Arthrosis of the knee jointis a degenerative-dystrophic disease of the cartilage tissue, which leads to the exposure of the bone heads and impaired mobility in the joints. The disease has a non-inflammatory nature and progresses slowly - the transition from the initial stage to disability lasts from several years to several decades. Knee osteoarthritis is one of the top 5 causes of disability and disability worldwide.
Knee osteoarthritis (gonarthrosis) affects more than 20% of people over the age of 55, but the disease is rapidly becoming younger - more and more often its symptoms appear at the age of 25.
Signs of osteoarthritis of the knee
The wear of the articular cartilage is accompanied by characteristic signs, the intensity of which depends on the stage of the disease.Most often, patients complain of:
- stiffness in the morning and reduced mobility in the joints (a warm-up is required after waking up);
- pain and discomfort in the knees, which increase after physical exertion (long walks, running or standing) and subside with rest;
- in the second stage - the so-called. initial pain that occurs after a long stay in one position;
- increased fatigue, which is often attributed to age-related changes;
- dry, harsh cracking, which recurs regularly when you bend and unbend the knees;
- edema and other symptoms of inflammation that appear in the second stage of the disease due to trauma to the periarticular tissues;
- meteosensitivity, increased symptoms in the cold season.
When you try to bend the knee affected by gonarthrosis to a stop, there is a sharp pain and a feeling of physical obstruction. In the later stages, even with the treatment of arthrosis of the knee joint, patients have a restless gait (standing up, patients walk on stiff legs), the deformation of the lower extremities appears in the form of the letters "O" or "X". ".
The cunning of the disease lies in the fact that it can continue in a latent form for years, and the first significant symptoms often appear only in the second stage - when complete restoration of the synovial cartilage is no longer possible.
Therefore, it is important to see a doctor at the first sign of discomfort in the knees - for example, weak, as if 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 arthrosis of the knee joint of the first degree can completely protect you from excruciating joint pain in old age.
What happens if osteoarthritis of the knee is not treated?
With self-medication, non-compliance with the doctor's recommendations or lack of treatment, osteoarthritis of the knee joint progresses on average 3-8 times faster than with complex therapy. If gonarthrosis continues aggressively, the patient may lose the ability to move normally even before retirement age.
Particularly important is the effective treatment of knee arthrosis in the acute phase. It can be provoked by cold wet weather, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in a word, any shock to the body. Aggravation of arthrosis occurs with the destruction of a large number of chondrocytes. In response, the body produces enzymes that are designed to process and remove dead cells. However, if their concentration is too high, healthy cartilage areas also suffer - cell membranes become thinner, foci of erosion appear in the synovial lining of the joint. This process, if not stopped by the treatment of knee arthrosis with drugs, can continue for several weeks and with chronic stress, lack of sleep or insufficient diet, it can be permanent.
After all, 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 bend the leg even by 30-45 °. Difficulty is not only climbing stairs, but also trying to get up from the sofa or normal movement. This condition is accompanied by pain, from which conventional analgesics do not help. In such cases, there is only one option for the treatment of arthrosis of the knee joint - surgical, with a complete replacement of the articular architecture with a prosthesis and then long-term rehabilitation. But even in this case, most patients do not manage to return to a completely normal life.
Treatment of osteoarthritis of the knee
Depending on the stage of the disease and the condition of the joint, conservative or surgical treatment of arthrosis of the knee joint is used.
Treatment of arthrosis of the knee joint of the first degree is always carried out with conservative methods - with a successful combination of circumstances and good self-discipline of the patient, it is possible to achieve a cure for the disease or a lasting remission.
The treatment of arthrosis of the knee joint of the second degree, as a rule, is based on the use of all methods of conservative treatment, however, the doctor may decide on minor surgical interventions on the joint if the disease develops aggressively or with complications.
Treatment for grade 3 knee osteoarthritis almost always involves surgery.
Comprehensive conservative treatment of arthrosis of the knee joint includes removal of pain and inflammation, restoration of cartilage tissue and an increase in the range of motion in the joint. For this, the patient is prescribed an orthopedic regimen of loads and rest, drugs with systemic and local action (hormonal and non-hormonal anti-inflammatories, analgesics, chondroprotectors and others). Innovative biological methods are also gaining popularity - injections of drugs for the treatment of arthrosis of the knee joint directly into the articular bag. In this case, PRP (platelet-rich plasma) injections are used, as well as stem cell injections taken from the patient's own adipose tissue. In parallel, auxiliary and rehabilitative methods are connected - physiotherapy, massage, manual therapy, therapeutic exercises.
Surgical treatment of osteoarthritis of the knee joint is performed in cases where medications are ineffective.With this pathology, the doctor can prescribe the following interventions:
- Arthroscopy of the knee. The collective name for a group of minimally invasive operations aimed at removing a broken piece of articular tissue or osteophytes, or partial removal of the articular membrane. This allows you to delay or exclude prostheses, as well as eliminate discomfort in the early stages of the disease. It is mainly used for the treatment of knee arthrosis in patients under 60 years of age.
