Osteoarthritis of the knee

15 September 2020

Osteoarthritis of the knee joint, also called gonarthrosis, can significantly impair a person's quality of life. During the development of the disease, there is a gradual loss of hyaline cartilage in the joint. Gradually the cartilage loses density and height. Its razvlecheniya and thinning is noticed, and in due course completely disappears. Accordingly, there is no soft protective base in the bone, which leads to an increased load on the end plate of the innervated articular surface of the bone. As a result of this load, pain develops. The code for osteoarthritis of the knee according to ICD-10 is M17.

The knee joint is affected quite often, because the knee is the one that has a significant load during walking, physical effort and running. In this case, uncomfortable movements can lead to soft tissue injuries of the knee and cause osteoarthritis. Therefore, gonarthrosis is one of the main causes of disability. According to statistics, this disease affects about 20% of people on the planet to varying degrees.

Why osteoarthritis develops, how to prevent the development of this disease, what doctor treats osteoarthritis of the knee and what methods of treatment a doctor can recommend after diagnosis, will be discussed in this article.

Pathogenesis

The disease develops against the background of a mismatch between the load on the joint and its ability to withstand it. In this case, the properties of cartilage can be determined genetically or changed due to the influence of acquired factors - both exogenous and endogenous. The development and progression of gonarthrosis can occur with age, in the background of obesity, due to dysplasia of the femoral-patellar joint or changes in the axis of the lower extremity, disorders of joint biomechanics, damage to the meniscus and ligaments.

The basis of pathogenesis is the predominance of catabolic over anabolic processes, which has been recorded in cartilaginous and subchondral bones, menisci and synovium. As a result, structural changes occur and the biological properties of cartilage are lost. Further, the pathological process spreads to the muscles and ligaments.

The basis of articular cartilage is the connective tissue matrix and chondrocytes. The connective tissue matrix contains molecules of collagen and type II aggregates. The properties of cartilage cushioning are provided by the connective tissue matrix.

The inflammatory process in arthrosis is not as intense as in arthritis. However, proinflammatory mediators are also present in osteoarthritis.

Classification

According to the origin of gonarthrosis, the following types are distinguished:

Primary (idiopathic)- develops without any external causes.
Secondary- certain factors lead to the development of the disease. They are most often associated with injuries, fractures, surgical interventions on the joint, as well as inflammatory factors - acute and chronic arthritis.

The following degrees of knee osteoarthritis are also identified:

Grade 1 osteoarthritis- is determined in the period from the appearance of the first signs of the disease to the development of bone deformities visible on X-ray or during the examination. During this period, pains of varying intensity appear during movement.
In stage 2- unpleasant sensations are noticed at the slightest effort. When walking and squatting the knee crunches, the mobility of the joint decreases. The picture shows the growth of bone tissue along the edges of the joint, as well as the narrowing of the joint space. On external examination, it may be noticed that the knee is enlarged.
At grade 3there is virtually no cartilage tissue inside the joint. If the development of the disease progresses, the bones can grow together, which causes complete immobility of the leg. Sleep is disturbed, it becomes impossible to move without a cane or crutch.

The following types of this disease are also distinguished:

Patelofemoral osteoarthritis of the knee- a condition in which degenerative changes in the posterior part of the patella or patella have been recorded. With this form of the disease, the pain is primarily disturbed when descending a ladder or from a mountain. Patelofemoral osteoarthritis can develop in runners. The disease is often diagnosed in young people.
Post-traumatic osteoarthritis of the knee joint- consequence of injury. The post-traumatic type of disease may not appear at first. But later, the person loses full motor activity of the joint.

Causes of osteoarthritis of the knee joint

Today, work is still being done to study the reasons that lead to the development of such pathology.

