The Osteoarthritis of the knee joint (gonarthrosis), treatment of arthrosis of the knee joint
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Osteoarthritis of the knee joint

Content:

Among diseases of the musculoskeletal system, osteoarthritis is the leader in frequency. It is believed that the vast majority of the world's population by the age of 60 have initial signs of articular cartilage change, and 14% have already manifestations of osteoarthritis. The most common variant of this disease is osteoarthritis of the knee joints.



All the same "arthrosis" or "arthritis"?

Osteoarthritis of the knee joint Do not confuse these two concepts. Arthrosis is a process of altering the structure of the joints first of all, and arthritis is an inflammation that could arise both against the background of the "untouched" structure and against the background of arthrosis.

Changes in bone with arthrosis can be compared, for example, with knotty outgrowths on the trunk of the tree, which grows close to the concrete fence and presses all this weight on this fence.

Normally, the bone surfaces facing each other are separated by two layers of cartilage and menisci (additional cartilaginous plates). In addition to the role of the "buffer" between the bones, the cartilage ensures the sliding of the bones and the mechanical matching of them to each other. Even more strengthen the contact of bones with each other menisci, which due to large or minor (but frequent) injuries, and over time lose their elasticity, can completely or partially burst.

With age, and especially in the presence of hereditary predisposition, the articular cartilage becomes thinner. That is why the bones of the thigh and lower leg, which make up the knee joint with their ends, are dangerously approaching each other, friction may even arise between them.

Usually, in parallel with the thinning of the cartilage, another unpleasant event occurs over the years: the amount of intra-articular fluid decreases. This liquid is not only a purely mechanical "lubrication" of the joint from the inside. It provides nutrition to the bone, menisci and articular cartilage. Breaking the "supply" of all these structures is a real catastrophe for the joint!

If there is a physical overload of the joint, then bony outgrowths appear on bone surfaces and begin to grow, more like cusps, or thorns. For the knee joint, such overloading will be lifting of weights (including excess weight of one's own body!), Physical labor with emphasis on the knees (for example, weeding the garden), constant walking on the stairs, running, wearing uncomfortable shoes, flat feet and many others. Now it is easy to imagine what is happening inside the knee joint with the development of arthrosis, and how this manifests itself externally.

How is the joint? What is the articular cartilage?

Each of us many times saw articular cartilage on the end, for example, of a chicken bone. It covers small areas of contiguous bones. Under the articular cartilage is subchondral, or okolochryshchevaya bone. The human musculoskeletal system is similar.

Most of the joints of man consist of bones, synovial (joint) membrane and intra-articular fluid.

What happens to the joint with arthrosis?

Under the influence of all those loads, which have already been mentioned, there is condensation and proliferation of the subchondral bone, as a result - increased traumatization of articular cartilage.

The products of cartilage destruction, formed as a result of microtrauma, enter the synovial fluid. So arranged by nature that they are foreign substances for the synovial membrane and provoke its inflammation. Violated the formation of synovial fluid, which is usually a sort of "conveyor", like a continuous cycle of enrichment and purification of blood. In addition, in the joint fluid becomes less hyaluronic acid. About this acid should be told specifically.

Hyaluronic acid provides the viscosity of the synovial fluid, creates a "buffer effect" and "lubrication effect" between the bones, reducing their friction against each other. It is thanks to this substance that the articular fluid resembles egg white, rather than water, in consistency. Another important role of hyaluronic acid is to ensure the delivery of nutrients from the articular fluid deep into the articular cartilage, since there is nowhere else to take food: the blood vessels do not fit directly to the cartilage. In the same way, the "spent" substances are removed from the cartilage into the joint fluid: with the help of molecules of hyaluronic acid.

So, there is an increased compaction of the bone and unbearable conditions are created for the articular cartilage.

Cartilage receives a signal to adapt to these extreme conditions, and begins to change it, in another way it is called remodeling. This is mainly manifested by a decrease in the elasticity of the cartilage.

In the late stage of the development of arthrosis, the bone becomes stiff, but at the same time more fragile, the cartilage itself is partially impregnated with calcium - it is calcified.

Diagnosis of arthrosis of the knee joint

Inspection

In the early stages of the disease the joint is unchanged, mobile, muscles around it are preserved, and strong enough. Only by palpation (pressing) of certain points, more often on the inner surface of the joint, local (local) soreness is determined. The doctor asks the patient to perform several sit-ups, bend, unbend his leg in the knee, put him on the couch face up and conduct the flexion-extension himself (this is called "passive" movements). In addition to pain and the limitation of the volume of movements, it is possible to determine the crunch, clicking the joints. With a pronounced inflammatory component, the joint is enlarged in size, it seems that it is "pumped up" with liquid. With a far-reaching process, flexion in the knee may be partially or completely absent, when viewed, the surface of the joint seems uneven, bumpy, the limb may be curved (displacement of the limb axis, "stiffness").