- Osteotomy. An operation to cut a part of the bone and correct the load axis in the affected knee, which allows you to slow down degenerative changes. It is usually performed in the treatment of arthrosis of the knee joint of the 2nd degree.
- Endoprosthetics. Partial or complete replacement of the knee joint with a titanium implant, which lasts 15-20 years. This technique is a last resort because it carries certain risks. Recommended for patients over 55 years old.
All these operations require a recovery period and have a number of contraindications, so the best option is prevention (exercise therapy, chondroprotectors) and treatment of knee arthrosis in the early stages.
In addition to the main methods of treatment, diet therapy and other methods of reducing body weight are used. Bandages and other orthoses (walking sticks, orthopedic beds, etc. ) are used to relieve the diseased joint.
Treatment of knee arthrosis is prescribed by a rheumatologist or orthopedist. At the first appointment, he palpates the joint, performs motor tests and then directs the patient to tomography or x-rays.
Therapeutic exercises for knee arthrosis
Therapeutic exercise for the lower limbs is considered the most effective method for reducing pain and treating arthrosis of the knee joint of the 1st degree. The first results from therapeutic exercises come after 2-4 weeks of continuous training. Continuity in the treatment of knee arthrosis is one of the main factors affecting the effectiveness of exercise therapy. A full lesson is held 1 time a day every day, it is also recommended to do at least 3-4 exercises during the day.
The main task of physical exercises in the treatment of osteoarthritis of the knee joint is to strengthen the muscles of the thigh and lower leg, maintain the elasticity of ligaments and tendons, as well as fight muscle atrophy, which is characteristic of arthrosis. This allows you to transfer the load from the joint to the periarticular structures - and thus slow down the mechanical wear of the cartilage, reduce inflammation.
Exercises for the treatment of knee arthrosis are performed for both legs! If there is a sharp pain, the session should be interrupted or continued at a gentler pace.
- Starting position - lying on the back. One leg is flat on the floor, the other is raised and bent at 90 ° (lower leg parallel to the floor). We perform movements with the lower leg up and down, as much as the range of motion in the joint allows.
- Starting position - lying on the back. Let's do the bike exercise.
- Initial position - lying on the stomach. We swing our legs in turn, trying to bring the heels as close to the buttocks as possible.
- Starting position - lying on your side, the arm is bent under the head or stretched over the head in line with the body. The other hand rests on the side. We move up with a straight leg. We change sides.
- Starting position - lying on the back. We pull the legs along the floor forward with the heel (away from you), the socks look "by themselves".
- Initial position - lying on the stomach. We do the "boat" exercise. If the physical ability does not allow, we place the palms on both sides of the chest and turn the legs in turn, experiencing tension in the back of the thigh and the lower part of the leg.
- Starting position - lying on the back. We rotate the legs alternately, trying to describe the full circle with socks.
- Starting position - standing against the wall. We sit down slowly and smoothly, without taking our backs off the wall, in order to distribute the load. When the legs are bent at the knees by 90 °, we begin a smooth upward movement.
- Starting position - standing. Alternately, we move our legs forward, backward and sideways.
Please note: therapeutic exercises after joint surgery have their own specifics and vary depending on the days that have passed since the surgery. It is prescribed by a doctor - surgeon or rehabilitation specialist.
Massage for osteoarthritis of the knee
Therapeutic massage for knee arthrosis is performed on both legs. In the beginning, at least 10-12 sessions are usually required with a massage therapist or with the help of hydromassage equipment, however, a simple restorative massage can be performed at home. It includes the following types of movements:
- surface impact and friction (up and down, clockwise and counterclockwise);
- probing and stretching with the fingertips of the deeper tissues;
- pressing and tapping on the skin.
Self-massage can be combined with the treatment of arthrosis of the knee joint with drugs: it will not be superfluous to apply a warming ointment or balm before or during the session. You can also take a warm shower before the procedure.
Important: massage is contraindicated in patients with symptoms of inflammation (osteoarthritis or worsening of arthrosis). In this case, acute phase therapy is required.
Diet therapy for arthritis
The standard nutritional protocol for treating osteoarthritis of the knee calls for:
- limit foods and dishes rich in simple carbohydrates (white bread, cakes, snacks, sweets, potatoes, sugar);
- exclude processed (ready-to-eat) and high-salt dishes - fast food, semi-finished products, sausages;
- avoid alcohol, decaffeinated coffee and fatty meat.
Instead, include in the menu:
- dishes from sprouted grains and whole grains;
- fatty fish of the northern seas and dietary poultry meat;
- cartilage (ears, nyushki, legs and other parts of farm animals rich in collagen), aspics and jelly;
- fruits and vegetables rich in vitamins and antioxidants (especially vitamins A, B12, C, E);
- walnuts and other sources of omega fatty acids and valuable minerals.
Treatment of osteoarthritis of the knee joint with drugs - vitamin-mineral complexes (2 courses per year) is also recommended.
Physiotherapy for the treatment of osteoarthritis of the knee
The following physiotherapy procedures are used to effectively treat knee arthrosis and increase the effect of medication:
- magnetic therapy;
- laser therapy;
- UHF;
- ultrasound therapy;
- amplipulse;
- electrophoresis (including medicinal - with analgin, novocaine or chymotrypsin);
- ozokerite and paraffin applications;
- thermotherapy (cryotherapy, inductothermy);
- phonophoresis (in particular, with hydrocortisone);
- balneological therapy (sulfur, hydrogen sulfide baths).
