Go Osteoarthritis of the knee joint (gonarthrosis), treatment of osteoarthritis of the knee joint
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Osteoarthritis of the knee

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



Still "arthrosis" or "arthritis"?

Osteoarthritis of the knee Do not mix these two concepts. Osteoarthritis is the process of primarily changing the structure of the joints, and arthritis is an inflammation that could occur on the background of an “intact” structure, as well as on the background of arthrosis.

Bone changes in arthrosis can be compared, for example, with knotted growths on a tree trunk, which grows close to the concrete fence and with all its weight puts pressure on this fence.

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

With age, and especially in the presence of hereditary predisposition, the articular cartilage becomes thinner. That is why the bones of the hip and shin, which constitute the ends of the knee joint, dangerously approach each other, and there may even be friction between them.

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

If there is a physical overload of the joint, then bone outgrowths appear on the bone surfaces and begin to grow, more like cusps, or spikes. For the knee joint, such an overload will be weight lifting (including overweight of your own body!), Physical work with emphasis on the knees (for example, weeding the vegetable garden), constant walking on stairs, running, wearing uncomfortable shoes, flat feet and many others. Now it is not difficult to imagine what happens inside the knee joint during the development of arthrosis, and how it manifests itself externally.

How is the joint? What is articular cartilage?

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

Most human joints are made up of bones, the synovial (articular) membrane and the intra-articular fluid.

What happens to a joint with arthrosis?

Under the influence of all those loads, which have already been mentioned, compaction and proliferation of the subchondral bone occurs, as a result of which - increased trauma to the articular cartilage.

The products of cartilage destruction resulting from microtraumas enter the synovial fluid. So arranged by nature that they are foreign substances for the synovial membrane and provoke its inflammation. The formation of synovial fluid, which is usually a sort of "conveyor", similar to the continuous circulation of blood enrichment and purification, is impaired. In addition, in the joint fluid becomes less hyaluronic acid. About this acid is worth to talk especially.

Hyaluronic acid provides 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 in consistency, but not water. Another important role of hyaluronic acid is to ensure the delivery of nutrients from the joint fluid deep into the articular cartilage, since there is no more food for it to take: blood vessels do not fit directly to the cartilage. In the same way, the removal of "waste" substances from the cartilage into the joint fluid: with the help of hyaluronic acid molecules.

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

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

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

Diagnosis of osteoarthritis of the knee joint

Inspection

In the early stages of the disease, the joint is not changed, it is mobile, the muscles around it are preserved, and quite strong. Only with palpation (pressure) of certain points, often on the inner surface of the joint, local (local) pain is determined. The doctor asks the patient to perform several squats, bend, straighten the leg at the knee, puts it face up on the couch and performs the flexion-extension itself (this is called “passive” movements). In addition to pain and limiting the range of motion, you can determine the crunch, the clicking on of the joints. With a pronounced inflammatory component, the joint is enlarged in size, it seems that it is “pumped” with fluid. In the case of a far advanced process, bending in the knee may be partially or completely absent, when viewed, the surface of the joint appears uneven, uneven, the limb may be curved (displacement of the axis of the extremity, "quilting").

Laboratory and instrumental studies

- The compulsory laboratory examination program includes general, biochemical and immunological blood tests, urinalysis . In general, a blood test will draw attention to itself: an increased level of leukocytes and an increased erythrocyte sedimentation rate, which indicates inflammation. In the biochemical analysis of blood, indicators of uric acid metabolism and the level of “hepatic” enzymes are important. In the immunological analysis will determine the presence or absence of signs of systemic inflammation - this is evidenced by the level of C-reactive protein. Urinalysis will reveal the content of "sand" - uric acid crystals.

- analysis of synovial (articular) fluid is appointed in the case when this fluid is in sufficient quantity. That is, when the joint is swollen, swollen. Under conditions of sterility, the doctor pierces the joint capsule in a strictly defined place, inserts a needle into the joint cavity, and then removes excess fluid. Part of the material received enters the laboratory for analysis. At the end of the procedure, an anti-inflammatory drug from the group of glucocorticosteroids (for example, diprospan) is most often injected into the joint cavity with a syringe.

- X-ray . It is mandatory to take a picture of both knee joints, it is necessary to compare the sick knee with a healthy one. The picture draws attention to the width of the joint space (it is judged on the condition of the menisci and cartilage), the presence or absence of osteophyte bone spines, signs of destruction (destruction) of bones.

- Ultrasound of the knee joints will answer questions about the safety of the meniscus, the presence of a Baker cyst, the severity of inflammation, the presence or absence of uric acid crystals (if there is gout).

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

- Arthroscopy . Allows you to visualize, that is, to personally assess the condition of the joint. The method is indispensable for controversial diagnoses, the suspicion of traumatic damage to the menisci and ligaments (then, right during the study, it is possible to promptly remove broken menisci or stitching the ligaments).

