One of the most common complaints that doctors hear from patients is knee pain. What causes this pain is not always possible to say right away. The knees can be affected by various diseases, for example, osteoarthritis of the knee joint. It is also known as gonarthrosis.
Gonarthrosis is a non-inflammatory joint injury that often leads to cartilage destruction, bone deformities, and limited movement. This disease has the code M17 in the International Classification of Diseases (ICD-10).
All patients can be divided into two groups. The first group includes young people, more often young men, with damage to one, less often both knee joints. They have a knee injury or surgery in their medical history.
The second group includes people who are obese, middle-aged or older, more often women, in whom gonarthrosis has developed on several parts of the body at the same time.
Symptoms of osteoarthritis of the knee
The symptoms of osteoarthritis of the knee gradually increase. Patients may not be aware that they are ill for years until they notice an obvious knee deformity or severe pain.
At the same time, arthritis of the knee joint in the initial stage of the disease is most often accompanied by uncomfortable and painful feelings in the knees, and few people seek medical advice.
Women prone to obesity, especially after the age of 40, are predisposed to this disease.
Varicose veins also contribute to the disease. At this stage, it is possible to treat the disease at home without the use of tablets and ointments.
The pain is not sudden, it occurs gradually, over several years. They usually occur during sports, walking and other physical activities.
Acute pain may not be a symptom of gonarthrosis, but a consequence of a crack, meniscus injury, or bruise. Severe pain becomes a motivation to consult a specialist.
The pain often worsens in the following cases:
- when walking;
- in a long standing position;
- during the slope;
- when lifting the body from a sitting position;
- when carrying heavy objects.
During the performance of these actions, the maximum load acts on the joints, therefore, if the patient feels strong discomfort, he can already be diagnosed with arthritis of the knee joint of the second stage. The person tries to move less, to take a static position to avoid pain, but with continued physical activity, the discomfort returns.
Deforming osteoarthritis of the knee joint is accompanied by such a symptom as deformity. It becomes noticeable already in the second or third stage of the disease. Her first signs: the knee was slightly swollen, but kept its shape. In the later stages, the shape of the knee changes, making one leg shorter or longer.
One of the most characteristic symptoms is squeaking in the joints, noticeable in the second and third phase. The main thing is to distinguish the audible squeaking in the joints of a healthy person from the deaf, dry crunching of a patient. This sound causes weakness of the ligament apparatus or great mobility of the joints.
To ensure immobility of the knee joint, it is recommended to wear a knee prosthesis.
Forms of gonarthrosis
There are two forms of the disease:
- Primary: Occurs as a result of congenital abnormal joint development.
- Secondary: Occurs as a result of illness and injury.
The primary form of osteoarthritis of the knee joint often develops in childhood and is caused by improper formation of ligaments and joints. They are subjected to heavy loads and are deformed during physical activity.
The secondary form of the disease is caused by the following factors:
- Injuries (bruises, sprains, dislocations, fractures), which result in injuries to the structure of bones, ligaments and cartilage. It is all a post-traumatic form of the disease.
- Surgery when the meniscus is displaced impairs the integrity of the knee structure.
- Too much load on the legs (typical for weightlifters).
- obesity. Being overweight puts pressure on the cartilage of the knee joints.
- Passive lifestyle.
- Diabetes.
- Age
- Arthritis (inflammatory process in the joints). Prolonged illness is accompanied by the formation of excess fluid in the joint cavity and causes complications.
- Metabolic disorders lead to salt deposition.
- knee transplant.
- Diseases that cause long-term muscle cramps in the legs or vasospasm.
The development of the disease can be unilateral or bilateral. Trauma often causes left or right gonarthrosis, and obesity is bilateral.
Stages of the disease
There are three stages of gonarthrosis:
- From the beginning of the first phase to the visible manifestations of the disease can take months or even years. The person complains of occasional pain in the legs, especially when moving or descending stairs and getting out of bed in the morning. The pictures most often show a narrowing of the connection between the joints, and as a rule, patients use traditional medicine instead of going to the doctor - ointments and tinctures.
