position. The pain goes away quickly in peace.

In the second stage, knee pain already occurs with normal exertion. The volume of active movements in the knee joint decreases. The shape of the joint changes due to bone deformity and the accumulation of abnormal fluid in the joint.

In the third stage, pain becomes chronic, occurs not only during movement, but also at rest. Night pain disturbs sleep. The knee is difficult to fit into bed without pain. Any swelling in the joint indicates additional inflammation. The mobility of the knee joints is reduced to a minimum.

The joint is clearly deformed, the legs become O- or X-shaped. In severe cases, the joint is completely destroyed with the development of ankylosis (immobility).

There are 4 types of pain in osteoarthritis of the knee:

  • The mechanical type of pain arises under the influence of physical activity during the day and subsides during sleep. This knee pain is associated with a decrease in the shock-absorbing capacity of cartilage and bone structures. Knee pain is usually localized in the front and inner area of the knee joint and in the upper part of the lower leg.
  • Night pain is associated with stagnation of venous blood, increased intraosseous pressure in the joint, and inflammation.
  • "Start" pain occurs after a period of rest and disappears 15 to 20 minutes after moving in the joint. This knee pain is caused by rubbing the articular surfaces on which fragments of cartilage decay are deposited.
  • Persistent knee pain is caused by muscle spasms and the development of synovitis.

Complications of knee osteoarthritis.Synovitis is inflammation of the synovial membrane that covers the inside of the joint cavity. Signs of inflammation: swelling, fever, redness, pain, joint dysfunction.

Usually the knee joint contains 3-5 ml of synovial fluid. In diseases of the joint, there is an increased production of inflammatory fluid. The amount of effusion (pathological fluid) can reach 30-70, and even more than 100 ml. The knee effusion first fills the cavity on the inside of the patella (medial fossa). With increasing volume, the upper volvulus fills with a massive swelling over the patella ("horse saddle").

Baker's cyst occurs with a significant increase in the volume of intra-articular fluid. A round, elastic bulge forms in the popliteal area. This is not a tumor, not an oncology, and it does not require surgery. A baker's cyst can cause discomfort, pressure and pain in the knee when moving. The diameter of the cyst is 2 to 6 cm. With even larger sizes, the cyst can crush the nearby peroneal nerve with the development of weakness and numbness in the foot.

Diagnosis of osteoarthritis of the knee joint.Laboratory tests are not useful for diagnosis, but are used to rule out other conditions with knee pain. In osteoarthritis, the blood count indicators without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. The uric acid level is in the normal range.

X-ray shows bone changes in the joint, excludes traumatic causes of joint pain. In our country, an X-ray classification of osteoarthritis by stage is used.

Stage 1 - the presence of marginal bone growth with a slight narrowing of the joint space;

Stage 2 - the joint space is narrowed more noticeably, subchondral sclerosis appears;

Stage 3 - a sharp narrowing of the joint space, flattening of the articular surfaces, development of cysts;

An MRI of the knee is indicated in the early stages of the disease, when radiological changes are not yet visible, but the patient has typical knee pain. With the help of MRI, you can assess the condition of the cartilage, menisci, ligaments and tendons. Ultrasound of the knee joint helps visualize soft tissues (menisci, muscles, ligaments) to determine effusion volume.

Arthroscopy is the most accurate way to diagnose osteoarthritis of the knee. A special probe is inserted into the joint cavity and the doctor assesses the degree of cartilage destruction under a microscope.

Treatment of knee osteoarthritisis a difficult task. In any case, you need to choose an individual treatment program.

If you start saying mundane things during the consultation, the patients look surprised at first. Is that what we came for? Give a miraculous injection so that my knee will never hurt again. We have to explain that there is no such method by which osteoarthritis can be eliminated. To recover, you need to get exercise, lose weight, and sign up for the pool. And a person wants to lie on the couch, grow a "beer belly", pick up the problem with a lot of drugs, and be healthy. But unfortunately !!! In this case, medicine is powerless.

Painkillers don't cure, they just relieve pain. Anti-inflammatory drugs are prescribed only during the period of exacerbation of pain in the knee joints. Some of the nonsteroidal drugs help further destroy the cartilage by relieving pain. Healing ointments do not cure osteoarthritis of the knee, but they do help to ease knee pain slightly. With edema, redness of the joint, warming ointments and compresses are contraindicated. It is better to use local medicines with nonsteroidal anti-inflammatory drugs.

