Any types of arthrosis occur with degenerative and dystrophic processes in the articular tissue. The disease always acquires a chronic nature and is not completely cured, you can only slow down or stop its progress.
According to ICD-10, gonarthrosis (damage to the knee joints) belongs to the group under the code "M17". The emphasis in treatment is on drug therapy, surgical intervention is used only when the course is advanced.
What happens to the knee joint with arthrosis?
Arthrosis of the knee joint is accompanied by degenerative and dystrophic processes, which, if untreated, progress steadily. In this case, inflammatory processes are not observed, with the exception of rare cases.
Degeneration and dystrophy of the joint at first has practically no effect on the functionality of the knee. Over time, these processes lead to a violation of the structure of the joint, it stops "sliding", bumps appear on its surface (due to deformative changes).
Blood circulation decreases, local metabolism (metabolic processes) worsens, which only increases the rate of progression of the disease. The process of degeneration of the hyaline cartilage begins very quickly, its thinning, exfoliation, and later the appearance of cracks on it.
The end result of the disease is the complete destruction (destruction) of the hyaline cartilage with exposure of the adjacent bone. But the problem does not end there: due to the exposure of the bone, the latter begins to thicken and bone growths appear on it (often in the form of thorns).
All this also leads to deformation of the affected limb, followed by its curvature. It is for this reason that the disease is also called "deforming arthrosis". With an already existing deformity of the limb, the disease cannot be cured without surgery.
The reasons for the development of the disease
Most often, the development of knee arthrosis is preceded by the emergence of several predisposing factors. It is not at all necessary to have congenital risk factors, the disease very often develops with acquired factors (trauma, infection, inflammation).
Main reasons:
- Severe disorders of metabolic / metabolic processes in the body (any acute or chronic severe diseases of the thyroid gland, adrenal glands).
- Circulatory disorders and the presence of a tendency to capillary bleeding (due to their fragility).
- Overweight (obesity stage II-III) with a serious increase in the load on the musculoskeletal system as a whole.
- Injury of the knee joints (including direct injuries, penetrating wounds, ruptures of the ligamentous apparatus, injuries of the menisci, fractures, dislocations and subluxations, cracks).
- Inflammatory pathologies suffered in the recent past (primarily arthritis or rheumatism).
- Excessive physical activity (the risk group includes athletes, gymnasts, people playing tennis, football, basketball).
- The aftermath of a long-standing, poorly treated knee injury.
- Congenital defects and anomalies in the structure of articular tissues, hereditary risk factors (genetic mutations).
There is a direct connection between the cause and the severity of arthrosis. If metabolic disorders or severe injuries are the cause, the prognosis is worse than in the case of arthrosis development against the background of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, arthrosis of the knee joint is very common; it occupies one of the leading places among all forms of arthrosis in general. Approximately 20% of patients who apply to specialized medical institutions suffer from gonarthrosis.
If we consider all diseases of the knee joints, then among them the share of arthrosis falls on about 53% of cases. Recently, there has been an increase in the number of cases of gonarthrosis among the population, especially in developed countries.
This is connected with an increase in average life expectancy (the older a person is, the greater the risk of this form of arthrosis), and with the predominance of a sedentary lifestyle. And this is really a problem, since doctors are still not able to completely cure gonarthrosis.
Why is gonarthrosis dangerous?
The main danger of gonarthrosis is disability due to the development of complications that are not amenable to conservative therapy. First of all, this is deformation of the joint and bone of the affected limb. Disability is possible already at the third stage of the disease.
The second danger is the development of chronic severe pain, which can disturb the patient so much that he will not be able to sleep normally. Constant awakening due to knee pain is one of the most common problems of stage 3-4 of gonarthrosis.
Lethal consequences precisely because of gonarthrosis do not arise. In theory, a serious injury could occur due to a sudden joint jamming. This is the so-called symptom of joint blockade, most often observed at 3-4 stages of the disease.
The degree of gonarthrosis and the difference between them
The disease is divided into four stages, which differ in the severity of the course, the severity and number of symptoms, and the final prognosis. Also, each stage of arthrosis is treated in a special way (although the differences in treatment regimens may seem small to a non-physician).
The degree of gonarthrosis:
- first degree: the disease practically does not manifest itself in any way, only slight discomfort is possible, but in general the patient feels well and therefore it is very problematic to diagnose the disease at the first stage;
- second degree: pronounced painful sensations appear, especially after a long walk or standing; a characteristic crunch develops during physical activity, the process of atrophy of the quadriceps femoral muscle may already begin;
- third degree: pains become excruciating, constantly bother the patient, pronounced deformative changes in the joint appear, it becomes hot to the touch, normal walking or even more running is impossible;
- fourth degree: it is very difficult with severe deformities of the joint and constant pain that does not even allow the patient to sleep; joint dysfunctions are so pronounced that ankylosis is possible (complete immobilization of the affected joint).
