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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 of age.In 2/3 of the cases, women predominate.
How does the disease develop?
Under the influence of external and internal factors, the blood supply and nutrition of the tissues are disturbed, degenerative-dystrophic damage to the articular cartilage develops with subsequent involvement of the underlying bone in the inflammatory process.Destruction of the articular 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 labor.Constant loads on the feet lead to microtraumas of the cartilage and the development of the inflammatory process.Loaders, installers, miners and quarry workers are at risk.Often, deforming osteoarthritis affects professional athletes (weightlifters, cyclists, tennis players, football players, basketball players, hockey players, etc.).
- Injuries.Damage to ligaments, tendons, menisci, contusions and fractures leads to disruption of the biomechanics of the joint.With improper treatment, this leads to the development of post-traumatic arthrosis.
- Surgical operations on the knee can lead to the development of pathology of the articular cartilage and surrounding tissues.
- Excess weight increases the load on the joints of the lower limbs.Up to 80-90% of the progression of all osteoarthritis diseases is related to overloading of the joints.
- old ageIn people over 50-60 years old, regenerative processes slow down, collagen production decreases, hormonal levels suffer.Which leads to the development of pathology.
- Hormonal changes in women.During menopause, estrogen production decreases, which impairs calcium absorption, weakens the musculoskeletal system, and makes bones brittle.The risk of developing osteoporosis increases.
- Thyroid problems.Thyroid hormones are involved in the metabolic processes of calcium and phosphorus in the body.Their deficiency or excess can provoke arthrosis of the knee.
- Genetic predisposition.Mutation of collagen can cause disorders in the elements of the connective tissue, which leads to deterioration of the cushioning function of the articular cartilage.
- Heredity.There is a high probability of developing the disease if there are relatives diagnosed with gonarthrosis in the patient's family, mainly on the female line.
- 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 proper nutrition, the blood supply is disturbed, which leads to the development of ischemia and degenerative-dystrophic changes in the articular cartilage.
- Poor nutrition and metabolic disorders.Eating foods high in purines (proteins) contributes to the deposition of salts in the knee, for example, gouty arthritis.
- Specific diseases such as gonorrhea, tuberculosis, syphilis, chlamydia and influenza can cause serious damage to the joint.
- Intoxication of the body with various chemicals, including some drugs.
- 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 gonarthrosis:
- Pain in the joint, pains in nature, sometimes at night, in case of exacerbation, severe stabbing;
- Crackling and clicking during movement are caused by a violation of the congruence of the joint surfaces, the presence of osteophytes and cartilage defects;
- Puffiness and swelling are associated with the development of an inflammatory process in the joint and surrounding soft tissues;
- Deformation of the joint space and 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;
- The limitation of mobility and stiffness of the joint is caused by pain, the development of adhesions and the appearance of osteophytes (bone spurs).
The first signs of arthrosis that you should pay attention to are pain that occurs during or after exercise.The pain goes away with rest and does not require medication.Morning stiffness in the knee, initial pain, before getting up and walking after sleep, takes some time for the joint to develop.
Signs of exacerbation
With the development of the pathology, the symptoms of arthrosis become more pronounced: the knees begin to hurt at rest, and at night, when bending and stretching the joint, extraneous sounds appear - crackling, crunching, clicking.Lameness develops, stiffness of movements, 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 the development of flexion contracture;
- weakness and atrophy of the thigh muscles.
Types and forms of the disease
There are:
- Primary.It develops as an independent disease.More often, such gonarthrosis of the knee is associated with age changes and heredity.
- Secondary.It occurs against the background of certain diseases or injuries, for example, post-traumatic osteoarthritis.
Depending on the causes, the following types of arthrosis are distinguished:
- Ischemic, associated with tissue blood supply problems and vascular disorders;
- Post-infectious is caused by infections, viruses, autoimmune processes;
- The idiopathic nature of the development of the pathology remains unclear;
- Metabolic is associated with metabolic disorders - gout, hemochromatosis, chondrocalcinosis;
- Involutional, as a result of age-related changes in the body;
- Post-traumatic, history of trauma;
- Dishormonal - a consequence of hormonal imbalance in the body.
Stages of development
I. Arthrosis 1st degree - the initial stage is associated with a deterioration in the quality and quantity of synovial fluid (joint fluid, provides cartilage nutrition, has shock-absorbing properties, promotes gliding of joint surfaces).Malnutrition leads to wear and tear of cartilage tissue and the appearance of the first signs of inflammation.In the initial stage, the movements are not disturbed.Patients experience slight pain, numbness, sometimes the joints can crack when moving.Symptoms occur during and after physical activity.Outwardly, the knee looks pretty strong.
II.Osteoarthritis 2nd degree - leads to thinning of the cartilage to 1.5-2.0 mm (normally 2.5-3.0 mm), narrowing of the joint space is observed, small single bone growths (osteophytes) appear.The inflammatory process has a wave-like character, alternating phases of remission and exacerbation.Gonarthrosis 1-2 degree 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 stiffer, morning stiffness and crunching appear in the joint.It is at this stage that patients most often turn to a doctor.
III.Gonarthrosis of the 3rd degree is manifested by external deformation of the joint, distortion of the axis of the limb.Cartilage tissue is severely damaged, thinned to 1-1.5 mm, exposed bone is visible in places.Bony growths can easily be felt under the skin, and range of motion is greatly reduced.At 2-3 degrees of arthrosis, the joint narrows, the joints cannot bend and unfold, all movements are accompanied by pain and crunching, morning stiffness intensifies.A characteristic joint contracture develops.I am concerned about sharp pain in my knee, even at rest.Patients often suffer from insomnia due to the fact that they cannot take a comfortable position that does not cause pain, and they feel changes in the weather.