Currently, the causes of gonarthrosis are related to the influence of the following factors:

Age - at a certain age, a person begins to have degenerative changes in the tissues, and the ability of cartilage tissue to regenerate decreases.
Arthritis - Over time, arthritis can lead to the development of osteoarthritis.
Delayed injuries and overloads - in addition to injuries, the development of the disease can cause the need for frequent kneeling, squatting, lifting weights.
Obesity and overweight - overweight causes increased strain on the ankles. In addition, the substances that cause its damage enter the blood from the pathological fatty tissue, and later into the joint.
Heredity - in some cases the development of the disease is determined by a defective gene responsible for the growth of cartilage tissue. As a consequence, this tissue may have low resistance to damage. If close relatives had arthrosis, this increases its probability.
Diseases leading to metabolic disorders - the risk of this pathology increases with atherosclerosis, diabetes mellitus.
Hormonal disorders - women get sick more often after the age of 55.
Sports - People who play certain sports are more likely to develop the disease. This is typical for runners, as well as football players, tennis players and basketball players.

Symptoms of knee osteoarthritis

Symptoms of osteoarthritis of the knee usually develop slowly, because the process of its development takes years. If multiple joints are affected, symptoms of polyarthrosis develop.

Manifestations of the disease depend on severity, age and a number of other factors.

However, the main symptoms of gonarthrosis are as follows:

Pain in the knee joint, intensified by activity. During rest, the knee hurts less.
Swelling in the knee area.
Feeling of warmth in the joint.
Unpleasant feelings of stiffness in the joint that occur after a person has been in a static position for a long time.
Reduced range of motion of the knee joint, which makes it difficult for a person to get up from a chair, get off the stairs or get out of the car.
Crunching and cracking in the knee, most commonly seen with sudden joint movements.
Weather changes are believed to affect the degree of pain and discomfort.

Analyzes and diagnostics

To determine if such a disease can be cured, the diagnosis must be confirmed initially. In the process of diagnosis, the doctor examines and interviews the patient. But the most informative study in this case is a knee x-ray.

Also, to clarify the diagnosis, it is advisable to undergo an ultrasound scan during which the arthritis can be ruled out and the height of the articular cartilage measured.

If necessary, schedule additional checkups.

Treatment of knee osteoarthritis

In order to treat this disease as effectively as possible, it is initially necessary to confirm the diagnosis and choose the correct scheme of complex therapy. Treatment of osteoarthritis of the knee joint at home is possible if the patient carefully follows all the recommendations of experts, practicing both medications and additional methods of treatment. Only in this case, home therapy can be effective.

Drug treatment and other therapies for this disease are used, depending on the degree of damage. The simplest treatment is 1st degree knee arthrosis. In the case of first-degree disease, a complex therapeutic scheme is used, which allows you to achieve the effect in the shortest possible time. Therefore, if a person is diagnosed with grade 1 osteoarthritis, the disease should be treated immediately.

Regarding the treatment of 2nd degree knee arthrosis, the doctor makes a decision based on the patient's condition. Since changes in cartilage tissue begin at this stage, treatment must be performed immediately.

Whether it is possible to cure grade 3 knee osteoarthritis depends on many factors. In stage 3, the cartilage becomes thinner, so treatment at this stage is long-lasting and least effective.

Medications

Medical treatment of knee osteoarthritis is aimed at providing analgesic and anti-inflammatory effect. It is also important to reduce the severity of cartilage damage.

The following medications are used for this purpose:

