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The disease is also known as gonarthrosis (from the Latin genu - knee), osteoarthritis (as the disease was previously called) and osteoarthritis (the term reflects the mechanism of development and modern understanding of the disease).Deforming osteoarthritis of the knee joint has a chronic course and develops over several years.The majority of patients are over 50 years old.Women predominate in 2/3 of cases.
How does the disease progress?
Under the influence of external and internal factors, blood supply and tissue nutrition are disrupted, degenerative-dystrophic lesions of the articular cartilage develop, with subsequent involvement of the underlying bone in the inflammatory process.Destruction of joint surfaces leads to loss of joint function, limits movement and impairs the patient's quality of life.
Causes and risk factors
The main reasons for the development of osteoarthritis:
- Heavy physical work.Constant loads on the legs lead to microtrauma of the cartilage and the development of the inflammatory process.Loaders, installers, miners and quarry workers are at risk.Deforming osteoarthritis often affects professional athletes (weightlifters, cyclists, tennis players, football players, basketball players, hockey players, etc.).
- Injuries.Damage to ligaments, tendons, menisci, bruises and fractures lead to disruption of the biomechanics of the joint.If treated incorrectly, this leads to the development of post-traumatic osteoarthritis.
- Surgical operations on the knee can lead to the development of pathology of the articular cartilage and surrounding tissues.
- Excess weight increases stress on the joints of the lower limbs.Up to 80 to 90% of the progression of all osteoarthritis is associated with joint overload.
- Old age.In people over 50-60 years old, regeneration processes slow down, collagen production decreases and hormonal levels suffer.Which leads to the development of a pathology.
- Hormonal changes in women.During menopause, estrogen production decreases, which disrupts calcium absorption, leads to a weakening of the musculoskeletal system and weakens bones.The risk of developing osteoporosis increases.
- Problems with the thyroid gland.Thyroid hormones are involved in calcium and phosphorus metabolic processes in the body.Their deficiency or excess can cause knee osteoarthritis.
- Genetic predisposition.Collagen mutation can cause disruptions in connective tissue elements, leading to deterioration of the shock-absorbing function of articular cartilage.
- Heredity.There is a high probability of developing the disease if the patient's family has relatives diagnosed with gonarthrosis, mainly on the female side.
- Inflammatory diseases.Infectious arthritis, bursitis, synovitis caused by bacterial or viral infection are often complicated by the development of gonarthrosis.
- Vascular diseases.The tissues do not receive adequate nutrition, the blood supply is impaired, which leads to the development of ischemia and degenerative-dystrophic changes in the articular cartilage.
- Poor diet and metabolic disorders.Eating foods high in purines (protein) contributes to the deposition of salts in the knee, for example in gouty arthritis.
- Some specific diseases, gonorrhea, tuberculosis, syphilis, chlamydia and influenza, can cause serious damage to the joints.
- Intoxication of the body with various chemicals, including some medications.
- Autoimmune diseases are associated with a violation of the body's immune defenses when antibodies are produced against its own cells, for example, rheumatoid arthritis.
Symptoms of the disease
The main symptoms of knee osteoarthritis:
- Pain in the joint, aching in nature, sometimes at night, in case of exacerbation, severe stabbing;
- Creaks and pops during movement are caused by a violation of the congruence of the articular surfaces, the presence of osteophytes and cartilaginous defects;
- Swellings and swellings are associated with the development of an inflammatory process in the joint and surrounding soft tissues;
- The deformation of the joint space and the axis of the limb indicates the progression of the disease;
- Atrophy and weakness of the thigh muscles, the volume of the quadriceps and biceps muscles decreases;
- Limited mobility and joint stiffness are caused by pain, the development of adhesions and the appearance of osteophytes (bone spurs).
The first signs of osteoarthritis to watch out for are pain that occurs during or after exercise.The pain goes away with rest and does not require medication.Morning knee stiffness, initial pain, before getting up and walking after sleep, it takes some time to develop the joint.
Signs of exacerbation
With the development of pathology, the symptoms of osteoarthritis become clearer: the knees begin to hurt at rest, and at night, when bending and extending the joint, extraneous sounds appear - crackles, crackles, clicks.Lameness, stiffness of movements develop, and swelling of soft tissues appears.
The following facts indicate the progression of the disease:
- the appearance of deformation of the axis of the limb in the form of O-shaped legs;
- constant nature of pain, pain at night and when the weather changes (weather sensitivity);
- further deterioration of joint mobility, with development of flexion contracture;
- weakness and atrophy of the thigh muscles.
