knee osteoarthritis

Arthropathy is a joint pathology associated with damage to cartilage tissue. Synonyms for arthropathy are knee joint disease, osteoarthritis deformans, osteoarthritis - all these terms mean a degenerative process in the cartilage covering the epiphysis of the joint bones.Although the lesion affects only cartilaginous structures, all joint elements are affected - the joint capsule, synovium, subchondral bone, and the ligaments and muscles surrounding the joint. Arthropathy can affect one or more joints.The most common localized forms of the disease have their own names: arthropathy of the hip joint is called coxarthrosis, and arthropathy of the knee joint is called stifroarthrosis.

Classification and reasons

Knee arthritis can be primary or secondary. The first group includes pathologies whose etiology has not yet been established, i. e. , they are idiopathic. Secondary arthropathy occurs after injury due to a background of congenital anomalies and systemic disease.The following are causes of knee arthritis:

• Autoimmune diseases - rheumatoid arthritis, lupus, scleroderma, etc. ;
• Inflammation of joints caused by certain infections (syphilis, gonorrhea, encephalitis);
• Genetic disorders of the musculoskeletal system and joints, mutations in type 2 collagen.

There are also many factors that have a negative impact on the joints and may cause pathological changes in the joints:

• Old age, overweight, osteoporosis;
• Hormonal changes, including reduced estrogen synthesis in postmenopausal women;
• Metabolic diseases;
• Lack of trace elements and vitamins in the diet;
• congenital and acquired skeletal malformations;
• hypothermia and poisoning with toxic compounds;
• Persistent joint injuries during sports training or hard work;
• Knee surgery - for example, removal of the meniscus.

symptoms and stages

Deformative arthropathy of the knee is characterized by intracellular changes at the morphological, molecular, biochemical, and biomechanical levels. The result of the pathological process is softening, fibrosis and loss of thickness of the articular cartilage. Additionally, the surface of the bone that forms the joint becomes denser and bone spurs (osteophytes) appear on it.DOA of the knee develops in 3 stages, with early stages likely to present only mild pain and discomfort after prolonged physical activity. Sometimes one of the characteristic symptoms of arthropathy occurs - morning stiffness. At this time, the composition of the synovial membrane and intra-articular fluid will change.As a result, the cartilage tissue does not receive enough nutrients and its ability to withstand stress begins to decrease. Therefore, pain occurs during strenuous exercise and long periods of walking.In the second stage of arthropathy, destruction of cartilage tissue progresses, and part of the increased load is borne by the articular surfaces of the bones. Because there is not enough supporting area, the edges of the bone become enlarged by osteophytes. The pain no longer goes away at rest like it used to and it bothers me even at night. The duration of morning stiffness also increases, and it takes a long time to "exercise" the legs so that I can walk normally. In addition, when the limb is bent, breaking and clicking sounds are heard, accompanied by severe pain. The leg doesn't always bend completely; it seems to be stuck, and further attempts end in severe crunching and pain.Due to the pain that occurs during any movement, people tend to move less, which can negatively affect the muscles around the joints. Changes in epiphyseal size can lead to displacement of the limb axis and the development of deformities. As the amount of fluid in the joint capsule decreases, the joint capsule becomes stiffer. Synovitis and chronic inflammation occur when osteophytes compress surrounding soft tissue.When entering the third stage, joint symptoms in the knee joint become very severe - the pain does not go away even at night, the ability to move almost ceases, and the leg appears bent and does not bend. Third degree arthropathy is characterized by an X- or O-shaped deformity that makes movement extremely difficult. Advanced forms of osteoarthritis can only be treated surgically.

diagnosis

Diagnosing knee osteoarthritis is not particularly difficult; doctors can predict knee osteoarthritis based on existing symptoms and characteristic visual signs. To confirm the diagnosis, an X-ray is required. Images will show joint space narrowing, bone growth, and subchondral bone hardening of the bone.X-rays are used to determine the cause of disease. Bone deformation is particularly evident in posttraumatic arthropathy. If cartilage degeneration is caused by arthritis, defects at the edges of the bones will be detected, as well as periarticular osteoporosis and atrophy of the bone structure. With various congenital anomalies, a distortion of the axis of one of the bones can be observed, leading to improper load distribution and the development of secondary osteoporosis.

treat

Treatment of arthroarthritis of the knee has 3 main goals - restoring cartilage tissue, improving joint mobility, and slowing the progression of the disease. It is very important to eliminate or attenuate symptoms - reduce the intensity of pain and inflammation. To address these issues, medications, physical therapy, and exercise therapy may be used. To obtain maximum therapeutic results, it is necessary to engage in moderate physical activity and adhere to an orthopedic treatment protocol.Medical treatments for knee joint disease include pain relievers and anti-inflammatory drugs, as well as chondroprotectants that promote the regeneration of cartilage tissue. Medications may be prescribed in the form of injections, tablets, ointments, and gels.If a first-degree knee joint disease is diagnosed, it is treated with physiotherapy methods, physiotherapy and massage. Early stages of the disease are easier to treat and you can expect a full recovery. An important condition is losing weight to reduce the load on sore joints.Treatment for stage II knee joint disease necessarily includes exercise therapy, wearing orthopedic devices, and dietary control. To relieve pain, doctors may prescribe nonsteroidal anti-inflammatory drugs, chondroprotectants, and intra-articular injections of hyaluronic acid. Acute arthropathy is characterized by severe pain that is inadequately treated with conventional NSAIDs. In this case, strong analgesics and injection of corticosteroids into the joint are required.If conservative methods fail, surgery is needed, which can be corrective or radical (replacing the joint with a prosthesis).Stage III knee deformity is characterized by the complete disappearance of the joint space and its replacement by bony structures. This condition requires surgical intervention as other methods are ineffective in this situation.

