One of the most common pathologies of the skeletal muscle system is arthrosis of the knee joint (otherwise gonartrosis) is a chronic disease, associated with dystrophy and destruction of articular knee structures.
The result of destructive processes is a sharp restriction or complete loss of joint mobility, and as a result - a decrease in performance, disability.
It is possible to prevent adverse consequences only if you are diagnosed early and time therapy.
Reason
Of origin, knee arthritis is primary and secondary.Starting develops as an independent disease, is more often diagnosed in older people, and in this case is due to age -related changes in tissues.Secondary gonartrosis becomes the result of other diseases and disorders in the body.
The development of Gonarthrosis contributes to:
- damage (displacements, fractures, meniscus damage);
- Diseases of the musculoskeletal system (congenital foot deformation, knee dysplasia, condrocalcinosis, arthritis, osteoporosis);
- Continuous high loads on union due to professional activities, professional sports;
- Overweight, overweight;
- endocrine diseases, including diabetes, hypothyroidism, acromyigaline;
- metabolic disorders;
- Genetic predisposition.
Symptoms
Inflammation with arthrosis of the knee joint is accompanied by two main clinical manifestations - pain and edema.The intensity and frequency of the appearance of pain depends on the depth of damage to the common structures.In the initial stage, the pain is felt only with one load, quickly passes to rest.With advanced gonartrosis, pain pain is constantly present, intensifies during movements, with a change of weather.
Other signs of knee joint arthrosis:
- cramp when moving;
- stiffness in coupling, motor function violation;
- Knee deformity (with neglected gonartrosis).
Gonartrosis can be associated with a synovit (fluid accumulation in the joint cavity) and subsequent formation of a copper cyst (elastic formation in the back of the knee).
Ladder
The symptoms of knee joint arthrosis vary depending on the depth of damage to the knee structures, and therefore the 3 stages of the pathology are distinguished.
- Knee joint arthrosis 1 degreeIt is manifested by poor load pain (at rest immediately), with a slight stiffness after sleep.In the radiographic view, an insignificant narrowing of the common gap (less than one third) is noted, the presence of single osteophytes (bone results) is observed.
- Arthrosis of the knee joint 2 degreesIt is associated with pain and crisis characteristic during movements.The pain persists for some time at rest.The stiffness of the morning is marked, the limit of the amplitude of the movements.Diagnostic procedures detect a marked narrowing of the common gap (more than half) and multiple osteophytes.
- Knee arthrosis 3 degreesIt is associated with constant pain pain, which, during movements and at night, intensifies.Breakfast stiffness remains longer than an hour with an irritation of inflammation and at least half an hour - during periods of prayer.The mobility of the joint is severely limited or completely lost.In radiographic appearance, numerous large osteophytes, cysts are visible.The common gap is narrowed by more than two -thirds by the norm.
Depending on the degree of arthrosis of the knee joint, the patient is prescribed conservative or surgical treatment.
Troubleshooting
The diagnosis of knee joint arthrosis includes visual examination, patient complaints analysis, laboratory tests (urine analysis, general and biochemical blood tests) and instrumental examination methods.
The following diagnostic procedures allow you to confirm or reject the diagnosis:
- Radiography;
- Ultrasound (ultrasound);
- MRI (magnetic resonance imaging);
- CT (calculated tomography);
- Arthroscopy and Skintigraphy (with the suspicion of a tumor).
Using these methods, it is possible to detect the narrowing of the joint gap, the degree of thinning and cartilage deformation, the presence of fluid in the joint cavity, the structural changes in the synovial membrane, the increase of osteophyte and the focus of the cartilage of the cartilage.
Conservative treatment
Conservative methods of treatment can reduce pain and inflammation, improve blood circulation and nutrition of nurses tissue, strengthen the muscle apparatus.
To this end, they are held:
- medication therapy;
- blockade;
- physiotherapy and manual therapy;
- Medical physical education.
An important component of the treatment of arthrosis is respect for a therapeutic diet.
Conservative treatment of knee joint arthrosis will be effective in the initial stage of the disease, when small distrophical cartridges of the cartilage, inflammation and damaged functions of the synovial shell are marked.
drug
Drug treatment includes the meeting:
- non -steroidal anti -inflammatory drugs (NSAIDs);
- chondroprotectors;
- Hyaluronic acid.
NSAID
Non -inflammatory drugs Non -inflammatory do not help relieve inflammation, reduce its main symptoms -Edema and pain.
Preparations are described in the form of solutions (for intramuscular administration) or tablets, capsules (for oral administration).Capsules and tablets from NSAID group arthritis are taken in short courses, as medicines have a strong irritating effect on the gastric mucosa and can provoke the development of peptic ulcer, have many other side effects.
Moreover, prescribed external medicines (ointments, gel, creams) based on anti -inflammatory non -steroidal ingredients.Local therapy is allowed to be performed for a longer time.
NSAIDs have a pronounced anti -inflammatory effect, but with prolonged use contribute to the further destruction of cartilage.
NSAIDs are symptomatic therapy.They help eliminate the unpleasant symptoms of the disease but do not affect the condition of the cartilage.In contrast to these products, chondroprotectors and hyaluronic acid accelerate the processes of cartilage regeneration and slow down its destruction.
