Osteoarthritis of the knee

The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slip. Malnutrition and loss of elasticity lead to its dystrophy (thinning) and resorption, while the bone tissue of the joint surfaces is exposed, the sliding is disturbed, the joint spaces of the knee become narrower, the biomechanics of the joint change. The synovial membrane that lines the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) becomes irritated, which leads to an increase in its quantity in the joint (synovitis). Against the background of the narrowing of the joint space, the volume of the joint decreases, synovial fluid protrudes from the back wall of the joint capsule, and a Becker's cyst is formed (which, reaching large sizes, can cause painin the popliteal fossa). The thin and delicate tissue of the joint capsule is replaced by coarse connective tissue, the shape of the joint changes. Periarticular bone tissue grows, osteophytes (pathological bone growths) are formed. Blood circulation in the periarticular tissues is impaired, underoxidized metabolic products that irritate chemoreceptors accumulate there, and a persistent pain syndrome develops. Against the background of changes in the anatomy of the joint, a violation of the surrounding muscles occurs, hypotrophy and spasms appear, and the gait is disturbed. There is a persistent limitation in the range of motion in the joint (contracture), sometimes so pronounced that only swaying movements (stiffness) or a complete lack of movement (ankylosis) is possible.

Regarding osteoarthritis of the knee, we can say that it is a fairly common disease: it affects 10% of the entire population of the planet, and from the age of 60, it affects aperson in three.

Causes of knee osteoarthritis

• Bone and joint injuries.
• Inflammatory diseases of the joints (rheumatoid, chlamydial arthritis, gout).
• Violation of mineral metabolism in various endocrinopathies (diabetes mellitus, diseases of the parathyroid glands, hemochromatosis).
• Diseases of the muscular system and neuropathy (Charcot's disease).

In addition to the main reasons, there are also underlying factors that are unfavorable for the development of knee osteoarthritis, including:

• overweight (literally puts pressure on the lower limbs);
• age (mainly the elderly are susceptible to the disease);
• female sex (according to statistics, women get sick more often);
• increase in professional and sporting physical activity.

Symptoms of osteoarthritis of the knee joints

• Pain that increases with walking and decreases at rest.
• Difficulty of usual physiological movements in the joints.
• The characteristic "crackle" in the joints.
• Joint enlargement and visible deformity.

Stages of knee osteoarthritis

There are several stages of osteoarthritis:

1. At the first stage, a person only experiences symptoms such asslight discomfortor "heaviness" in the knee, disturbing when walking long distances or during increased physical exertion. X-ray examination will be of little information: only a slight narrowing of the joint space can be detected, there will be no other changes. At the onset of the defeat of osteoarthritis of the knee joint, a person does not turn to specialists without attaching special importance to the symptoms that have arisen.
2. For the second stage of osteoarthritis of the knee joint,tangible pain, the severity of which decreases at rest. Difficulty of movements in the joints appears, when walking a characteristic "crunch" is heard (from the patient you can hear a common phrase in everyday life - "crunch of the knees"). When taking an x-ray, a clearly distinguishable joint space narrowing and unique osteophytes are found.
3. With the passage of knee osteoarthritis to the next third stage,the pain symptoms will constantly bother the patient, including at rest, there is a violation of the configuration of the joints, that is , deformation, aggravated by edema at the time of joining the inflammation. On radiographs, moderate joint space narrowing and multiple osteophytes are determined. At the third stage, many already consult a doctor, since the quality of life is significantly affected by pain and difficulty in walking normally.
4. The fourth stage of osteoarthritis of the knee joint is accompanied byunquenchable and exhausting pain. . . Minimal attempts at movement become a difficult test for a person, the deformation of the joints is visually noticeable, walking is extremely difficult. The x-ray reveals significant changes: the joint space is practically undetectable on the images, multiple macroscopic osteophytes, "joint mice" (fragments of bone which collapse falling into the joint cavity) are revealed. This stage of knee osteoarthritis almost always leads to disability: often the result of the disease is the complete fusion of the joint, its instability and the formation of a "false joint".

Who treats osteoarthritis of the knee?