Acupuncture in the treatment of arthrosis of the knee joint of the second degree, as a rule, is not used.
Before visiting the procedures, it is necessary to consult your doctor - many types of physiotherapy are contraindicated in case of worsening of the disease.
Medicines for the treatment of arthrosis of the knee joint
Treatment of osteoarthritis of the knee joint with drugs is carried out symptomatically and taking into account the patient's individual response to the selected drugs. Drug therapy - injections, ointments or tablets for the treatment of knee arthrosis - is usually prescribed in courses or as needed.
There are several directions in the treatment of knee arthrosis medications: making life easier for the patient, improving cartilage nutrition, regenerating cartilage tissue and maintaining the normal musculoskeletal system.
Non-steroidal anti-inflammatory drugs
To relieve irritations, 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 contrary to the instructions or recommendations of the doctor is fraught with ulcers in the stomach or intestines. They should be taken with extreme caution in combination with glucocorticosteroids and medications that affect blood coagulation. Additional risk factors are age over 65 years, smoking, drinking alcohol during the course. In these cases, doctors usually recommend injecting drugs, bypassing the gastrointestinal tract. Together with NSAIDs, it is desirable to take gastroprotectors.
The maximum effect can be achieved with a combination of systemic NSAIDs (for internal use) and external ones - in the form of 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 drugs used to treat osteoarthritis of the knee)
Hormonal drugs (HA) are usually used for the so-called. Steroid blockade of the knee in cases where NSAIDs are insufficient to relieve pain and inflammation.
Glucocorticoid injections are considered the last resort in the drug 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 taken improperly. Because of the side effects, many orthopedists prefer knee surgery to long-term HA therapy.
Chondroprotectors in the treatment of knee arthrosis
Chondroprotective agents based on extracts from the veins and cartilage of cattle, marine fish and shellfish contribute to the restoration of synovial cartilage and are therefore indispensable for 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, enrich the synovial fluid.
Unlike anti-inflammatory drugs, chondroprotectors have practically no contraindications. They provide a cumulative, prolonged effect - the first improvements occur after 1-3 months from admission, and the duration of the course is 3-6 months.
Skin irritants
External preparations for the treatment of knee arthrosis with a local irritant effect improve blood circulation and nutrition of the joint, as well as remove the patient from pain. For this purpose, ointments, gels, creams and balms based on natural ingredients are used - bee venom, hot pepper extract.
In the presence of an allergic reaction (redness and constant pain of the skin, redness), during pregnancy and lactation, as well as in the presence of other contraindications, it is better to avoid heating ointments for the treatment of arthrosis of the knee joint. and limit yourself to warm baths, applications and external anti-inflammatories.
Synovial fluid prostheses
If there is too little synovial fluid in the joint, the gliding of the articular surfaces is disturbed. And most importantly, it begins to starve the cartilage, because the synovial fluid that nourishes it like a sponge normally supplies nutrients for the growth and maintenance of cartilage tissue. To prevent cellular destruction and mechanical wear and tear of the knee cartilage, the doctor may prescribe injections of high molecular weight hyaluron derivatives. Drug injections in the treatment of arthrosis of the knee joint (viscosupplementation) are made directly into the joint capsule, which leads to rapid relief, which lasts from 3 to 12 months after the end of the course. However, with the insertion of prostheses, the risk of necrotic changes or infection in the joint remains.
Antispasmodic, analgesic, muscle relaxant
In cases where spasms and muscle tension prevent the patient from sleeping, create pain during movement, the doctor prescribes antispasmodics and muscle relaxants.
Simple analgesics are not used in the treatment of arthrosis of the knee joint, as they mask the pain, but do not relieve inflammation. You can use them or NSAIDs available without a doctor's prescription for up to 10 days, after which an examination is required.
The form of release 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 different forms. Is there any difference between them and which should I choose?
Capsules, bags and tablets for the treatment of knee arthrosis
Nonsteroidal anti-inflammatory drugs, corticosteroids, chondroprotectors, and muscle relaxants are available in oral forms. In this case, they are easy to dose, waiting is possible without the participation of a medical worker, 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 a bag).
Solution for injection
In the form of injections, you can take the already mentioned NSAIDs, HA, chondroprotectors and muscle relaxants, as well as synovial fluid prostheses. This method of treating osteoarthritis of the knee joint with drugs demonstrates maximum bioavailability.
This method of treating arthrosis of the knee with drugs is safe for digestion, but it is desirable that the injections (intravenous, intramuscular in the joint area or intra-articular) are made by qualified medical personnel. Intramuscular injections in the buttocks or thighs can be done independently.
Products for external use
Local irritating, anti-inflammatory and chondroprotective ointments are applied externally for the treatment of arthrosis of the knee joint. The advantage of this drug administration is the direct effect on the affected tissue. But the skin barrier prevents the active substances - unfortunately, often only 5% of the active ingredients reach the desired tissue layers.