Chondroprotectors
The chondroprotector group drugs contain chondroitin and glucosamine (structural elements of the cartilage) and help restore knee arthritis.They are available in the form of tablets, powder for oral administration, an injection solution.
The minimum course of taking tablets and dust is 3 months.After a break, the course is repeated 2-3 times.The course of treatment with a solution includes 12-15 injections, repeated 2-3 times a year.
The first positive results of chondroprotectors are visible only a few months after the start of therapy.
Hyaluronic acid
Hyaluronic acid is inserted injected into the affected joint.Cure for knee joint arthrosis performs the role of lubrication - envelop the articular surfaces, thereby reducing the friction between them.
Hyaluronic acid drugs help increase the elasticity of cartilage tissue, prevents further destruction of articular structures, which improves the movement of the joint, the symptoms of inflammation are reduced.Medications are well tolerated, they do not cause side effects.Their only obstacle is the high cost.
The course of hyaluronic acid treatment usually includes 3-4 injections, which are performed on a vacation of 10-14 days.
lock
If with non -inflammatory drugs non -inflammatory, it is not possible to relieve knee pain with arthrosis, a blockade -a treatment method in which the medication is injected directly into the affected tissues to relieve pain and inflammation.In arthrosis therapy, articular (injections in the articular cavity) and periarticular blockade (in the periarticular cavity) are used.
The main advantage of the method is an immediate deliberate action, as with such an input the maximum concentration of the active substance is created precisely in the area of inflammation.Moreover, medicines do not fall into the systemic blood flow, which significantly reduces the risk of side reactions.
In the later stages of gonartrosis, the articular gap narrows, osteophytes grow, the common surfaces are deformed, therefore, only perirticular blockages are allowed.
Knee joint blockage for arthritis can be performed using anesthetics and corticosteroids.
Anesthesia is usually introduced in combination with steroid hormones to reduce the pain of the procedure.
Hyaluronic acid and chondroprotectors can also be inserted directly into the joint.But in this case, we are not talking about the blockade, but about intra -articular injection, as these medicines do not block pain impulses, but cause the regeneration processes of cartilage tissue.
Physiotherapy and manual therapy
The main methods of physiotherapeutic effects used in the treatment of arthrosis include:
- Laser treatment;
- ultrasound therapy;
- Cryotherapy;
- paraffin and ozokerite therapy;
- Mud
The main task of all physiotherapeutic procedures is to stimulate blood circulation in nearby tissues, improve cartilage nutrition.
Exercise therapy
Pain syndrome forces a patient with gonarthrosis to limit motor activity, as a result of which atrophy of the nearby ligaments and muscles.This condition adversely affects the joint tissues, as it is during the movement that nutrients penetrate from synovial fluid into the cartilage.If the knot is constantly at rest, the dystrophic processes deteriorate.
This is why physiotherapy exercises are an integral component of conservative therapy.Moderate physical activity allows you to strengthen your muscle apparatus, improve the power of articular structures, eliminate stiffness and improve motor function of the knee.
Exercises of therapeutic exercises are developed by the physician individually for each patient, taking into account the depth of the lesion and the functional condition of the articular structures.
General recommendations for performing exercises therapy for knee arthritis:
- Start classes only after stopping signs of acute inflammation;
- Perform all exercises without problems, without unexpected movements;
- The load is gradually increased;
- eliminate high loads on the joint (extensive knee flexion/stretch);
- If pain or discomfort appears, stop training.
Diet
With gonartrosis, products containing: containing:
- amino acids (dairy products, low meat varieties);
- collagen (gelatin dishes);
- irreplaceable fatty acids (vegetable oils, fish);
- Sulfur and selenium (legumes, cereals, cabbage and apples, beef, chicken, eggs).
Also important:
- eliminate the use of smoked meat, pickles, marinades;
- limit salt consumption;
- Respect a 5-fold diet;
- Observe the way of drinking.
Excessive body weight is one of the main factors that provokes the development of knee joint arthrosis.Therefore, the task of overweight patients is a decrease in body weight.In this case, you can only achieve the result with the help of a diet, as intense sports are harmful to the inflamed node.
To reduce body weight, it is recommended to be excluded from the menu:
- fatty varieties of meat and fish;
- cream, home sour cream and other dairy products with a high percentage of fat content;
- Margarine, mayonnaise, various sauces;
- cakes;
- fast food;
- Sweet drinks.
Surgical treatment
Knee joint arthrosis of the 3rd degree is not suitable for conservative therapy, so surgery is the only way out to the patient.
There are two options for surgical intervention:
- Osteotomy corrective- performed at the initial stage of development of the 3rd phase of gonarthrosis, if the cartilage is partially destroyed, it is possible to remove osteophytes;
- Endoprosthetics- The replacement of the union or its destroyed parts is carried out with the complete destruction of the cartilage.
Predict
Pathological changes in common structures are progressive, irreversible.However, with early diagnosis and proper treatment, you can completely stop inflammation and stop dystrophic changes in cartilage tissue - knee joint arthrosis of 1 degree is given well -conservative therapy.
With 2nd degree arthrosis, which is associated with the destruction of cartilage and the formation of osteophytes, conservative methods allow you to slow down or suspend cartilage deformity, stop inflammation and improve motor activity.However, doctors are often forced to use blockade, arthroscopy.
It is impossible to cure the arthrosis of the knee joint of 3 degrees in a conservative way.The only way to restore knee movement is surgical intervention.