One of the most common complaints doctors hear from patients is pain in the knees. What causes this pain is not always possible to tell right away. The knees can be affected by various diseases, for example, osteoarthritis of the knee joint. It is also known as gonarthrosis.
Knee osteoarthritis is a non-inflammatory joint injury that often leads to cartilage destruction, bone deformity, and limitation of 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, less often to both knee joints. They have a knee injury or surgery in their medical history.
The second group includes obese, middle-aged or elderly people, more often women, in whom gonarthrosis has developed in several parts of the body at the same time.
Symptoms of knee osteoarthritis
The symptoms of osteoarthritis of the knee gradually increase. Patients may not realize they are sick for years until they notice an obvious knee deformity or severe pain.
At the same time, arthritis of the knee joint in the initial stage of the disease is often accompanied by unpleasant and painful sensations in the knees, and few people seek medical attention.
Women prone to obesity, especially after the age of 40, 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 the use of tablets and ointments.
The pain is not sudden, it comes on gradually, over several years. They usually occur during sports, walking, and other physical activities.
Acute pain may not be a symptom of knee osteoarthritis, but rather a consequence of a fissure, meniscus injury, or hematoma. It is the intense pain that becomes the motivation to go to a specialist.
The pain often worsens in the following cases:
- To walk;
- in a long standing position;
- during slopes;
- 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 great 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 deformity. It is already noticeable in the second or third stage of the disease. His first signs: the knee was slightly swollen, but kept its shape. In later stages, there is a change in the shape of the knee, shortening or lengthening one leg.
One of the most characteristic symptoms is a cracking sound in the joints, which is noticeable in the second and third stages. The main thing is to distinguish the loud crunch in the joints of a healthy person from the dry dull crunch of the patient. This sound causes weakness of the ligamentous apparatus or high mobility of the joints.
To ensure immobility of the knee joint, the use of knee braces is recommended.
Forms of gonarthrosis
There are two forms of the disease:
- Primary: It appears as a consequence of a congenital abnormal development 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 improper formation of ligaments and joints. They are subjected to heavy loads and deform during physical activity.
The secondary form of the disease is caused by the following factors:
- Injuries (bruises, sprains, dislocations, fractures), entailing violations of the structure of bones, ligaments and cartilage. All this is a post-traumatic form of the disease.
- Operations when the meniscus is displaced violate the integrity of the knee structure.
- Too much load on the legs (typical of weightlifters).
- Obesity. Excess weight causes pressure on the cartilage in the knee joints.
- Passive lifestyle.
- Diabetes.
- Get older.
- Arthritis (inflammatory process in the joints). Prolonged disease is accompanied by the formation of excess fluid in the joint cavity and leads to complications.
- Metabolic disorders lead to the deposition of salts.
- knee transplant
- Diseases that cause prolonged muscle cramps in the legs or vasospasm.
The development of the disease can take a unilateral or bilateral form. Trauma often causes left-sided or right-sided gonarthrosis, and obesity is bilateral.
disease stages
There are three stages of gonarthrosis:
- From the onset of the first stage to the visible manifestations of the disease, several months or even years may pass. The person complains of intermittent pain in the legs, especially when starting to go up or down stairs and when getting out of bed in the morning. The pictures usually show a narrowing of the connection between the joints, and, as a rule, instead of going to the doctor, patients use traditional medicine - ointments and tinctures.
- The second stage is characterized by more acute pain, which does not stop with immobility of the limb. A crack appears. Fluid accumulates in the joint cavity, the x-ray shows 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 stage, 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 must take a complex of chondroprotectors. The patient's gait changes: he walks with his legs half bent or rolls from side to side.
Causes of the disease. groups at risk
Over weight
Most often, osteoarthritis deformans affects the elderly. In a special risk group are overweight women after 40 years. The probability of pathology in obese people is 4 times higher than in people with 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 fall under the blow, because they are forced to bear the greatest load.
Overweight people also face hormonal imbalances and metabolic disorders, which contribute to the development of obesity and osteoarthritis.
Get older
Older people can be called those who have reached the age of more than 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 the worn cartilage can no longer heal on its own.
Congenital pathologies and hereditary factors
The disease can affect both young people and those who are not overweight. As a rule, in such situations, the disease occurs due to congenital defects of the knee joints, for example, lack of intra-articular lubrication. Heredity also plays an important role.
However, most of the patients suffering from knee pain are people of respectable age. Osteoarthritis is rare among young people. Unfortunately, young patients do not always receive the necessary treatment, as not all doctors consider it necessary to provide them with the necessary care.
high loads
People who make a living with hard physical labor and athletes of various levels are also at risk for osteoarthritis of the knees. In this case, the disease becomes a professional pathology.