Types and forms of the disease
There is :
- Primary.It develops as an independent disease.Most often, such gonarthrosis of the knee is associated with age-related changes and heredity.
- Secondary.Occurs against the background of certain diseases or injuries, for example, post-traumatic osteoarthritis.
Depending on the causes, the following types of osteoarthritis are distinguished:
- Ischemic, associated with problems with blood supply to tissues and vascular disorders;
- Post-infectious infections are caused by infections, viruses, and autoimmune processes;
- The idiopathic nature of the progression of the pathology remains unclear;
- Metabolism is associated with metabolic disorders - gout, hemochromatosis, chondrocalcinosis;
- Involutional, due to age-related bodily changes;
- Post-traumatic, history of trauma;
- Dishormonal - a consequence of hormonal imbalances in the body.
Development stages
I. Osteoarthritis of the 1st degree - the initial stage is associated with a deterioration in the quality and quantity of synovial fluid (joint fluid, nourishes the cartilage, has cushioning properties, promotes sliding of the joint surfaces).Malnutrition leads to the wear and tear of cartilage tissue, as well as the appearance of the first signs of inflammation.At the initial stage, movements are not impaired.Patients feel mild pain, tingling, and sometimes the joints may crack during movement.Symptoms occur during and after physical activity.Outwardly, the knee appears quite healthy.
II.Osteoarthritis of the 2nd degree - leads to thinning of the cartilage up to 1.5-2.0 mm (normal 2.5-3.0 mm), a narrowing of the joint space is observed and small single bony growths (osteophytes) appear.The inflammatory process is wave-like in nature, alternating between phases of remission and exacerbation.Gonarthrosis grade 1-2 is accompanied by swelling and weakness of the thigh muscles.The pain bothers me at rest, when the weather changes and after walking I feel tired.Movements become more rigid, morning stiffness and cracking in the joint appear.It is at this stage that patients most often consult a doctor.
III.3rd degree gonarthrosis manifests itself by an external deformation of the joint, curvature of the axis of the limb.The cartilaginous tissue is severely damaged, thinned to 1-1.5 mm, and exposed bone is visible in some places.Bony growths can be easily felt under the skin and the range of motion is significantly reduced.At 2-3 degrees of osteoarthritis, the joint space narrows, the joints cannot bend and unfold, all movements are accompanied by pain and crunching, and morning stiffness intensifies.A characteristic joint contracture develops.I'm worried about sharp pain in my knee, even when resting.Patients often suffer from insomnia due to the fact that they cannot take a comfortable position that does not cause pain and they feel weather changes.
IV.Grade 4 gonarthrosis is characterized by complete destruction of the articular surfaces, exposed bone is visible and cartilage is represented by rare “islets”.The joint space is almost invisible.A pronounced O-shaped deformation of the lower extremities and swelling are noticeable.Mobility is almost completely lost.Treatment by non-surgical methods at this stage is ineffective;Arthroplasty using an endoprosthesis is indicated.
Comment from an orthopedic doctor: In order to accurately determine the degree of osteoarthritis of the knee joint, in addition to examining the patient, it is extremely important to carry out an instrumental examination (ultrasound, x-ray or MRI of the joint).Bilateral knee osteoarthritis is very common, so it is recommended to examine the left and right knee joints.This will help you choose the optimal treatment and therefore prevent the progression of the disease.
Diagnosis
To make a diagnosis, it is usually sufficient to take an x-ray or ultrasound of the knee joint.In difficult cases, laboratory tests and magnetic resonance imaging (MRI) are prescribed.If pathological fluid accumulates in the joint, a puncture and subsequent examination may be necessary.
Ultrasound diagnosis
Helps identify the disease at an early stage.Allows you to measure the thickness of the cartilaginous layer, the relief of the joint, the presence of joint fluid, the size of osteophytes and ossifications.
X-ray
Perform to assess the degree of damage, the condition of bone and cartilage tissues.It will show the presence of osteophytes, narrowing of the joint space and joint deformity.In the early stages of the disease, the examination is not informative.
Analytics
General blood and urine tests, blood biochemistry show signs of inflammation, the presence of infection and disorders of bone and cartilage tissues.They allow you to assess the general condition of the body, determine the causes of the disease, gonarthrosis and exclude pathologies with similar symptoms.
MRI
Magnetic resonance imaging A very precise diagnostic method that allows even the most minor changes to be visualized.This will help establish a diagnosis at an early stage and in complex cases before surgical treatment.
Which doctor treats you?
