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 lasts from several years to several decades. Knee osteoarthritis is one of the top 5 causes of disability and disability worldwide.
Osteoarthritis of the knee (gonarthrosis) affects more than 20% of people over 55 years of age, but the disease is rapidly growing younger - more and more often its symptoms appear at the age of 25.
Symptoms of knee osteoarthritis
Erosion of articular cartilage is accompanied by characteristic symptoms, the intensity of which depends on the stage of the disease.Patients often complain of:
- morning stiffness and reduced mobility in the joint (warming up is required after waking up);
- pain and discomfort in the knees, which increases after physical exertion (long walking, running or standing) and decreases with rest;
- In the 2nd stage - so-called. pain that begins after staying in one position for a long time;
- increased fatigue, often attributed to age-related changes;
- a dry rough crisis that regularly recurs when bending and opening the knees;
- edema and other inflammatory symptoms that appear in the 2nd stage of the disease as a result of periarticular tissue trauma;
- sensitivity to weather, increased symptoms in the cold season.
When trying to bend the knee affected by gonarthrosis to a stop, there is a sharp pain and a feeling of physical obstruction. In the later stages, even with the treatment of arthrosis of the knee joint, patients' gait is disturbed (begging, patients walk with stiff legs), deformation of the lower limbs appears in the form of the letters "O" or "X". ".
The insidiousness of the disease is that it can last for years in a latent form, and the first significant symptoms often appear only at the 2nd stage - when the synovial cartilage is no longer fully restored.
That's why it's important to see a doctor at the first sign of discomfort in the knees - such as weak, pulling pains that occur when there is insufficient production of synovial fluid. Remember: knee pain is not normal regardless of age. Timely examination and treatment of arthrosis of the knee joint of the 1st degree can completely protect you from unbearable pain in the joints in old age.
What happens if knee osteoarthritis is left untreated?
With self-medication, failure to follow doctor's recommendations or treatment, arthrosis of the knee joint progresses 3-8 times faster on average than with complex therapy. If gonarthrosis continues aggressively, the patient may lose the ability to move normally even before retirement age.
Effective treatment of arthrosis of the knees in the acute stage is especially important. It can be provoked by damp cold weather, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in short, 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 the cartilage also suffer - the cell membranes become thinner, erosion foci appear in the synovial lining of the joint. This process can continue for several weeks if not stopped by the treatment of knee arthrosis with drugs, and it can be permanent with chronic stress, lack of sleep or insufficient diet.
Finally, without treatment, osteoarthritis of the knee leads to a complete reduction of the lumen of the joint cavity due to the growth of osteophytes. The gap necessary for normal movement is closed, and the patient cannot bend the leg even 30-45 °. The difficulty is not only climbing the stairs, but also trying to get up from the couch 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, complete replacement of the articular architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients cannot 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 arthrosis of the knee joint of the 1st degree is always carried out by conservative methods - with a successful combination of conditions and good discipline of the patient, it is possible to cure the disease or achieve a stable remission.
The treatment of grade 2 arthrosis of the knee joint is usually based on the use of all methods of conservative treatment, but if the disease develops aggressively or with complications, the doctor may decide on minor surgical interventions on the joint.
Treatment of grade 3 knee osteoarthritis almost always involves surgery.
Complex conservative treatment of arthrosis of the knee joint involves the elimination of pain and inflammation, the restoration of cartilage tissue, and increasing the range of motion in the joint. For this, the patient is prescribed orthopedic load and rest regime, systemic and locally effective drugs (hormonal and non-hormonal anti-inflammatory drugs, analgesics, chondroprotectors, etc. ). Innovative biological methods are also gaining popularity - injections of drugs directly into the articular bag for the treatment of arthrosis of the knee joint. In this case, injections of PRP (platelet-rich plasma) are used, as well as injections of stem cells taken from the patient's own fat tissue. In parallel, auxiliary and rehabilitation methods are combined - physiotherapy, massage, manual therapy, therapeutic exercises.
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:
- Knee arthroscopy. The collective name of a group of minimally invasive operations aimed at removing the broken part of the articular tissue or osteophyte or partial cutting of the joint membrane. This allows to delay or exclude prostheses, as well as to eliminate discomfort in the early stages of the disease. It is mainly used for the treatment of knee arthrosis in patients under 60 years of age.