Operations, injuries and other illnesses
Surgery, trauma, various joint diseases can provoke the appearance of gonarthrosis.
When the cause remains unknown, osteoarthritis of the knee joint is commonly referred to as idiopathic.
Diagnosis of osteoarthritis of the knee joint.
This diagnosis is made on the basis of the patient's complaints, examination data, palpation of the diseased joint and X-ray examination.
Radiography is a standard research method that allows you to confirm the diagnosis, establish the degree of pathological changes, monitor the dynamics of the process, and also allows you to exclude other pathological processes (for example, tumors) in the tibia and femur. .
It should be noted that primary changes in the structures of the knee joint on radiographs may be absent. Subsequently, the narrowing of the joint space and the compaction of the subchondral area are 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 identify 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 remission phase, when the active manifestations of the disease are minimized or completely disappear.
Physiotherapy treatment in combination with chondroprotective drugs gives positive results.
Treatment options include:
- drug therapy (chondroprotectors);
- Surgical intervention;
- rehabilitation course (exercise therapy, massage, etc. ).
drug treatment
With drug therapy, the use of non-steroidal analgesics is prescribed. These medications help relieve pain and symptoms of synovitis (inflammation). If the pain is especially severe or the synovium of the knee joint is severely inflamed, then corticosteroids may be used. These drugs have a more powerful analgesic and anti-inflammatory effect than non-hormonal analgesics. Muscle relaxants and antispasmodics will help the periarticular muscles to get rid of spasms.
Antioxidants and vasodilators improve cartilage nutrition. The main drugs for the conservative treatment of the disease are chondroprotectors containing chondroitin and glucosamine sulfate (natural components of cartilage).
The use of pathogenic drugs must be systemic and prolonged.
Physiotherapy
Physiotherapy treatment methods (UHF, ultrasound or phototherapy) are considered additional means of accelerating the healing process.
They also include:
- Acupuncture. This method relieves muscle spasm near the affected joint, normalizes metabolic processes in them, thereby restoring damaged cartilage tissues.
- Hirudotherapy. Leech treatment 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.
- Magnet therapy. The influence of the magnetic field not only improves blood circulation in the tissues, but also relieves swelling and inflammation.
- Electromyostimulation. With the help of micro current discharges of different frequencies, the muscles are restored and strengthened, and blood circulation in the extremities improves.
The treatment of gonarthrosis of the knee with physiotherapy is effective, since it reduces pain. The attending physician usually prescribes such treatment according to the stage of the disease.
Physiotherapy
Exercise therapy for osteoarthritis of the knee joint is one of the main means of restoring atrophied muscles, and it must be carried out very carefully and slowly. If the patient feels that the pain is returning, she should stop the exercise.
During therapeutic exercises, it is necessary to use special knee braces-fixators. The rehabilitation course also includes the use of these braces, their objective is to reduce the load of the affected knee to the cane or prosthesis. Knee braces are often prescribed for patients with gonarthrosis to relieve pain while walking.
Therapeutic gymnastics for gonarthrosis reduces the load on the damaged joint and develops the leg muscles. Exercises that load the joint are strictly contraindicated. Aqua fit and swimming are ideal activities.
orthopedic therapy
To reduce the load on the affected joints, the patient must use a cane. A good helper for knee arthrosis is orthopedic shoes that provide 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 work capacity (especially up to 45 years of age) 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
As for the special diet for gonarthrosis, most often it is aimed at reducing the patient's weight, since being overweight leads to overloading of the joints. It is recommended to eat small meals every 3 hours, eat lean meat (chicken, turkey, rabbit) and exclude pork fat, and get the necessary protein from legumes.
Refined oil should be replaced with unrefined oil, salt intake should be limited. The therapeutic diet also implies the rejection of canned, fried and smoked foods. To restore the 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 eliminate toxins and deflate the body.
Fish and various jellies act as chondroprotectors and help restore cartilage not only in the initial stages, but also during periods of exacerbation.
Folk methods of treatment
There are many ointments, compresses, tinctures that are used by lovers of traditional medicine. These remedies are usually made from herbs, medical bile, and help improve circulation in the joints.
Compresses and ointments also relax the muscles, their effectiveness is very high, but at 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 need to 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:
- balance diet;
- abandonment of bad habits (smoking, alcohol);
- Sports;
- keep a healthy weight;
- prevention of sports injuries (contusions, displacements, fractures).
Knee osteoarthritis has several treatment options depending on the age and physical condition of the patient. To prevent and control the disease in its early stages, sports are necessary, as well as timely treatment.