NSAIDs and corticosteroids

To save patients from physical and mental pain, acute joint treatment begins with pain relief. Medications in the nonsteroidal anti-inflammatory drug (NSAID) group, available as tablets or used topically, have been shown to be effective.The analgesic effects are not always immediate, but peak after two or three days and the pain disappears. Courses of NSAIDs are limited to two weeks, as longer use increases the risk of side effects. People with gastrointestinal problems and those with high blood pressure should be especially careful.If there are no results, hormonal medications are prescribed to relieve inflammation. In the case of left-sided knee arthrosis, the drug is injected into the left knee, and on the right side into the right knee.Hormone injections can be given every 10 days instead of more frequently. Indications for this treatment are large accumulations of fluid in the joints due to inflammation. As symptoms subside, they switch to tablet form.

Chondroprotectant and hyaluronic acid

Chondroprotectants work in three directions – restoring damaged cartilage tissue, reducing pain, and neutralizing the inflammatory response. Taking chondroprotectants helps normalize the composition and properties of synovial fluid, nourish the cartilage and protect pain receptors from irritation.As a result, the cartilage structure is destroyed, slowing the progression of the disease. After taking a course of medication, the shock-absorbing and lubricating functions of the joints are restored.In the early stages of the disease, chondroprotectants in the form of ointments or gels can be used. However, intra-articular injections are most effective. Modern methods of treating joint diseases include the use of combination drugs, which contain not only chondroprotective substances, but also anti-inflammatory ingredients and vitamins.Hyaluronic acid is the main component of synovial fluid and determines its viscosity and consistency. This is actually a biological lubricant that provides elasticity, elasticity, and strength to the cartilage.With the development of joint lesions, the volume of hyaluronic acid will be reduced by 2-4 times, which will inevitably lead to excessive bone friction. Through intra-articular injection of hyaluronic acid, knee joint function returns to normal and people can move normally.

Surgery

Surgery is the ultimate method to partially or completely restore joint function. The degree of intervention may vary depending on the stage of the arthrosis. The mildest procedure is arthroscopic surgery - the recovery period after it is performed is minimally painful for the patient.

important:Arthroscopy can be used not only for treatment but also for diagnosis of joint pathology. This process allows you to identify damage that would otherwise be undetectable.

The purpose of arthroscopy is to extend the life of the joint by clearing the joint cavity of dead and damaged tissue. As a result, pain disappears, resistance to stress increases, and movement ability is restored.If severe deformity occurs, an osteotomy—creating an artificial fracture in a specific area—will be performed. Knee osteotomy literally means "cutting the bone"—during the procedure, the surgeon removes a wedge-shaped portion of the femur or tibia and then joins the bones in their most physiological position. If necessary, the resulting gap can be filled with bone graft. During the healing period, the structure is fixed with special clamps.Endoprosthetic replacement is an alternative to outdated arthrodesis, which essentially involves replacing part or all of a diseased joint with a prosthesis. As a result, knee joint function was fully restored in more than 90% of cases, significantly improving the patient's quality of life.

physiotherapy

Physical therapy procedures play an important role in the treatment of arthropathy, as they have a beneficial effect on damaged joints. Physical therapy procedures speed up the regeneration process and eliminate pain and muscle spasms. Additionally, some procedures allow for administration through the skin, thereby reducing the dose of oral medications.For damaged joints, the following techniques are recommended:

• magnet therapy;
• Mid-wave ultraviolet (WUV);
• Infrared laser;
• UHF;
• ultrasound;
• diameter and sinusoidally modulated current (amplified pulse therapy);
• Darsenval.

Effective methods of treating joint disease are also balneotherapy - radon baths, hydrogen sulfide baths, hydrochlorite baths, mineral baths and sage baths. They have anti-inflammatory, analgesic and restorative effects on joints.

at last

If you suspect knee arthritis, you should consult an orthopedic or traumatologist who diagnoses and treats these conditions. In order not to aggravate the condition, it is necessary to avoid excessive physical activity on the legs and get rid of excess weight.There is no special diet for arthritis, but it is recommended to avoid concentrated meat and fish soups, fatty meats and bacon, and to reduce salt intake. The diet should be based on foods rich in vitamins and minerals, as well as vegetable oils. In addition, it is recommended to arrange a fasting day once a week - kefir, cottage cheese or fruits and vegetables.To strengthen the muscles of the lower body and increase blood flow, regular therapeutic exercises are required, which are individually selected by a physical therapy trainer.Therefore, taking medications, physical therapy, a balanced diet, and physical exercise will definitely help people suffering from joint disease. And to avoid traumatic surgery, you should seek medical help as early as possible. healthy!