Laboratory and instrumental research

- The obligatory program of laboratory examination includes general, biochemical and immunological analyzes of blood, urinalysis . In the general analysis of blood, attention will be drawn to: increased levels of leukocytes and an increased rate of erythrocyte sedimentation, which indicates inflammation. In the biochemical analysis of blood, the indicators of uric acid exchange, the level of "liver" enzymes are important. In the immunological analysis determine the presence or absence of signs of systemic inflammation - this is indicated by the level of C-reactive protein. The analysis of urine will reveal the content of "sand" - crystals of uric acid.

- Analysis of synovial (articular) fluid is prescribed when this fluid is in sufficient quantity. That is, when the joint is swollen, swollen. In the conditions of compliance with sterility, the doctor pierces the joint capsule in a strictly defined place, inserts the needle into the joint cavity, and then removes excess fluid. Some of the material is sent to the laboratory for analysis. At the conclusion of the procedure, an anti-inflammatory drug from the group of glucocorticosteroids (for example, diprospan) is most frequently injected into the joint cavity with a syringe.

- Radiography . A photograph of both knee joints is mandatory, it is necessary to compare a diseased knee with a healthy one. The picture draws attention to the width of the articulation gap (it is judged on the condition of meniscuses and cartilages), the presence or absence of osteophyte bone spines, signs of destruction (destruction) of bones.

- The ultrasound of the knee joints will answer questions about the safety of meniscuses, the presence of Baker's cyst, the severity of inflammation, the presence or absence of uric acid crystals (in the presence of gout).

- MRI (magnetic resonance imaging) . This research is appointed if ultrasound does not provide an exhaustive answer to specialist questions. Mandatory MRI is performed for patients who are scheduled to perform arthroscopy.

- Arthroscopy . Allows you to visualize, that is, personally assess the condition of the joint. The method is indispensable in case of disputable diagnoses, suspicion of traumatic injury of meniscuses and ligaments (then, at the time of the study, operative removal of broken menisci or ligament ligation) is possible.

Treatment of arthrosis of the knee joint

One should adhere to the principles of complex treatment, which include:

  1. Detailed informing the patient about the disease
  2. The use of curative physical exercises, which includes: specific exercises for joints in the prone position, swimming
  3. Maintaining optimal body weight
  4. Wearing an orthosis (soft bandage or at least elastic bandage) during an increased load on the joint - on the road, during walking and so on.
  5. Non-medicinal methods (physiotherapy). This type of treatment gives excellent results with arthrosis of the knee (gonarthrosis). Apparently, this is due to the fact that the joint is available for exposure to such factors as magnetic and laser radiation. For the treatment of the knee joint, you can apply magnetic currents, UHF, cryo-impact (in translation from Greek means exposure to cold). Physiotherapeutic procedures are widespread, treatment courses are usually short-10, maximum sessions daily or every other day. One should only remember about possible contraindications, which include tumor processes, diseases of the thyroid gland and pelvic organs, as well as systemic (autoimmune) inflammatory diseases.
  6. Drug therapy.

Principles of therapy of osteoarthritis:

  • Relieve pain
  • Delay further destruction of joint structures
  • To restore the lost function of the joint.

For anesthesia, drugs from the group of NSAIDs or NSAIDs are used - non-steroidal anti-inflammatory drugs. They are applied inside and in the form of applications (application to the skin). Application (local therapy) is a very effective method, especially when it comes to the early stages of the disease. Before applying the gel or cream containing NSAIDs, you need to make sure there are no changes on the skin, whether it's rashes, abscesses or cracks. The general rule of local treatment is to use the chosen cream or gel at least twice a day, and in case of unpleasant sensations, cancel until the disappearance of these manifestations. Intramuscular administration of painkillers is currently not recommended, since the risk of side effects from syringe administration does not decrease, but rather vice versa. In the case of severe inflammation, the accumulation of a large amount of fluid, intraocular glucocorticoid preparations (eg, diprospan) are allowed, but it should be noted that this procedure should be performed no more than once in 3 months.

A higher "stage" of anti-inflammatory action in osteoarthritis is the preparation of chondroitin or glucosamine . They, like NSAIDs, fight inflammation at the level of fine joint structures, but have fewer side effects, and, most importantly, retain their anti-inflammatory effect for several months after cancellation.

Chondroprotectors . This is a collective name for a group of drugs containing both chondroitin sulfate and glucosamine, the "building blocks" of cartilage. Despite the seemingly high cost of treatment with chondroprotectors, their convenience for patients and efficacy can not be overemphasized. First, these substances taken inwards are perfectly absorbed from the stomach, and the loss of the medicine "on the way" to the cartilage is minimal. Secondly, they are able to suppress inflammation in the joint, and, in addition, reliably slow down the process of destruction of the articular cartilage! Most often they are appointed courses, because they have a fairly long "aftereffect", which lasts for several months, and sometimes even up to six months.