The first two degrees of gonarthrosis are considered conditionally favorable, since they practically do not interfere with a person's normal life. The last two stages are very severe and lead to disability.
Symptoms of gonarthrosis at different stages
The clinical picture of gonarthrosis depends on the stage of the disease. At the first stage, there may be no symptoms, while at the fourth stage they are very pronounced and do not cease to bother the patient even under powerful drug therapy.
Stage 1 symptoms:
- Slight discomfort or pain with severe stress on the joint.
- Barely noticeable crunch.
- Subtle increase in the size of the joint.
Stage 2 symptoms:
- pain of moderate intensity, usually occurring with a period of exacerbations and remissions;
- the joint becomes warm to the touch;
- redness of the skin over the affected joint is possible;
- moderate knee dysfunctions (walking and running is still possible, but with some difficulty);
- increased pain in the morning and after a long stay in a standing position.
Stage 3 symptoms:
- severe pains that bother the patient around the clock, but during periods of exacerbation (triggers for exacerbation each patient has their own), the pain intensifies several times;
- visible deformative changes in the knee, its increase in size;
- the affected joint becomes hot on palpation;
- normal movement is impossible due to partial immobilization of the joint;
- possibly curvature of the lower leg.
Stage 4 symptoms:
- pains become excruciating, do not allow the patient to do everyday things (including intellectual ones, since pain impairs cognitive functions);
- the appearance of synovitis due to the accumulation of effusion in the cavity of the knee cartilage;
- now deformative changes are already clearly visible not only in the joint, but also in the limb as a whole;
- a feeling of fluctuation on palpation of the patella and surrounding tissues;
- almost complete or even complete immobilization of the knee joint (in this case, only surgery will help to restore the functionality of the limb).
If it is not possible to eliminate or significantly reduce pain at 3-4 stages of arthrosis, doctors resort to analgesic blockades, but blockages cannot be done daily.
Diagnostics
The emphasis in the diagnosis of knee arthrosis is on imaging techniques, while laboratory tests usually show nothing.
Diagnostic methods used:
- Examination by an orthopedist with palpation of the affected joint, linear measurements of bones, angiometry.
- Clinical blood tests (total and erythrocyte sedimentation / ESR), determination in blood and urine of the level of fibrinogen and, above all, urea, as well as other biochemical parameters.
- Radiography (narrowing of the joint space, deformities, cartilage sclerosis, accumulation of salts, and even bone osteophytes are revealed).
- Ultrasound examination (for differential diagnosis only).
- Magnetic resonance imaging or computed tomography (the most informative, in terms of imaging, diagnostic methods).
Usually, an X-ray is enough to make a diagnosis, especially if the disease is in an advanced stage. In relatively rare cases, computed or magnetic resonance imaging is required.
Treatment of gonarthrosis: methods
Treatment of knee arthrosis is only complex, since no method of treatment is isolated from others with a good effect (even medications). The treatment is long, it can last for years, sometimes it is even prescribed for the rest of your life.
Treatment methods used:
- drug therapy - the basis of treatment;
- physiotherapy exercises;
- diet therapy;
- physiotherapy treatment;
- surgical intervention.
The main thing in the treatment of arthrosis is the systematic nature of the process and unquestioning adherence to the recommendations of the attending physician. Attempts to independently treat gonarthrosis, including ignoring the doctor's prescription, usually end in disability.
Exercise therapy
Physiotherapy exercises are best suited for the treatment of 1-2 stages of arthrosis of the knee joints. At such stages, this is almost the main method of treatment, since physical education can slow down the progression of the disease and eliminate most of the symptoms.
However, there is no special sense from classical physical education, it can also be harmful. Therefore, the patient is prescribed special exercises, and individually (since gonarthrosis can proceed differently in individual patients).
There is no timeframe for treatment with exercise therapy methods - ideally, you need to engage in the prescribed exercises for life, from time to time visiting a doctor for dynamic monitoring of the joint. It is very useful to combine exercise therapy with exercises in the pool (there the load on the joints is much less).
Diet
Although nutritional correction can be very helpful, it is not a mandatory treatment method. Only in 40% of cases, diet therapy gives noticeable results, and usually in those people in whom the onset of arthrosis was provoked by endocrine pathologies.
The patient is instructed to give up fatty, fried, salty and smoked foods. A ban is introduced on the use of alcoholic beverages, and sometimes tobacco smoking is also prohibited. At the same time, the consumption of large quantities of vegetables, fruits and meat products is prescribed.
In this case, sausages, sausages or wieners cannot be called meat products. The patient is instructed to consume lean meats, boiled chicken is especially useful (due to the relatively low calorie content and high protein content).
Physiotherapy
Physiotherapy procedures are useful only in terms of relieving the symptoms of arthrosis, but they do not directly affect the disease. That is, it is impossible to cure even the first stage of arthrosis with the help of physiotherapy, no matter what some "specialists" say there.
Physiotherapy is good for relieving pain, but only if it is mild. With severe pain (stage 3-4 of arthrosis), physiotherapy will not help, as well as most medications (especially for oral use).