Nonsteroidal anti-inflammatory drugs - both tablets and topical drugs are used - ointments, gels. The most efficient local and systemic application of such funds.
Chondroprotectors for osteoarthritis of the knee joint - chondroprotectors from the group of glucosaminoglycans (hyaluronic acid), chondroitin sulfates and others are used. Such drugs for osteoarthritis of the knee joint are prescribed as part of a complex treatment. The price of a chondroprotector depends on the drug and varies significantly.
For severe illnesses, medications include steroids. Injections for osteoarthritis of the knee joint can be given intramuscularly, as well as external agents with steroids.
External agents with skin irritants. You can also find irritating compresses in the description of folk remedies.
During treatment, your doctor may prescribe injections into your knee. Various medications can be used for injections into the knee joint from osteoarthritis. Corticosteroids are specifically injected to relieve severe inflammation. Injection reviews show that steroids in this form work the fastest and most effectively. Knee block can be performed not only with glucocorticosteroids but also with anesthetics. Blockade reviews show that this method effectively relieves even severe pain. Also, an injection into the knee can be performed during treatment with chondroprotectors. Improves metabolic processes, activates collagen production. But in order to achieve the effect, it is necessary to perform at least five injections. Also, hyaluronic acid is injected intraarticularly, which improves the quality of intraarticular fluid and provides effective protection of cartilage tissue. Vitamins can also be given intra-articularly.
Plasmolifting method - its essence consists in the introduction of platelet-rich blood plasma into the affected knee.
Medical bile for osteoarthritis of the knee - used for dressings. It should be noted that medical bile can be an effective remedy only if its use is prescribed by a doctor according to a certain scheme. Therefore, the option of “treating at home” without consulting a doctor is unacceptable in this case.

Procedures and Operations

For arthrosis and polyarthrosis, non-medical methods of treatment are also used, the use of which is no less effective.

Physiotherapy. Various techniques are used, including the method of shock wave therapy, myostimulation, phonophoresis, ozone therapy, kinesitherapy and others. Physiotherapy can reduce pain, relieve inflammation. Any physiotherapy prescribed by a doctor should be performed exactly in the complex that the doctor advised.

Laser therapy- produces decongestant, analgesic, anti-inflammatory effects.

Ozone therapy- relieves pain, produces anti-inflammatory effect, which allows to reduce the amount of hormonal agents used.

Knee arthrosis pads- wearing such devices reduces the severity of pain. In addition, the knee brace protects it from instability. But to achieve the desired effect, you need to choose the right knee pads or knee brace. There are many general tips on how to choose knee pads for osteoarthritis. In addition, many different models of such knee pads are offered - with restrictions on movement, amplifiers and the like. But still, those who want to buy knee protectors for osteoarthritis, it is advisable not to rely on user reviews, but on the recommendations of doctors. The price of an orthopedic knee pillow depends on different characteristics - material, quality. Knee pads are especially important if a patient develops post-traumatic osteoarthritis. But patellofemoral arthrosis, as well as other types of diseases, can be treated with this method.

Therapeutic gymnastics for knee osteoarthritisis an effective method that allows you to improve the condition and prevent surgery, provided that the person regularly and persistently performs exercise therapy for osteoarthritis of the knee. Physiotherapy exercises help strengthen the leg muscles and stop the development of the pathological process. However, a set of exercises for osteoarthritis of the knee joint must be performed in a certain sequence, and such gymnastics is chosen individually. Therefore, it is best that the basis for teaching is not video gymnastics, but a set of exercises developed by a doctor. In this case, it is not only the filling that is important, but the full-fledged exercise therapy.

Different types of exercise can be practiced with similar pathology.

Special gymnastics.Such exercises are recommended both during treatment and for prevention in people older than 40 years. Knee exercises should be done every day. These exercises are also suitable for older adults because they can be done at a leisurely pace.

Massage and manual therapy- suitable for patients with limited mobility, can be combined with exercise. In the absence of the opportunity to visit a massage therapist, self-massage can be performed according to the scheme that will be shown by a specialist.

Yoga, acupuncture, joint stretching, special exercises on simulators (exercise bike and others) can be practiced as additional methods for improving the patient's condition and active rehabilitation.

If conservative methods prove ineffective, surgical treatment is performed.

The following techniques can be used:

Puncture- Removing excess fluid in the joint can reduce the symptoms of inflammation and restore mobility.
Arthroscopy- can be performed using endoscopy. This technique cleans the joint surfaces of fragments of destroyed cartilage tissue.
Periarticular osteotomy- during such an intervention one of the bones that make up the knee joint is sawn and reattached at a different angle. As a result, the intensity of the pain decreases and the mobility of the knee increases. The intervention is effective in the first and second degree of the disease.
Endoprosthetics- replacement of the knee joint with a special biocompatible construction. This is a very complex intervention that is performed with the third degree of the disease.