Qualified medical care for knee osteoarthritis can be provided to the patient by a therapist, rheumatologist and general practitioner (family doctor), but these specialists deal with the treatment of the knee joint for uncomplicated osteoarthritis.

When synovitis occurs or the treatment prescribed by the therapist does not give the desired effect, then one cannot do without the help of an orthopedist. In situations where surgical care is required, a patient with osteoarthritis of the knee joint is referred to a specialized orthopedic and trauma service.

How and how to treat osteoarthritis of the knee?

Currently known methods of treating patients with osteoarthritis of the knee joint are subdivided into non-drug, medical and surgical preservatives.

Non-drug methods

Many patients ask themselves the question: "How to treat osteoarthritis of the knee joint without pills? " Answering it, we have to say with regret that knee osteoarthritis is a chronic disease, it is impossible to eliminate it forever. However, many of the non-pharmacological methods (ie.

With a timely visit to a doctor and sufficient motivation of the patient to recover, sometimes it is enough to eliminate the negative factors. For example, reducing excess weight has been shown to reduce the manifestation of the main symptoms of the disease.

Elimination of pathological physical activity and, on the contrary,therapeutic gymnasticswith the use of rational physical programs, they reduce the intensity of pain. Exercises to strengthen the femoral quadriceps have been shown to have a comparable effect to anti-inflammatory drugs.

If we are treating osteoarthritis of the knee joint, then it is necessary to strive toadequate nutrition: to improve the elastic properties of articular cartilage will help products with a large amount of animal collagen (types of meat and fish diet) and cartilage components (shrimp, crabs, krill), vegetables and fresh fruits saturated withplant collagen and antioxidants, and a passion for smoked meats, marinades, preservatives, sweet and savory dishes, on the contrary, potentiates the disruption of metabolic processes in the body and the accumulation of overweight up to theobesity.

Thinking about the most effective treatment for osteoarthritis of the knee, it is worth remembering such an effective treatment and prophylactic method asorthotics: Attaching knee pads, orthotics, elastic bandages and orthopedic insoles reduce and properly distribute the load on the joint, thereby reducing the intensity of pain. The use of a cane is also recommended to effectively relieve the knee joints. It should be in the hand opposite to the affected limb.

Comprehensive treatment of osteoarthritis of the knee joint also involves the appointment of very effective, even with advanced forms of the diseasephysiotherapy. . . Widely used in different categories of patients with osteoarthritis of any degree, it has proven its effectivenessmagnetotherapy: after several interventions, the intensity of the pain decreases, thanks to the improvement of blood circulation, the reduction of edema and the elimination of muscle spasms, the mobility of the joint increases. The effect of magnetotherapy is especially pronounced with the development of active inflammation in the joint: the severity of edema is significantly reduced, the symptoms of synovitis regress. Physiotherapy methods such aslaser therapyandcryotherapy(exposure to cold), which have a pronounced analgesic effect.

Medical treatment

In schemes of effective treatment of osteoarthritis of the knee joint, the following drugs are used.

Nonsteroidal anti-inflammatory drugs (NSAIDs), produced in forms for external (various gels, ointments) and systemic (tablets, suppositories, solutions) use, have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors. By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling, and slow the progression of the disease. With the first manifestations of the disease, the local use of these drugs in combination with non-drug methods (therapeutic exercises, magnetotherapy) is effective. But with advanced osteoarthritis of the knee joints, pills, and sometimes injections of NSAIDs, are essential. It should be remembered that a prolonged systemic intake of NSAIDs can provoke the development and exacerbation of ulcerative processes in the gastrointestinal tract and, in addition, negatively affect the function of the kidneys and liver. Therefore, patients who have been taking NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor the laboratory performance of internal organs.

