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 joint. The disease has a non-inflammatory nature and progresses slowly - the transition from the initial stage to disability takes from several years to several decades. Knee osteoarthritis is one of the top 5 causes of disability and impairment worldwide.
Osteoarthritis of the knee (gonarthrosis) affects more than 20% of people over 55 years of age, but the disease is rapidly rejuvenating - more and more often its symptoms appear over the age of 25.
Signs of osteoarthritis of the knee joint
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:
- morning stiffness and reduced mobility of the joint (warming up after waking up is necessary);
- pain and discomfort in the knees, which increase after physical exertion (prolonged walking, running or standing) and subside with rest;
- at the 2nd stage - the so-called initial pain that appears after a long stay in one position;
- increased fatigue, which is often due to age-related changes;
- dry, rough crisis, which regularly recurs on bending and extending the knees;
- edema and other symptoms of inflammation that appear at the 2nd stage of the disease due to trauma to the periarticular tissues;
- weather sensitivity, increased symptoms in the cold season.
When you try to bend the knee affected by gonarthrosis all the way, there is a sharp pain and a feeling of physical obstruction. In the later stages, even with treatment of arthrosis of the knee joint, patients have a disturbed gait (they become wobbly, patients walk on stiff legs), the deformation of the lower limbs manifests itself in the form of the letters "O" or "X".
The insidiousness of the disease lies in the fact that it can take place 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.
That's why it's important to see a doctor at the first signs of discomfort in the knees - for example, weak, as if pulling pains that occur with insufficient production of synovial fluid. Remember: knee pain is not normal, regardless of age. Timely examination and treatment of knee osteoarthritis of the 1st 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, arthrosis of the knee joint progresses on average 3-8 times faster than with complex therapy. If gonarthrosis proceeds aggressively, the patient may lose the ability to move normally even before reaching retirement age.
Effective treatment of knee arthrosis in the acute stage is particularly important. It can be provoked by wet cold 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 designed to process and remove dead cells. However, if their concentration is too high, healthy areas of cartilage also suffer - cell membranes become thinner, foci of erosion appear on the synovial lining of the joint. This process, if not stopped by the treatment of knee arthrosis with drugs, can last for several weeks, and with chronic stress, lack of sleep or insufficient nutrition, it can be permanent.
Ultimately, without treatment, arthrosis 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 closes 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 joint architecture with a prosthesis and subsequent 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 knee arthrosis of the 1st 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 of the disease or a stable remission.
The treatment of arthrosis of the knee joint of the 2nd degree, as a rule, is based on the use of all methods of conservative treatment, but the doctor may decide on light surgical interventions in the joint if the disease develops aggressively or with complications.
Treatment for grade 3 osteoarthritis of the knee almost always involves surgery.
Comprehensive conservative treatment of arthrosis of the knee joint includes eliminating pain and inflammation, restoring cartilage tissue and increasing the range of motion in the joint. For this, the patient is prescribed an orthopedic regimen of exercise 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 - injecting drugs for the treatment of arthrosis of the knee joint directly into the joint bag. In this case, PRP injections (platelet-rich plasma) are used, as well as stem cell injections obtained from the patient's own fat tissue. In parallel, auxiliary and rehabilitation methods are connected - physiotherapy, massage, manual therapy, therapeutic gymnastics.
Surgical treatment of arthrosis of the knee joint is performed in cases where drugs are ineffective.With this pathology, the doctor can prescribe the following interventions:
- Arthroscopy of the knee joint. General name for a group of minimally invasive operations aimed at removing a broken piece of joint tissue or osteophyte or partial excision of the joint membrane. It allows you to postpone or exclude prosthetics, as well as to eliminate discomfort in the early stages of the disease. It is mainly used to treat osteoarthritis of the knee in patients under 60 years of age.
- Osteotomy. Surgery to cut out part of the bone and correct the load axis of 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 total knee joint replacement with a titanium implant that lasts 15-20 years. This technique is a last resort because it carries certain risks. Recommended for patients over 55 years of age.
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 (canes, orthopedic insoles, 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 refers the patient to tomography or radiography.