- Osteotomy. Surgery to cut part of the bone and correct the axis of load in the affected knee, allowing to slow down the degenerative changes. It is usually performed in the treatment of arthrosis of the knee joint of the 2nd degree.
- Endoprostheses. Partial or complete replacement of the knee joint with a titanium implant lasting 15-20 years. This technique is a last resort because it carries certain risks. It is 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 are used to reduce body weight. Bandages and other orthoses (walking sticks, 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 exercise for the limbs of the lower girdle is 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. Durability in the treatment of knee arthrosis is one of the main factors affecting the effectiveness of exercise therapy. A full-fledged class is held 1 time per day, and it is also recommended to do at least 3-4 exercises 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 lower leg, to maintain the flexibility of ligaments and tendons, and also to fight muscle atrophy, which is characteristic of arthrosis. This allows you to transfer the load from the joint to the periarticular structures - thereby slowing down the mechanical wear of the cartilage, reducing inflammation.
Exercises for the treatment of knee arthrosis are performed for both legs! If there is sharp pain, the session should be stopped or continued at a gentler pace.
- Starting position - lying on the back. One leg is extended to the floor, the other is raised bent at 90 ° (the lower leg is parallel to the floor). We make up and down movements with the lower leg as far as the range of motion in the joint allows.
- Starting position - lying on the back. Let's do the cycling exercise.
- Starting position - lying on the stomach. We alternately swing our legs, trying to bring the heels as close to the hips as possible.
- Starting position - when lying on the side, the arm is bent under the head or stretched over the head in line with the body. The other hand rests on the side. We go up with straight legs. We change sides.
- Starting position - lying on the back. We move the feet along the floor with the heel forward (away from you), the socks are facing "themselves".
- Starting position - lying on the stomach. We do the "Ship" exercise. If physical training does not allow, we place our palms on both sides of the chest and alternately pull our legs back, experiencing tension on the back of the thigh and lower leg.
- Starting position - lying on the back. We rotate the legs alternately, trying to describe a complete circle with socks.
- Starting position - standing against the wall. We squat slowly and smoothly without lifting our backs from the wall to distribute the load. When the legs are bent at the knees 90 °, we start a smooth upward movement.
- Starting position - standing. Alternately, we swing our legs forward, backward and sideways.
Please note: therapeutic exercises after surgery on the joint have their own characteristics and vary depending on how many days have passed since the operation. It is prescribed by a doctor - a surgeon or a rehabilitation specialist.
Massage for knee arthrosis
Therapeutic massage for knee arthrosis is performed on both legs. Initially, at least 10-12 sessions are usually required with the help of a masseur-rehabilitator or hydromassage equipment, but a simple restorative massage can be done at home. It includes the following types of actions:
- surface stroke and rub (up and down, clockwise and counterclockwise);
- fingertip probing and stretching of deeper tissues;
- pinching and tapping on the skin.
Self-massage can be combined with the treatment of arthrosis of the knee joint with drugs: it will not be superfluous to apply warming ointment or balm before or during the session. You can take a warm bath before the procedure.
Important: massage is contraindicated in patients with inflammatory symptoms (osteoarthritis or arthrosis exacerbation). In this case, acute phase therapy is required.
Diet therapy for arthritis
A standard nutritional protocol for treating osteoarthritis of the knee requires:
- limit foods and meals rich in simple carbohydrates (white bread, confectionery, snacks, sweets, potatoes, sugar);
- exclude processed (ready-to-eat) and salt-rich foods - fast food, semi-finished products, sausages;
- Avoid alcohol, decaffeinated coffee and fatty meats.
Instead, enter the menu:
- foods from sprouted and whole grains;
- fatty fish of the northern seas and dietary poultry;
- cartilage (ears, nyushki, legs and other parts of farm animals rich in collagen), aspics 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.
It is also recommended to treat arthrosis of the knee joint with drugs - vitamin-mineral complexes (2 courses per year).
Physiotherapy for the treatment of osteoarthritis of the knee
The following physiotherapy procedures are used to effectively treat arthrosis of the knees and increase the effect of drugs:
- magnetotherapy;
- laser therapy;
- UHF;
- ultrasound therapy;
- amplipulse;
- electrophoresis (including medication - with analgin, novocaine or chymotrypsin);
- ozokerite and paraffin applications;
- thermotherapy (cryotherapy, inductothermy);
- phonophoresis (especially with hydrocortisone);
- balneological therapy (sulfur, hydrogen sulfide baths).