Medicines based on hyaluronic acid - the so-called hyaluronates . These drugs are sold as prepared syringes for intra-articular injection. Hyaluronates are an artificial synovial fluid. The effect of this method can last up to 12 months.

Surgical treatment of arthrosis of the knee joint

As with arthrosis of the hip joints, in the case of major changes and a persistent loss of function, we are talking about surgery. In gonarthrosis, two types of interventions are currently performed: arthrodesis (fixed joint) and endoprosthetics. The first operation is performed rarely, according to special indications, when the endoprosthesis installation is impossible for any reason. The result of this operation is that the knee becomes stationary. But also does not hurt. It is much more beneficial in terms of the function of endoprosthetics. Recall that with a large body weight, this operation is not performed - the risk of complications in the postoperative period is too great. Since the removal of damaged areas of the joint and the installation of the prosthesis before the complete restoration of the function usually takes no more than three weeks.

What can be treated with untreated osteoarthritis?

Over time, osteoarthritis does not reverse, but only worsens, especially with the persistence of provoking factors. Consider the main sources of danger to the health and life of a patient with osteoarthritis.

  • Chronic pain of varying intensity is a very important risk factor, especially in the elderly. Constantly experienced discomfort can lead to sleep disturbance, reduced background mood and even depression. Which chain of unfavorable events will draw the listed phenomena, it is difficult to predict.
  • Pathology of veins . Constant inflammation in the knee area, proliferation of bone osteophyte spines, which can mechanically injure the popliteal vessels, can lead to the development or progression of varicose veins of the shins. Sometimes orthopedic surgeons refuse to operate their knees until varicose nodules are removed, but surgeons-phlebologists (specialists in veins) do not start operations on veins until there are pronounced changes in the knee joints.
  • Decreased limb function . With a far-reaching process, the joint can completely lose its ability to move, and this, in most cases, is a sign of disability.
  • Involvement of other joints . We have already figured out how such a seemingly common phenomenon as flat feet can pull the knee and lead to the development of osteoarthritis. Similarly, along the chain, there is involvement of the knee joint in the painful process from the opposite side. If the patient neglects the recommendations, refuses to wear the cane, preferring to "limp on his own two", soon arthrosis of the hip joints develops quite soon. The legs are warped, the gait becomes a "duck".
  • Immobility . This serious complication of the disease occurs when the joint bones are severely damaged, cartilage is absent, movement in the joint is severely painful or impossible at all due to the fusion (this is called "ankylosis") of the bones with each other. In this situation, only an operation can help a patient, but only if it is technically feasible. Immobility is dangerous in a general sense: it becomes the cause of obesity, osteoporosis, muscle atrophy, rapid development of diseases of internal organs. In addition, an immobilized person, of course, constantly needs to care for himself.
  • Inoperability . Unfortunately, there are a number of conditions that make the operation impossible, and one of them is far-gone, "neglected" osteoarthritis in patients older than 80 years with severe concomitant diseases.

Prevention of arthrosis of the knee joint

- to exclude traumatization of the joint. It would seem: there is nothing easier. At the time to give up jumping, running, walking the stairs, dancing, high heels is not at all difficult. In practice, however, it turns out that this particular item causes the most protests from patients. A person, if he is recently ill, is usually not prepared for the fact that some important moment of his daily life will be missed. But if you do not follow these tips, there is a danger of a rapid decline in the quality of life and disability.

- Weight reduction and maintaining it within optimal limits is an extremely important recommendation! No matter how miraculous the effect of this or that remedy, obese people will not be able to appreciate it. Because while there is an overload of joints by excessive weight, microtraumas are repeated daily. This can reduce to "no" all diligence. In addition, for some treatments, obesity is a direct contraindication.

- walking with support. The universal rule for unloading a joint with a support is: a walking stick, a crutch or a handrail should be in the hand opposite the affected limb. That is, if the right knee hurts, the cane should be kept in the left, and vice versa.

- Flatfoot correction. It would seem, how can flatfoot and arthrosis of the knee joint be associated? It turns out, directly. If the foot is incorrectly installed (now we are talking about longitudinal or mixed flatfoot, not about transverse), there is a redistribution of the load in the knee joint. In this case, the weight of the body at the step is not on the center of the joint, but on the right or left part of it. Accordingly, the left or right meniscus suffers more, and as more suffers - wears out more quickly. Next comes the "turn" of articular cartilage where the meniscus does not cope with its function. This process ends with the formation of typical unilateral "arthrotic" changes in the knee joint (appearance of bony outgrowths).


| 16 January 2014 | | 5 212 | Uncategorized
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