Therapeutic exercises for knee arthrosis
Therapeutic exercises for the limbs of the lower girdle are considered the most effective method for reducing pain and treating arthrosis of the knee joint of the 1st degree. The first results of therapeutic exercises come after 2-4 weeks of continuous training. Continuity in the treatment of osteoarthritis of the knee joint is one of the main factors that influence the effectiveness of exercise therapy. A full-fledged lesson is held 1 time a day every day, it is also recommended to do at least 3-4 training sessions during the day.
The main task of physical exercises in the treatment of arthrosis of the knee joint is to strengthen the muscles of the thigh and the lower part of the leg, to maintain the elasticity of the ligaments and tendons, as well as to combat 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 abrasion of the cartilage, reduce inflammation.
Knee osteoarthritis treatment exercises are performed for both legs! If there is acute pain, the session should be stopped or continued at a lighter pace.
- Starting position - lying on your back. One leg is stretched out on the floor, the other is raised, bent at 90 ° (the lower part of the leg is parallel to the floor). We perform movements with the lower leg up and down as far as the range of motion in the joint allows.
- Starting position - lying on your back. Let's do the bike exercise.
- Starting position - lying on the stomach. We rotate our legs in turn, trying to bring the heels as close as possible to the buttocks.
- Starting position – lying on one side, the arm is folded under the head or stretched above the head in line with the body. The other hand rests at the side. We swing up with a straight leg. We switch sides.
- Starting position - lying on your back. We pull the legs forward on the floor with the heel (away from you), the socks look "at yourself".
- Starting position - lying on the stomach. We do the "boat" exercise. If physical training does not allow, we place our palms on both sides of the chest and bring our legs back in turn, feeling tension in the back of the thigh and lower leg.
- Starting position - lying on your back. We alternate rotating the feet, trying to describe the full circle with the socks.
- Starting position - standing next to the wall. We squat slowly and smoothly without lifting our back from the wall to distribute the load. When the legs are bent at the knees at 90 °, we begin a smooth upward movement.
- Starting position - standing. We alternately swing our legs forward, backward and sideways.
Please note: therapeutic gymnastics after joint surgery has its specifics and varies depending on how many days have passed since the operation. It is prescribed by a doctor - a surgeon or a rehabilitator.
Massage for arthrosis of the knee
Therapeutic massage for knee arthrosis is performed on both legs. Initially, at least 10-12 sessions with a massage therapist or with the help of hydromassage equipment are usually needed, but a simple restorative massage can be done at home. It includes the following types of movements:
- superficial stroking and rubbing (up and down, clockwise and counterclockwise);
- fingertip probing and stretching of deeper tissues;
- pinching and tapping the skin.
Self-massage can be combined with 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 bath before the procedure.
Important: massage is contraindicated in patients with symptoms of inflammation (osteoarthritis or exacerbation of arthrosis). In this case, therapy in the acute phase is necessary.
Diet therapy for arthritis
The standard nutritional protocol for treating osteoarthritis of the knee calls for:
- limit foods and meals rich in simple carbohydrates (white bread, confectionery, snacks, sweets, potatoes, sugar);
- exclude processed (ready-to-eat) and salt-rich dishes - fast food, semi-finished products, sausages;
- avoid alcohol, decaffeinated coffee and fatty meats.
Instead, include in the menu:
- sprouted and whole grain cereal dishes;
- fatty fish from the northern seas and dietary poultry;
- cartilage (ears, snouts, feet and other collagen-rich parts of farm animals), aspic and jelly;
- fruits and vegetables rich in vitamins and antioxidants (especially vitamins A, B12, C, E);
- nuts and other sources of omega fatty acids and valuable minerals.
Treatment of arthrosis 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 enhance the effect of drugs:
- magnetic therapy;
- laser therapy;
- UHF;
- ultrasound therapy;
- amplipulse;
- electrophoresis (including medicinal - with analgin, novocaine or chymotrypsin);
- ozokerite and paraffin applications;
- thermotherapy (cryotherapy, inductothermy);
- phonophoresis (especially with hydrocortisone);
- balneotherapy (sulphur, hydrogen sulphide baths).