The following specialists treat gonarthrosis of the knee:
- Orthopedic doctor - diagnoses the disease, intra-articular injections, plasma therapy, provides high-tech assistance and surgical treatment.
- Physiotherapist - responsible for instrumental physiotherapeutic treatment.
- Rheumatologist - will help if the disease is associated with autoimmune diseases.
- Sports doctor - will be required if there is a sports history of illness.
- A nutritionist is needed if the patient is overweight.
At the recovery stage, the attending physician may call on other specialists:
- Masseur - massages the lower extremities, restores muscle tone, thereby stimulating blood circulation and helping to restore joint mobility.
- Physiotherapist doctor - selects special exercises and controls their implementation.
- Rehabilitation specialist - helps with the patient's social adaptation;the specialist is particularly sought after after severe reconstructive knee surgery.
What treatment is prescribed?
The earlier the disease is detected and the symptoms of osteoarthritis are treated, the greater the chances of recovery.Otherwise, the disease can have irreversible consequences and significantly worsen the quality of life.
Thus, treatment of osteoarthritis of the knee joint of 1-2 degrees has a good chance of completely restoring the function of the knee joint.Unfortunately, patients do not always seek medical attention in the early stages.
How to quickly relieve pain and how to treat it?
First of all, it is necessary to eliminate pain and inflammation.Prescribed:
- Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics.Medications allow you to quickly eliminate inflammation related to osteoarthritis and help reduce pain and swelling.
- Corticosteroids are used when NSAIDs and painkillers are not helpful, for example, in the treatment of osteoarthritis of the knee joint grade 3 or 4. The patient undergoes drug blockade - drugs are injected directly into the joint cavity.this helps ease the pain and get relief within a few minutes after the injection.
- Special ointments and analgesic patches.
An orthopedic doctor comments: Treatment of osteoarthritis of the knee joint of 2-3 degrees is always complex, as a rule, it includes more than 15 (!) points of recommendations in the prescription sheet.It's not just about medications and injections.This is a whole series of rehabilitation measures aimed at correcting the biomechanics of the joint and the patient's lifestyle.Only this approach will preserve the joint and stop the progression of the disease.
Preparations that strengthen bone and cartilage tissues:
- Chondroprotectors based on chondroitin and glucosamine constitute the nutritional basis of chondrocytes.
- Hyaluronic acid preparations serve as analogues of synovial fluid.
- Drugs that improve microcirculation and blood supply to articular cartilage.
- Calcium and vitamin D supplements strengthen the bones that form the knee joint.
- Intra-articular injections of hyaluronic acid preparations, an artificial analogue of synovial fluid, help lubricate joint surfaces.
- Medication blockages help to quickly relieve swelling, pain and inflammation.Typically, the effect is noticeable the next day.
Treatment of knee osteoarthritis also includes physiotherapy:
- Electrophoresis.Using an electric current, the medicine enters the affected area.Electrophoresis is used to treat knee pain due to knee osteoarthritis.
- Phonophoresis.The medicine enters the area of inflammation under the influence of sound waves.An additional advantage of the method in the treatment of deforming gonarthrosis is the thermal effect.
- Shock wave therapy.The procedure improves blood circulation, stimulates tissue nutrition and is used to destroy osteophytes and scar tissue.
- Traction therapy (joint traction) - helps to unload the joint space, stretching it by several millimeters, thereby reducing the mutual pressure of the joint surfaces.
- Electromyostimulation - stimulates blood circulation and muscle function using electric current, restores muscle tone.
- Mechanotherapy helps to develop joint movements and combat contractures using special robotic simulators.
- Laser therapy creates deep tissue heating and reduces the inflammatory response.
- Magnetotherapy.The therapeutic effect relies on the properties of the magnetic field to reduce pain, inflammation and tissue swelling.
Orthobiology methods are aimed at stimulating regeneration and replacing defects in cartilage tissue:
- Plasmolifting is a plasma-based medicine, made from the patient's blood, which triggers regeneration processes and contains growth factors.
- PRP therapy – plasma obtained from the patient's blood is used as medicine.Platelet-rich plasma stimulates the regeneration of chondrocytes and alleviates the inflammatory process.
- SVF therapy is based on the use of stromal vascular fraction cells obtained from the patient's adipose tissue.
- SVF therapy + PRP therapy - the simultaneous use of concentrated plasma and progenitor cells allows you to achieve the best results.
- Stem cell treatment.The method is based on the use of bone marrow cells and is currently under development.
Each case is individual and requires the development of a separate rehabilitation program for the treatment of osteoarthritis of the knee joint.
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