IV.Gonarthrosis of the 4th degree is characterized by complete destruction of the joint surfaces, the exposed bone is visible, and the cartilage is represented by rare "islands".The joint space is almost invisible.A pronounced O-shaped deformity of the lower limbs and swelling is noted.Mobility is almost completely lost.Treatment with non-surgical methods at this stage is ineffective;joint replacement with an endoprosthesis is indicated.
Orthopedic doctor's comment: In order to accurately determine the degree of arthrosis of the knee joint, in addition to examining the patient, it is extremely important to perform an instrumental examination (ultrasound, X-ray or MRI of the joint).Bilateral gonarthrosis is very common, so it is recommended to examine both the left and right knee joints.This will help you choose the optimal treatment and therefore prevent further progression of the disease.
Diagnosis
To make a diagnosis, it is usually enough to do an X-ray or ultrasound examination of the knee joint.In difficult cases, laboratory tests and nuclear magnetic resonance are prescribed.If pathological fluid accumulates in the joint, a puncture and subsequent examination may be necessary.
Ultrasound diagnostics
It helps to identify the disease at an early stage.It allows you to measure the thickness of the cartilage layer, the relief of the joint, the presence of joint fluid, the size of osteophytes and ossifications.
Radiography
Perform to assess the degree of damage, the condition of the bone and cartilage tissue.It will show the presence of osteophytes, narrowing of the joint space and deformity of the joint.In the initial stages of the disease, the study is not informative.
Analyzes
General tests of blood and urine, blood biochemistry show signs of inflammation, presence of infection and disorders in bone and cartilage tissue.They allow you to assess the general condition of the body, determine the causes of the disease, gonarthrosis and rule out pathologies with similar symptoms.
MRI
Magnetic resonance Extremely accurate diagnostic method that helps to visualize even the most insignificant changes.It will help to make the diagnosis both 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 physiotherapy treatment.
- Rheumatologist - will help if the disease is related to autoimmune diseases.
- Sports doctor - will be required in case of sports history of illness.
- A nutritionist is needed if the patient is overweight.
At the stage of recovery, the attending physician may involve other specialists:
- Masseur - massages the lower limbs, restores muscle tone, thereby stimulating blood circulation and helping to restore joint mobility.
- Physiotherapy doctor - selects special exercises and supervises their implementation.
- Rehabilitation specialist - supports the patient's social adaptation;the specialist is especially in demand after severe reconstructive knee surgeries.
What treatment is prescribed?
The earlier the disease is detected and the treatment of osteoarthritis symptoms begins, the greater the chance of recovery.Otherwise, the disease can lead to irreversible consequences and significantly worsen the quality of life.
In this way, the treatment of arthrosis of the knee joint of 1-2 degrees has a good chance of fully restoring the function of the knee joint.Unfortunately, patients do not always seek medical help in the initial stages.
How to quickly relieve pain and how to treat it?
First of all, it is necessary to remove the pain and inflammation.Prescribed:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and pain relievers.Medicines allow you to quickly remove inflammation in arthrosis and help reduce pain and swelling.
- Corticosteroids are used when NSAIDs and analgesics do not help, for example, in the treatment of arthrosis of the knee joint 3-4 degrees.The patient is given a drug blockade - drugs are injected directly into the joint cavity.this helps to relieve the pain and achieve relief within a few minutes after the injection.
- Special ointments and pain-relieving patches.
Orthopedic doctor comments: The treatment of arthrosis 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 drugs 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 help preserve the joint and stop the progression of the disease.
Preparations for strengthening bone and cartilage tissue:
- The nutritional basis of chondrocytes are chondroprotectors based on chondroitin and glucosamine.
- Preparations with hyaluronic acid serve as analogs of synovial fluid.
- Medicines that improve microcirculation and blood supply to articular cartilage.
- Calcium and vitamin D supplements strengthen the bones that make up the knee joint.
- Intra-articular injections of hyaluronic acid preparations, an artificial analogue of synovial fluid, help to lubricate the joint surfaces.
- Medicinal blocks help to quickly relieve swelling, pain and inflammation.As a rule, the effect is noticeable the next day.
The treatment of arthrosis of the knee joint also includes physiotherapy:
- Electrophoresis.With the help of an electric current, the drug penetrates the affected area.Electrophoresis is used to treat knee pain due to gonarthrosis.
- 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 scars.
- Traction therapy (joint traction) - helps to unload the joint gap, stretching it by several millimeters, thereby reducing the mutual pressure of the joint surfaces.
- Electromyostimulation - stimulates blood flow and muscle function with the help of electric current, restores muscle tone.
- Mechanotherapy helps to develop movements in the joint and combat contracture with the help of special robotic simulators.
- Laser therapy creates deep tissue heating and reduces the inflammatory response.
- Magnetotherapy.The therapeutic effect is based on the properties of the magnetic field to reduce pain, inflammation and tissue swelling.
Orthobiological methods are aimed at stimulating regeneration and replacing defects in cartilage tissue:
- Plasmolifting is a medicine based on plasma, produced from the patient's own blood, which triggers regeneration processes and contains growth factors.
- PRP therapy - plasma obtained from the patient's blood is used as a medicine.Platelet-rich plasma stimulates the regeneration of chondrocytes and relieves the inflammatory process.
- SVF therapy is based on the use of stromal vascular fraction cells derived from the patient's own 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 arthrosis of the knee joint.
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