Glucocorticoids (GCS)- hormonal drugs with a pronounced anti-inflammatory effect. They are recommended when the NSAIDs previously prescribed to the patient do not eliminate the manifestations of inflammation. As a potent anti-inflammatory agent, GCS in the treatment of osteoarthritis have certain contraindications, as they can cause a number of important side effects. In systemic forms with knee osteoarthritis, they are practically not prescribed. As a rule, for the effective treatment of osteoarthritis is meant injections of GCS into the periarticular pain points, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted side effects of the drug. This manipulation can be performed by a rheumatologist or a traumatologist. With concomitant synovitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single administration of GCS, the effect of such treatment lasts up to 1 month. In accordance with national guidelines for the treatment of osteoarthritis, do not give more than three injections of the drug per year into the same joint.

In "neglected" advanced osteoarthritis, when a person experiences excruciating pain that does not subside even at rest, disrupts normal sleep, and is not eliminated by NSAIDs, GCSs, and non-drug methods, it isis possible to prescribeopioid pain relievers. . . These drugs are used only on prescription from a doctor, who considers the advisability of their appointment in each case.

Chondroprotectors(literally translated as "protect the cartilage"). This name is understood as various drugs, united by one property - the action of structural modification, that is, the ability to slow down degenerative changes in cartilage and narrowing of joint space. They are produced in forms both for oral administration and for introduction into the joint cavity. Of course, these drugs don't work miracles or "grow" new cartilage, but they can stop its destruction. To achieve a lasting effect, they should be applied for a long time, with regular courses several times a year.

Surgical treatment of osteoarthritis of the knee joints

There are frequent cases when, despite adequate complex treatment, the disease progresses, gradually reducing the quality of human life. In such situations, the patient begins to ask questions: "What if the prescribed drugs do not help in the fight against osteoarthritis of the knee? """ Is surgical treatment indicated for osteoarthritis of the knee? In answering these questions, it should be clarified that the indications for surgical treatment of osteoarthritis of the knee joints are intractable pain syndrome and significant joint dysfunction, which cannot be ruled out with the use ofcomplex conservative treatment, which is possible with the last, fourth degree of the disease.

The most popular type of surgical care for third and fourth degree osteoarthritis isendoprostheses, that is to say. removal of your own joint with the simultaneous installation of a replacement metal prosthesis, the design of which is similar to the anatomy of the human knee joint. In that case, a prerequisite for this type of surgical treatment is: the absence of gross deformities of the joint, formed "false joints", muscle contractures and severe muscle atrophy. In severe osteoporosis (significant decrease in bone mineral density), the endoprosthesis is not indicated either: the bone "in sugar" will not resist the introduction of metal pins, and rapid resorption (resorption) of bone tissue will begin at their site of installation, pathological fractures may occur. Therefore, a timely decision on whether to install a stent seems to be so important - it should be taken when the age and general condition of the human body still allow the operation to be performed. According to the results of long-term studies, the duration of effect of stents in patients with advanced osteoarthritis, that is, the temporary duration of absence of significant motor limitations and maintenance of qualitydecent life is about ten years. The best results of surgical treatment are observed in people aged 45-75 years with low body weight (less than 70 kg) and a relatively high standard of living.

Despite the widespread use of knee replacement surgery, the results of these operations are often unsatisfactory and the percentage of complications is high. This is due to the design features of stents and the complexity of the surgery itself (hip joint replacement is much easier in technical terms). This dictates the need to perform organ preservation operations (joint preservation). These include in particular an arthromedullary bypass and a corrective osteotomy.

Arthromedullary bypass- connection of the medullary canal of the femur with the cavity of the knee joint using a shunt - a hollow metal tube. This allows fatty bone marrow from the lower third of the femur to enter the knee joint, nourishing and lubricating the cartilage, greatly reducing pain.

When changing the axis of the lower limb (but provided that there is a slight restriction in the range of motion), it is effectivecorrective osteotomy- section of the tibia with correction of its axis, followed by fixation with a plate and screws in the desired position. At the same time, two goals are achieved - the normalization of biomechanics through the restoration of the axis of the limbs, as well as the activation of blood circulation and metabolism during bone fusion.

Summarizing the above, I would like to note that the treatment of knee osteoarthritis is a complex social task. And although medicine today is not able to offer a drug that will get rid of it forever, or other means of curing this disease completely, a healthy lifestyle, seeking helptimely medical treatment and adherence to doctor's recommendations can stop its progression.