- The second stage is characterized by more acute pain, which does not cease with limb immobility. A crunch appears. Fluid accumulates in the joint cavity, X-ray shows deformation and bone growth. At this stage, the patient tries in all possible ways not to move the affected limb. The doctor prescribes injections and chondroprotectors - drugs that help regenerate cartilage tissue.
- In the last third stage, the pain becomes constant and often worsens with changing weather conditions. X-ray shows a significant deformity of the knee, which can only be corrected by surgery, the patient must take a chondroprotector complex. The patient's gait changes: he walks on half-bent legs or rolls from one side to the other.
Causes of disease. Risk groups
Overweight
Most often, deforming osteoarthritis affects the elderly. Women who are overweight after the age of 40 are in a special risk group. The probability of pathology in obese people is 4 times higher than in people with normal body weight. The pattern is simple: the older a person is, the faster the disease develops and the more severe it is. In this case, the form of the disease can be called acquired. The joints of the lower extremities fall under the impact, because they are forced to bear the greatest load.
Overweight people also experience hormonal imbalances and metabolic disorders, which contribute to the development of obesity and osteoarthritis.
Age
Those who have reached the age of 60-65 can be called older. In this population, osteoarthritis occurs in 65-85 percent of people.
The reason is age-related changes that negatively affect the structure of the joints. Even ordinary walking can become a significant burden and encourage the development of disease, while worn-out cartilage can no longer recover on its own.
Congenital pathologies and hereditary factors
The disease can affect both young people and those who do not suffer from overweight. As a rule, in such situations, the disease occurs due to congenital defects of the knee joints, for example, lack of intra-articular lubrication. Heritage also plays an important role.
However, most patients who suffer from knee pain are people of respectable age. Osteoarthritis is rare in young people. Unfortunately, young patients do not always receive the necessary therapy, because not all doctors consider it necessary to pay them the necessary attention.
High loads
People who earn their living by hard physical work, as well as athletes of various levels, are also at risk of developing osteoarthritis of the knee. In that case, the disease becomes an occupational pathology.
Surgery, injuries and other diseases
Surgery, trauma, various joint diseases can cause gonarthrosis.
When the cause remains unknown, osteoarthritis of the knee joint is usually called idiopathic.
Diagnosis of osteoarthritis of the knee
This diagnosis is made on the basis of patient complaints, examination data, palpation of the diseased joint and X-ray examination.
X-ray is a standard research method that allows you to confirm the diagnosis, determine the degree of pathological changes, monitor the dynamics of the process, and also allows you to exclude other pathological processes (for example, tumors) in the tibia and femur. .
It should be noted that primary changes in knee joint structures on radiographs may be absent. After that, the narrowing of the joint space and the compaction of the subchondral zone are determined. The articular ends of the femur and especially the tibia expand, the edges of the condyle become pointed.
Auxiliary diagnostic methods are CT (computed tomography) and MRI (magnetic resonance imaging), which allow a more detailed study of pathological changes in bone structures and the identification of changes in soft tissues.
How to treat gonarthrosis of the knee joint
The more acute the stage of the disease, the more complex the treatment of gonarthrosis. The chronic nature of the pathology can remain in the remission phase, when the active manifestations of the disease are minimized or completely absent.
Physiotherapy treatment in combination with chondroprotective drugs gives positive results.
Treatment options include:
- drug therapy (chondroprotectors);
- surgical intervention;
- rehabilitation course (exercise, massage, etc. ).
Drug treatment
In addition to drug therapy, the use of nonsteroidal analgesics is prescribed. These medications help relieve the pain and symptoms of synovitis (inflammation). If the pain is particularly intense or the synovium of the knee joint is very inflamed, then corticosteroids can be used. These drugs have stronger analgesic and anti-inflammatory effects than non-hormonal painkillers. Muscle relaxants and antispasmodics will help the periarticular muscles to get rid of cramps.
Antioxidants and vasodilators improve cartilage nutrition. The main drugs for the conservative treatment of the disease are chondroprotectors containing chondroitin and glucosamine sulfate (natural components of cartilage).
