One of the most common complaints doctors hear from patients is pain in the knees. What causes this pain cannot always be said immediately. The knees can be affected by various diseases, for example arthrosis of the knee joint. It is also known as gonarthrosis.
Osteoarthritis of the knee is a non-inflammatory joint injury that often results in cartilage destruction, bone deformity, and limited movement. This disease has the code M17 in the International Classification of Diseases (ICD-10).
All patients can be divided into two groups. The first group includes young people, more often young men, with damage to one, more rarely both knee joints. You have a history of an injury or knee surgery.
The second group includes people who are overweight, middle-aged and older, more often women, in whom gonarthrosis has developed in several parts of the body at the same time.
Symptoms of osteoarthritis of the knee
Symptoms of osteoarthritis of the knee gradually increase. Patients may not be aware they are ill for years, until they notice an obvious deformity of the knee or severe pain.
At the same time, arthritis of the knee joint at the initial stage of the disease is most often accompanied by unpleasant and painful sensations in the knees, and few people seek medical advice.
Women prone to obesity, especially after 40 years, are predisposed to this disease.
Varicose veins also contribute to the development of the disease. At this stage, it is possible to treat the disease at home without tablets and ointments.
The pain is not sudden, it comes on gradually over several years. They usually appear with exercise, walking, and other physical activities.
Acute pain may not be a symptom of gonarthrosis, but a result of a tear, meniscus injury, or bruise. It is severe pain that becomes a motivation to contact a specialist.
The pain often worsens in the following cases:
- while walking;
- in a long-term position;
- on inclines;
- when raising the body from a sitting position;
- when carrying heavy objects.
During the performance of these actions, the maximum load acts on the joints. Therefore, if the patient feels severe discomfort, he can already be diagnosed with arthritis of the knee joint of the second stage. A person tries to move less, take a static position to avoid pain, but with continued physical activity, the discomfort returns.
Deforming osteoarthritis of the knee joint accompanies such a symptom as a deformity. It becomes noticeable as early as the second or third stage of the disease. Her first signs: The knee was slightly swollen but kept its shape. In later stages, there is a change in the shape of the knee, causing one leg to become shorter or longer.
One of the most characteristic symptoms is a crunch in the joints, which becomes noticeable in the second and third stages. The main thing is to distinguish the sonorous crunch in the joints of a healthy person from the numb, dry crunch of the patient. This noise causes weakness of the ligaments or high mobility of the joints.
To ensure the immobility of the knee joint, wearing knee orthoses is recommended.
Forms of gonarthrosis
There are two forms of the disease:
- Primary: Appears as a result of congenital maldevelopment of the joints.
- Secondary: Appears as a result of illness and injury.
The primary form of osteoarthritis of the knee joint often develops in childhood and is caused by malformation of ligaments and joints. They are heavily loaded and deformed during physical activity.
The secondary form of the disease is caused by the following factors:
- Injuries (bruises, sprains, dislocations, fractures) resulting in damage to the structure of bones, ligaments and cartilage. All this is a post-traumatic form of the disease.
- Operations in which the meniscus is displaced violate the integrity of the knee structure.
- Excessive load on the legs (typical for weightlifters).
- Obesity. Being overweight puts pressure on the cartilage of the knee joints.
- passive lifestyle.
- Diabetes.
- Age.
- Arthritis (inflammatory process in the joints). Prolonged disease is accompanied by the formation of excess fluid in the joint cavity and causes complications.
- Metabolic disorders lead to the deposition of salts.
- knee transplant.
- Diseases that cause persistent muscle spasms in the legs or vasospasm.
The development of the disease can be unilateral or bilateral. Trauma often causes left or right sided gonarthrosis, and obesity is bilateral.
stages of the disease
There are three stages of gonarthrosis:
- From the onset of the first stage to the visible manifestations of the disease, it can take several months or even years. The person complains of intermittent pain in the legs, especially when climbing or climbing stairs and in the morning when getting up. The pictures usually show a narrowing of the connection between the joints, and instead of going to the doctor, patients usually use traditional medicine - ointments and tinctures.