Treatment of osteoarthritis of the knee joint with folk remedies

Numerous reviews on the treatment of folk remedies for this disease confirm that such methods can be used as an aid, alleviating the patient's condition. However, such methods should not replace the main treatment. Folk remedies are used for rubbing, compresses, baths, swallowing. Any thematic forum contains a lot of advice on this issue.

Rubbing with garlic. A few cloves of garlic should be peeled and chopped. Mix the resulting porridge with 200 ml of vegetable oil and insist in a dark place for a week. Apply to the knee overnight with a film and a warm cloth on top.
Mustard Milling. To prepare the medicine, take 50 g of camphor and mustard powder, 500 ml of vodka, the protein of one egg. Everything is mixed and stored in a jar in a dark place for a week. Next, the product must be rubbed into the knee three times a day.
Elecampane Grind. Pour 50 g of elecampane root with 125 ml of vodka and insist on it for two weeks. Rub twice a day.
Velcro wraps. Burdock is a popular folk remedy for treating osteoarthritis. A few leaves of burdock should be folded with a fleece side and lubricated with vegetable oil. Attach them to the knee and cover with cellophane and a warm cloth on top. You can also lubricate burdock leaves with vodka. The dressing is applied at night. Similarly, horseradish leaf treatment is performed.
Cabbage Leaf. It is also applied to the sore spot at night. It is pre-lubricated with honey, cologne or vodka.
Honey wrap. It is necessary to mix equal parts of honey, ammonia (10%), glycerin and medicinal bile, add a few drops of iodine. Store the mixture in a dark place for 10 days. Warm up before applying the dressing.
Onion Decoction. It is taken internally. To prepare the soup, you need to take two large onions, slice them and pour with 1 liter of water. Cook until the onions are soft. Take a decoction of 100 ml three times a day.
Celery juice. Grind celery stalks in a blender, squeeze the juice. Drink 100 ml of juice three times a day.
Gelatin. In osteoarthritis, it is recommended to consume food that contains gelatin. It is recommended to include jellies, jellies and other dishes with gelatin on the menu.
Bath with pine needles. Pour 1 kg of pine needles with boiling water and leave for a few hours. Add to a warm bath in which you can dissolve and 0, 5 kg of salt. Bathe for 20-30 minutes.

Prevention

In order to prevent the development of osteoarthritis of the knee joint, the following preventive measures must be observed:

Eat right and incorporate a variety of foods that contain vitamins and minerals into your diet.
Avoid excessive strain on the knee joint, protect it from injury.
Stop bad habits.
Track weight, prevent obesity.
Treat all diseases in a timely manner, undergo preventive examinations.
Do sports, preferring gentle physical activity.
Wear the highest quality footwear as comfortable as possible.
Ensure proper posture.

Diet for osteoarthritis of the knee

Efficacy: healing effect
Conditions: permanent

Diet is very important during treatment and rehabilitation. First of all, food should be healthy and light - it is important to prevent excessive weight gain, which can worsen the condition and cause acute osteoarthritis. But the acute course of the disease requires not only treatment, but also weight loss.

It is also important to include in your diet foods that contain components important for cartilage tissue:

Poultry, rabbit.
Sea fish.
Soy products.
Eggs.
Greens, zucchini, carrots, pumpkins.
Nuts.
Fruit, berry fruit.
Vegetable oils.
Dishes with gelatin.

At the same time, you must limit the consumption of such products:

Beans, sorrel, spinach, tomatoes.
Flour dishes.
Animal fat.
Spices, vinegar.
Alcohol.
Red meat

It should be eaten often, in small meals. You should also drink about 2 liters of fluid a day.

Consequences and complications

If treatment is not given immediately, osteoarthritis can lead to the following complications:

Inflammatory process of periarticular tissues.
Restriction of joint mobility.
Change the shape of the joints.
Hip joint degeneration.

Such complications can lead to the development of disability and irreversible changes.

Forecast

It is important to treat the disease on time. The best prognosis will be if you start treatment in stages 1 or 2 of the disease.