Chondroprotectors do not relieve pain, are expensive and have to be taken for a long time. I consider them "dummies" and practically do not appoint them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this drug in my clinical practice and I do not have my own opinion about its effectiveness.

For the treatment and prevention of osteoarthritis of the knee joint, it is necessary to carry out suitable physical therapy exercises in a sitting or lying position. Squats and jumps are strictly prohibited. Cycling, swimming or sports in the water, skiing are useful. And workers in the country often lead to increased pain in the knees. If you have osteoarthritis of the knee joints, running, walking briskly uphill, and lifting weights is not recommended.

Diet against osteoarthritis of the knee joint.The knee joints carry a load in the form of their own weight. Therefore, obese people need to lose at least 3-5 kg. And some patients have to lose more than a dozen kilograms. Otherwise, no treatment will be effective. It is not necessary to "sit" on a diet, it is harmful to the body.

You need to change the way you eat for the rest of your life and just stop loving all harmful products (sweet, starchy foods, beer, etc. ). Eating right should become a habit. To lose weight, you need to eat the right foods every 3 hours.

To reduce inflammation in the joints, homeopaths recommend foods that alkalize the blood and intra-articular fluid. To do this, it is necessary to severely limit meat consumption and increase the amount of vegetables and fruits in the diet.

It is believed that sausages, sausages, smoked meat and fast food increase the inflammatory processes in the joints. Instead of pharmaceutical chondroprotectors, I recommend eating properly prepared jellied meat.

The orthopedic correction reduces the stress on the knee joints. If you have pain in your knee joints, you need to pick up the patella. In advanced cases, walking with a stick is indicated. A heel insole is recommended when shortening the leg. Recently, it has become fashionable to use kinesio tapes. These are adhesive tapes made of natural cotton that are stuck around the affected knee, do not restrict mobility, but relieve the joint and reduce muscle spasms.

I consider interstitial electrical stimulation to be the most effective method of treating pain associated with osteoarthritis. In combination with hirudotherapy (leech therapy) and pharmacopuncture, VTES delivers very good results. I will give a case from practice.

A 54-year-old man with stage II osteoarthritis of the right knee asked me for help. Knee pain bothered him for 6 years. Over the years he completed numerous courses in drug therapy, physical therapy, blockade with corticosteroids and repeated courses in a rehabilitation center. However, the patient's condition only worsened. He came to me for advice on whether I should agree to joint replacement surgery or try something else conservatively. I didn't have to convince him for a long time, he immediately agreed to the treatment I proposed.

In the first session, I gave him 6 leeches which helped cope with joint swelling and relieved night pain. The knee is easier and more free to move. The man felt a little relieved. Then we performed three interstitial electrical stimulation procedures and almost completely stopped the pain syndrome.

Thereafter, the success was consolidated by the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effects in the acupuncture points. 3 weeks after starting therapy, the patient threw away the stick and began to move freely without limping. 3 years have passed since then. The knee pain did not return. Once a year we hold a VTES meeting with a preventive purpose.

Intra-articular injections of hormones are very effective in relieving severe pain, swelling, and inflammation in an emergency. The indication is an effusion, a blockade with corticosteroids in the "dry joint" is prohibited! They temporarily relieve the pain, but such injections do not cure the osteoarthritis itself, and the cartilage after them is destroyed even more. They should be carried out by a specially trained physician who is well aware of the indications, contraindications, drugs and points of administration. In total, no more than 3 blocks per connection are required.

After removing the swelling and inflammation, hyaluronic acid preparations, so-called liquid prostheses, are injected into the joint. They act as a natural lubricant on the joint, improve the sliding of the bone surfaces and restore the shock-absorbing functions of the cartilage. However, hyaluronic acid supplements are expensive and only last 6-8 months. There is no point in giving hyaluronic acid supplements with complete loss of joint space and in patients over 65 years of age.

Treatment with folk remedies.You can use tincture or decoction of cinquefoil, compresses with radish, horseradish or ginger, baths of turpentine.

Endoprosthetics of the joints should only be carried out in the event of severe functional disorders of the knee joint, as this joint has to be changed again after 10-15 years. Will there be enough strength and health every 10-15 years for an operation under general anesthesia and subsequent rehabilitation? So do not rush to agree to an operation! Take care of your joints!