- The second stage is characterized by more acute pain that does not stop with limb immobility. A crunch occurs. Fluid accumulates in the joint cavity, X-rays show the deformation and growth of the bone. The patient at this stage tries in every possible way not to move the affected limb. The attending physician prescribes injections and chondroprotectors - drugs that help restore cartilage tissue.
- In the last third of the phase, the pain becomes constant and often worsens with changing weather conditions. The X-ray shows a significant deformity of the knee, which can only be corrected by surgery, the patient needs to take a complex of chondroprotectors. The patient's gait changes: he walks on half-bent legs or rolls from side to side.
causes of disease. risk groups
overweight
Most often, deforming osteoarthritis affects older people. Overweight women after the age of 40 are in a special risk group. The probability of pathology in obese people is four times higher than in people of normal body weight. The pattern is simple: the greater a person's weight, the faster the disease develops and the more severe it is. In this case, the form of the disease can be called acquired. It is the joints of the lower extremities that take the hit because they are forced to take the most stress.
Overweight people also face hormonal imbalances and metabolic disorders that contribute to the development of obesity and osteoarthritis.
Age
Older people can be defined as those who have reached the age of over 60-65 years. In this population, osteoarthritis occurs in 65-85 percent of people.
The reason is age-related changes that negatively affect the structure of the joints. Even normal walking can become a significant burden and stimulate the development of the disease, while worn cartilage can no longer regenerate on its own.
Congenital pathologies and hereditary factors
The disease can affect both young people and people who are not overweight. In such situations, as a rule, the disease occurs due to congenital defects of the knee joints, for example, a lack of intra-articular lubrication. Heredity also plays an important role.
However, the majority of patients who suffer from knee pain are people of a respectable age. Osteoarthritis is rare in young people. Unfortunately, young patients do not always receive the necessary treatment, since not all doctors consider it necessary to give them the necessary attention.
High loads
People who do heavy physical labor for a living and athletes of all levels are also at risk of developing knee osteoarthritis. In this case, the disease becomes an occupational pathology.
Operations, injuries and other illnesses
Operations, trauma and various diseases of the joints can provoke the appearance of gonarthrosis.
When the cause remains unknown, osteoarthritis of the knee joint is commonly referred to as idiopathic.
Diagnosis of arthrosis of the knee joint
This diagnosis is made on the basis of patient complaints, examination data, palpation of the diseased joint and x-ray examination.
X-ray is a standard research method that allows you to confirm the diagnosis, determine the degree of pathological changes, monitor the dynamics of the process and exclude other pathological processes (for example, tumors) in the tibia and femur .
It should be noted that the primary changes in the structures of the knee joint may be absent on radiographs. The narrowing of the joint space and the compression of the subchondral zone are then determined. The articular ends of the femur, and especially the tibia, expand, the edges of the condyles become pointed.
Auxiliary diagnostic methods are CT (computed tomography) and MRI (magnetic resonance imaging), which allow a more detailed study of pathological changes in bone structures and detect changes in soft tissues.
How to treat gonarthrosis of the knee joint
The more acute the stage of the disease, the more complex the treatment of gonarthrosis becomes. The chronic nature of the pathology can remain in the period of remission, when the active manifestations of the disease are minimized or absent altogether.
Physiotherapeutic treatment in combination with chondroprotective drugs gives positive results.
Treatment options include:
- drug therapy (chondroprotectors);
- surgical intervention;
- Rehabilitation course (exercise therapy, massage, etc. ).
treatment with medication
With drug therapy, the use of nonsteroidal analgesics is prescribed. These drugs help reduce pain and symptoms of synovitis (inflammation). Corticosteroids can be used in the case of particularly severe pain or severely inflamed synovium in the knee joint. These drugs have a stronger analgesic and anti-inflammatory effect than non-hormonal painkillers. Muscle relaxants and antispasmodics help the periarticular muscles get rid of spasms.
Antioxidants and vasodilators improve cartilage nutrition. The main drugs for conservative treatment of the disease are chondroprotectors containing chondroitin and glucosamine sulfate (natural components of cartilage).