The most preferred for the treatment of arthrosis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Shock physical therapy techniques are prohibited due to the threat of additional joint damage.
Operation
Surgical intervention is required only at 3-4 stages of the disease, when conservative methods are no longer necessary. Different types of procedures can be used: drainage of the articular cavity, removal of bone osteophytes, replacement (prosthetics) of the joint.
To restore the functionality of the joint, its transplant is best, but the problem is that it is a very expensive procedure. As a result, only 10-15% of patients can afford such an operation. But even with the required amount of money, it is not always possible to replace the joint.
The fact is that such a procedure is contraindicated in patients in serious condition, or in patients who are over 65-70 years old. Keep in mind that any knee surgery has its own risks of complications (even lethal complications are possible, but they are very rare).
Medication
Along with physiotherapy exercises are the basis of treatment and its mandatory component. If other procedures can still not be used, then it is impossible to do without drug therapy in conjunction with exercise therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed pain relievers (with severe pain - blockade), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, injections of hyaluronic acid (replacing the physiological lubrication of the joints) are possible.
Medications can really affect the disease only at stages 1-2 of arthrosis. At 3-4 stages of the disease, drug therapy plays only the role of a way to deal with symptoms, while nothing but an operation can affect the disease.
The nuances of treatment in the stage of exacerbation and in remission
The approaches to the treatment of knee arthrosis during exacerbation and remission are somewhat different. In the exacerbation stage, aggressive therapy is used, aimed at the fastest possible restoration of joint function and elimination of symptoms.
Pain reaches its peak precisely in the stage of exacerbation of the disease, therefore, in such cases, drug blockades can be prescribed.
Non-steroidal anti-inflammatory drugs may be prescribed. Despite the fact that arthrosis usually proceeds without inflammation, it can occur in the acute stage. The patient is prescribed bed rest, minimal stress on the affected joint and avoidance of overheating of the limb.
On the contrary, in the stage of remission, physical exercise is prescribed and, in general, an increase in physical activity is generally prescribed. The reason is that it is in the remission stage that normal walking is possible, since the function of the joint improves, and the pain is usually of moderate intensity.
It is necessary to use remission skillfully - this is the very period when classes in the pools, classes with a rehabilitation therapist and attempts to restore the functionality of the joint are possible. You cannot do without medication at this stage.
Most often, chondroprotectors, oral pain relievers are prescribed (at the discretion of the patient, since if the pain is barely noticeable, there is no need to take them). Ointments, gels and creams can be prescribed, including those with a warming effect (which is better not to use during an exacerbation).
Additionally, massage can be prescribed, including manual therapy (only if the disease is at 1-2 stages). With the permission of the doctor, special gymnastic techniques can be used.
Remission is the ideal time for physiotherapy, but the choice of specific physiotherapy should be handled by the physician, not the patient. In the end, if necessary, during remission, injections of hyaluronic acid preparations can be given.
With an exacerbation of arthrosis, hyaluronic acid is not prescribed, since against the background of inflammation, such injections will lead to serious consequences. Please note: injections should only be given by a suitably qualified person.
Ordinary doctors, and even more so mid-level medical personnel (paramedics, nurses), are not allowed to perform such injections. Independent injections into the joint are fraught not only with disability, but also with death (due to the threat of anaphylactic shock or a blood clot if the needle accidentally enters the vessel).
Treatment prognosis
The prognosis for the treatment of gonarthrosis differs depending on the stage of the disease and the general health of the patient. If this is stage 1-2 and treatment is started immediately, the prognosis is very good, especially in people of working age.
With arthrosis stage 3-4, the prognosis is extremely poor, both in young patients and in elderly people. Although it has been noticed that young people tolerate arthrosis much easier at such stages, it still inevitably leads to disability.
However, having arthrosis stage 3-4 is not tantamount to a sentence. In fact, with the help of surgical intervention, you can try to restore, if not all the functionality of the knee, then most of it. Implantation of an artificial joint can give an excellent result.
Prevention of arthrosis of the knee joint
Arthrosis is a group of diseases that can be completely prevented by following fairly simple preventive measures. Of course, such measures do not guarantee 100% protection, but they can reduce the risks of the disease (especially in people at risk).
Preventive measures:
- It is necessary to avoid unnecessary stress on the joints (such loads include professional sports).
- Rational nutrition, with a predominance of fruits and vegetables in the daily diet.
- Maintaining good physical shape, regular gymnastics.
- Prevention or elimination of obesity (more body mass - more stress on the joints in the body).
- Preventive treatment with chondroprotectors after reaching 45 years of age (only after consulting a doctor).
- Adequate daily fluid intake (about 1. 5 liters of water per day), minimizing salt intake.
The main thing is not to overdo it with physical activity, since it is useful only in moderation (if there is no wear of the musculoskeletal system). Physical education is useful, sports are not, especially for the joints and the cardiovascular system.