Acupuncture in the treatment of arthrosis of the knee joint of the 2nd 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 exacerbation of the disease.
Medicines for the treatment of arthrosis of the knee joint
Treatment of arthrosis of the knee joint with drugs is carried out symptomatically and taking into account the individual reaction of the patient to the selected drugs. Drug therapy - injections, ointments or tablets to treat knee osteoarthritis - is usually prescribed in courses or as needed.
There are several directions in the treatment of arthrosis of the knee joint with drugs: facilitating the patient's life, improving the nutrition of the cartilage, regenerating the cartilage tissue and maintaining the normal musculoskeletal system.
Nonsteroidal anti-inflammatory drugs
To relieve exacerbations, 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 in violation of the doctor's instructions or recommendations is fraught with stomach or intestinal ulcers. They should be taken with extreme caution in combination with glucocorticosteroids and drugs that affect blood clotting. Additional risk factors are age over 65 years, smoking, alcohol use during the course. In these cases, doctors usually recommend injecting drugs, bypassing the gastrointestinal tract. Together with NSAIDs, it is desirable to take gastroprotectors.
Maximum effect can be achieved with a combination of systemic NSAIDs (for internal use) and external - 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 preparations (HP) are usually used for the so-called steroid blockade of the knee in cases where NSAIDs are not sufficient to relieve pain and inflammation.
Glucocorticoid injections are considered a last resort in the treatment of osteoarthritis of the knee with drugs. They provide relief as early as 20 minutes after intake, but can lead to hormonal imbalance and cartilage damage if taken incorrectly. Because of the side effects, many orthopedists prefer knee surgery to long-term HA therapy.
Chondroprotectors in the treatment of arthrosis of the knee joint
Chondroprotectors based on extracts from veins and cartilage of cattle, marine fish and shellfish contribute to the restoration of synovial cartilage and are therefore indispensable for 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, long-lasting effect - the first improvements occur after 1-3 months of admission, and the duration of the course is 3-6 months.
Skin irritants
External preparations for the treatment of arthrosis of the knee with a local irritating effect improve blood circulation and nutrition of the joint, and also distract the patient from the pain. For this purpose, ointments, gels, creams and balms are used based on natural ingredients - bee venom, hot pepper extract.
In the presence of an allergic reaction (prolonged redness and soreness of the skin, rash), during pregnancy and breastfeeding, as well as in the presence of other contraindications, it is better to avoid warming ointments for the treatment of arthrosis of the knee joint and limit yourselfto warm baths, applications and external anti-inflammatory agents.
Prostheses for synovial fluid
If there is too little synovial fluid in the joint, the gliding of the joint surfaces is impaired. 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. In order to prevent cell destruction and mechanical abrasion of the knee cartilage, the doctor can prescribe injections with high molecular weight hyaluronic derivatives. Injections of the drug in the treatment of arthrosis of the knee joint (viscosupplementation) are made directly into the joint capsule, which leads to rapid relief that lasts from 3 to 12 months after completing the course. However, with the introduction of prostheses, the risk of necrotic changes or infection in the joint remains.
Antispasmodics, analgesics, muscle relaxants
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, because they mask the pain, but do not relieve the inflammation. You can use them or available NSAIDs without a doctor's prescription for up to 10 days, after which an examination is required.
Drug release form for the treatment of osteoarthritis 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 a difference between them and which one should I choose?
Capsules, sachets 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, the reception is possible without the participation of a medical worker, it is easy to control 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 sachet).
Solutions for injections
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 arthrosis of the knee joint with drugs shows maximum bioavailability.
This method of treating arthrosis of the knee with drugs is safe for digestion, but it is desirable that the injections (venous, muscular in the joint area or intra-articular) are performed by qualified medical personnel. Intramuscular injections in the buttock or thigh can be done independently.
Products for external use
For the treatment of arthrosis of the knee joint, topically irritating, anti-inflammatory and chondroprotective ointments are applied externally. The advantage of this application of drugs is the direct effect on the affected tissue. But the skin barrier prevents the active substances - alas, often only 5% of the active ingredients reach the desired tissue layers.