The use of pathogenetic drugs should be systemic and prolonged.
physical therapy
Methods of physiotherapeutic treatment (UHF, ultrasound or phototherapy) are considered additional means of accelerating the healing process.
This includes:
- Acupuncture. This method relieves muscle spasms near the affected joint, normalizes metabolic processes in them, thereby restoring damaged cartilage tissue.
- hirudotherapy. Treatment with leeches has the same effect as injections, as it improves blood circulation.
- laser therapy. Such procedures relieve inflammation, swelling, improve metabolism and neutralize pain.
- cryotherapy. Both liquid nitrogen treatment and ordinary ice at home are effective.
- magnetotherapy. The influence of the magnetic field not only improves blood circulation in tissues, but also reduces swelling and inflammation.
- electromyostimulation. With the help of micro-discharges of current of different frequencies, muscles are restored and strengthened, blood circulation in the limbs is improved.
Treatment of gonarthrosis of the knee with physical therapy is effective because it reduces pain. The attending physician usually prescribes such treatment depending on the stage of the disease.
physical therapy
Exercise therapy for arthrosis of the knee joint is one of the most important means of restoring atrophied muscles and must be carried out very carefully and slowly. If the patient feels that the pain is returning, the exercise should be stopped.
Special knee pad fixators must be worn during therapeutic exercises. The rehabilitation course also includes the use of these orthopedic devices, the aim of which is to reduce the load on the affected knee on the stick or prosthesis. Patients with osteoarthritis of the knee are often prescribed wearing knee braces to relieve pain when walking.
Remedial gymnastics for gonarthrosis reduces the load on the damaged joint and develops the leg muscles. Exercises that load the joint are strictly contraindicated. Water aerobics and swimming are ideal activities.
orthopedic therapy
To reduce the load on the affected joints, the patient should use a cane. A good helper for knee arthrosis are orthopedic shoes, which ensure a natural foot position and even load distribution.
massage
Massage relieves muscle spasms, reduces pain and increases range of motion. This procedure also improves blood circulation and provides nutrients to the joint.
Surgical intervention
A pronounced decrease in working capacity (especially up to 45 years) requires surgical treatment. The choice between corrective (osteophyte removal) and radical (knee arthroplasty) treatment methods depends on the stage of the disease, the patient's age, symptoms and other factors.
nutrition
The special diet for osteoarthritis of the knee is most often aimed at reducing the patient's weight, since excess weight leads to overloading of the joints. It is recommended to eat small meals every 3 hours, eat lean meats (chicken, turkey, rabbit) and exclude fatty pork, and get the necessary proteins from legumes.
Refined oil should be replaced with unrefined oil, salt intake should be limited. The therapeutic diet also implies the refusal of canned, fried and smoked foods. In order to restore destroyed cartilage, it is necessary to provide the body with carbohydrates, which are found in cereals and wholemeal flour.
In addition, it is recommended to drink freshly squeezed juices such as carrot, beet and apple to remove toxins and reduce inflammation in the body.
Fish and various jellies act as chondroprotectors, helping to restore cartilage not only at the initial stage, but also during periods of exacerbation.
Folk methods of treatment
There are many ointments, compresses and tinctures used by lovers of traditional medicine. Usually made from herbs and medicinal bile, these remedies help improve blood flow to the joints.
Compresses and ointments also relax the muscles, their effectiveness is very high, but in the third stage of gonarthrosis without the use of drugs, they are practically useless.
Traditional medicine should not be neglected, as it helps relieve discomfort and reduce many of the symptoms of the disease. But in any case, you should consult a doctor, and not self-medicate.
There are contraindications, it is necessary to consult a specialist.
prevention
It is recommended to adhere to the following principles of a healthy lifestyle:
- balanced nutrition;
- give up bad habits (smoking, alcohol);
- Sports;
- maintaining a healthy weight;
- Prevention of sports injuries (bruises, dislocations, broken bones).
Osteoarthritis of the knee has several treatment options, depending on the age and physical condition of the patient. To prevent and control the disease in its early stages, exercise and timely treatment are required.