The use of pathogenetic drugs should be systemic and long-lasting.
Physiotherapy
Physiotherapy methods (UHF, ultrasound or phototherapy) are considered additional means to accelerate the healing process.
They also include:
- Acupuncture. This method relieves muscle spasms near the affected joint, normalizes metabolic processes in them, which restores damaged cartilage tissues.
- Hirudotherapy. Leech treatment has the same effect as injections, as it improves blood circulation.
- laser therapy. Such procedures relieve inflammation, swelling, improve metabolism and neutralize pain.
- Cryotherapy. Both liquid nitrogen treatment and plain ice at home are effective.
- Magnetotherapy. The influence of the magnetic field not only improves blood circulation in the tissues, but also alleviates swelling and inflammation.
- Electromyostimulation. With the help of micro-discharge of current of different frequencies, the muscles are renewed and strengthened, and the blood circulation in the limbs is improved.
Treatment of knee gonarthrosis with physiotherapy is effective because it reduces pain. The doctor usually prescribes such treatment according to the stage of the disease.
Physiotherapy
Exercise therapy for osteoarthritis of the knee joint is one of the main ways to restore atrophied muscles and must be carried out very carefully and slowly. If the patient feels the pain return, the exercise should be stopped.
During therapeutic exercises, it is necessary to wear special knee protectors. The rehabilitation course also includes the use of these orthopedic aids, which aim to reduce the load from the diseased knee to a cane or prosthesis. Patients with gonarthrosis are often prescribed to wear knee prostheses to relieve pain when walking.
Therapeutic gymnastics for gonarthrosis reduces the load on the damaged joint, developing the leg muscles. Exercises that strain the joint are strictly contraindicated. Water gymnastics and swimming are ideal activities.
Orthopedic therapy
To reduce the load on the affected joints, the patient should use a cane. A good helper for osteoarthritis of the knee are orthopedic shoes that provide a natural foot position and even load distribution.
Massage
Massage relieves muscle cramps, reduces pain and increases range of motion. This procedure also improves blood circulation and supplies the joint with nutrients.
Surgical intervention
A marked decrease in working capacity (especially up to the age of 45) requires surgical treatment. The choice between corrective (osteophyte removal) and radical (knee arthroplasty) treatment methods depends on the stage of the disease, the patient's age, symptoms and other factors.
Nutrition
As for the special diet for gonarthrosis, it is most often aimed at reducing the patient's body weight, because being overweight leads to overload of the joints. It is recommended to eat small meals every 3 hours, eat lean meat (chicken, turkey, rabbit) and exclude fatty pork, and get the necessary protein from legumes.
Refined oil should be replaced by unrefined, and salt intake should be limited. Therapeutic diet also involves the rejection of canned foods, fried and smoked foods. In order to rebuild the destroyed cartilage, it is necessary to provide the body with carbohydrates found in cereals and whole grain flour.
In addition, it is recommended to drink freshly squeezed juices, such as carrots, beets and apples, to remove toxins and reduce inflammation in the body.
Fish and various jellies act as chondroprotectors and help restore cartilage not only in the initial stages, but also in periods of deterioration.
Folk methods of treatment
There are many ointments, coatings, tinctures used by fans of traditional medicine. These medicines are usually made from medicinal herbs, medicinal bile and help to improve the circulation in the joints.
Compresses and ointments also relax muscles, their effectiveness is very high, but in the third stage of gonarthrosis without the use of drugs are practically useless.
Traditional medicine should not be neglected either, because it helps alleviate the ailments and alleviate many of the symptoms of the disease. But in any case, you should consult a doctor and do not self-medicate.
There are contraindications, it is necessary to consult specialists.
Prevention
It is recommended to adhere to the following principles of a healthy lifestyle:
- balanced diet;
- giving up bad habits (smoking, alcohol);
- sports;
- maintaining a healthy weight;
- prevention of sports injuries (bruises, shifts, fractures).
Knee osteoarthritis has several treatment options depending on the age and physical condition of the patient. For the prevention and control of the disease in the early stages, sports are necessary, as well as timely treatment.