As a rule, acupuncture is not used in the treatment of arthrosis of the knee joint of the 2nd degree.
Before visiting the procedures, you should consult your doctor - in case of exacerbation of the disease, many types of physiotherapy are contraindicated.
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 - injection, ointment or tablets for the treatment of knee arthrosis - is usually prescribed in courses or as needed.
There are several directions in the treatment of arthrosis of the knee joint with drugs: to make the patient's life easier, to improve cartilage nutrition, to restore cartilage tissue and to maintain a normal musculoskeletal system.
Non-steroidal anti-inflammatory drugs
To eliminate 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, violating the doctor's instructions or recommendations, is fraught with stomach or intestinal ulcers. They should be taken with extreme caution along with glucocorticosteroids and drugs that affect blood clotting. Additional risk factors are over 65 years of age, smoking, drinking alcohol during the course. In these cases, doctors usually recommend injecting drugs through the gastrointestinal tract. It is desirable to take gastroprotectors together with NSAIDs.
The maximum effect can be achieved by a combination of systemic NSAIDs (for internal use) and external ones - 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 drugs (HA) are usually used orally. Steroid blockade of the knee when NSAIDs are insufficient to relieve pain and inflammation.
Glucocorticoid injections are considered the last resort in the treatment of arthrosis of the knee joint with drugs. They provide relief within 20 minutes of application, but can cause hormonal imbalances and cartilage damage if not taken properly. 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
Chondroprotective substances based on extracts from veins and cartilages of cattle, marine fish and shellfish contribute to the regeneration of synovial cartilages and are therefore indispensable for the 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, and enrich the synovial fluid.
Unlike anti-inflammatory drugs, chondroprotectors have practically no contraindications. They have a cumulative, long-term effect - the first improvements occur 1-3 months after admission, and the duration of the course is 3-6 months.
Skin irritants
External preparations for the treatment of knee arthrosis with a local irritant effect improve blood circulation and nutrition of the joint, and also distract the patient from pain. Ointments, gels, creams and balms based on natural substances - bee venom, hot pepper extract are used for this purpose.
It is better to avoid warming ointments for the treatment of arthrosis of the knee joint in case of an allergic reaction (persistent redness and pain of the skin, rashes), during pregnancy and lactation, as well as in the presence of other contraindications. and limit yourself to hot baths, applications, and external anti-inflammatories.
Synovial fluid prostheses
If there is too little synovial fluid in the joint, the sliding of the articular surfaces is disturbed. Most importantly, the cartilage begins to starve, because the synovial fluid that nourishes it like a sponge normally provides nutrients for the growth and maintenance of cartilage tissue. To prevent the destruction of cells and mechanical wear of the knee cartilage, the doctor can prescribe injections of high molecular weight hyaluronic derivatives. In the treatment of arthrosis of the knee joint, injections of the drug (viscosupplementation) are made directly into the joint capsule, which causes rapid relief lasting from 3 to 12 months after the end of the course. However, the risk of joint necrotic changes or infection remains with the application of prostheses.
Antispasmodics, analgesics, muscle relaxants
In cases where spasms and muscle tension prevent the patient from falling asleep, causing 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 pain, but do not eliminate inflammation. You can use them or existing NSAIDs without a doctor's prescription for up to 10 days, after which an examination is required.
Release form of drugs for the treatment of arthrosis of the knee joint
For the convenience of patients, drugs for the treatment of arthrosis of the knee joint are produced in various forms. Is there a difference between them and which one should I choose?
Capsules, packs and tablets for the treatment of knee arthrosis
Nonsteroidal anti-inflammatory drugs, corticosteroids, chondroprotectors, and muscle relaxants are available orally. In this case, their dosage is easy, reception is possible without the presence of a medical professional, 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 package).
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 knee arthrosis with drugs is safe for digestion, but it is desirable that the injections (intravenous, intramuscular, into the joint area or intra-articular) be carried out by qualified medical personnel. Intramuscular injections of the hip or thigh can be done independently.
Products for external use
Local irritant, anti-inflammatory and chondroprotective ointments are applied externally for the treatment of arthrosis of the knee joint. The advantage of this administration of drugs is the direct effect on the affected tissue. But the skin barrier prevents the active ingredients - unfortunately, often only 5% of the active ingredients reach the desired tissue layers.