Treatment of osteoarthritis of the knee

It is necessary to adhere to the principles of complex treatment, which include:

  1. Detailed patient information about the disease
  2. The use of physical therapy, which includes: specific exercises for the joints in the prone position, swimming
  3. Maintain optimal body weight
  4. Wearing an orthosis (soft band, or at least an elastic bandage) during increased stress on the joint — on the road, during a walk, and so on.
  5. Non-medicinal methods (physiotherapy). This type of treatment gives excellent results in cases of osteoarthritis of the knee joint (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, magnetic currents, UHF, cryo-effects can be used (translated from Greek means exposure to cold). Physiotherapy procedures are widespread, courses of treatment are usually short-lived - 10, maximum sessions daily or every other day. It should only be aware of 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 treatment of osteoarthritis:

  • relieve pain
  • delay the further destruction of articular structures
  • restore the lost function of the joint.

For anesthesia used drugs from the group of NSAIDs or NSAIDs - non-steroidal anti-inflammatory drugs. They are applied inside and in the form of applications (application to the skin). Applications (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 must make sure that there are no changes on the skin, whether it is rash, pustules or cracks. The general rule of local treatment is to use the chosen cream or gel at least twice a day, and in the event of unpleasant sensations, cancel until all manifestations disappear. Intramuscular administration of painkillers is currently not recommended, because the risk of side effects resulting from the injection with a syringe does not decrease, but rather the opposite. In case of severe inflammation, accumulation of a large amount of fluid, intra-articular glucocorticosteroid preparations (eg, diprospan) are allowed, but it should be noted that this procedure should be carried out no more than 1 time in 3 months.

A higher "level" of anti-inflammatory action in osteoarthrosis - drugs chondroitin or glucosamine . They, like NSAIDs, fight inflammation at the level of fine structures of the joints, but have fewer side effects and, most importantly, retain their anti-inflammatory effect for several months after withdrawal.

Chondroprotectors . This is a collective name for a group of drugs containing both chondroitin sulfate and glucosamine at the same time, the “building bricks” of cartilage. Despite the seemingly high cost of treatment with chondroprotectors, their convenience for patients and effectiveness cannot be overestimated. First, these substances, taken orally, are perfectly absorbed from the stomach, and the loss of medication “on the way” to the cartilage is minimal. Secondly, they are able to suppress inflammation in the joint, and, moreover, reliably slow down the process of destruction of the articular cartilage! Most often they are prescribed courses, because they have a rather long “after-effect”, which lasts for several months, and sometimes even up to six months.

Hyaluronic acid drugs are called hyaluronates . These funds are sold in the form of prepared syringes for intraarticular injection. Hyaluronates are an artificial synovial fluid. The effect of treatment with this method can last up to 12 months.

Surgical treatment of osteoarthritis of the knee

As with osteoarthritis of the hip joints, in the event of major changes and a permanent loss of function, we are talking about surgery. In case of gonarthrosis, two types of interventions are currently performed: arthrodesis (fixed joint) and endoprosthetics. The first operation is performed rarely, for particular reasons, when the installation of the endoprosthesis for any reason is impossible. The result of this operation is that the knee becomes immobile. But it does not hurt either. Much more advantageous in terms of function endoprosthesis surgery. Recall that with a large body mass, this operation is not performed - the risk of complications in the postoperative period is too great. From the moment of removal of damaged areas of the joint and the installation of the prosthesis to full restoration of function, it usually takes less than three weeks.

What can threaten untreated osteoarthritis?

Over time, osteoarthritis is not reversed, but only aggravated, especially while maintaining 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, lowered mood and even depression. It is difficult to predict what chain of adverse events will follow the listed phenomena.
  • pathology of veins . Permanent inflammation in the knee area, the growth of osteophyte bone spikes, which can mechanically injure the popliteal vessels, can lead to the development or progression of varicose veins of the lower leg veins. Sometimes, orthopedic surgeons refuse to operate on their knees until the varicose nodes are removed, but surgeons-phlebologists (vein specialists) do not begin surgery on the veins while there are marked changes in the knee joints.
  • decreased limb function . With a far-reaching process, the joint may completely lose the 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, like flat feet, can “pull” the knee joint and lead to the development of osteoarthritis. Similarly, along the chain, the knee joint is involved in the painful process from the opposite side. If the patient neglects the recommendations, refuses to carry the cane, preferring to "limp on his own two," arthrosis of the hip joints develops rather quickly. Legs bend, gait becomes "duck".
  • immobility This serious complication of the disease occurs in those cases when the bones of the joint are severely damaged, there is no cartilage, movement in the joint is extremely painful or impossible due to the accretion (this is called "ankylosis") of the bones with each other. In this situation, the patient can only help the operation, but only if it is technically feasible. Immobility is also dangerous in a general sense: it causes obesity, osteoporosis, muscle atrophy, and the rapid development of diseases of internal organs. In addition, the immobilized person, naturally, constantly needs self-care.
  • inoperability . Unfortunately, there are a number of conditions that make the operation impossible, and one of them is far advanced, “neglected” osteoarthritis in patients over 80 years old with severe concomitant diseases.

Prevention of osteoarthritis of the knee joint

- eliminate trauma of the joint. It would seem: there is nothing easier. For the time being, it is not difficult to give up jumping, running, walking upstairs, dancing, high heels. In practice, it turns out that it is this point that causes the most protests from patients. A person, if he has recently been ill, is usually not ready 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 in the optimal range - a very important recommendation! No matter how miraculous the effect of this or that means, obese people will not be able to appreciate it. Because while the overload of the joints is overweight, microtraumas recur daily. This can reduce to no. In addition, obesity is a direct contraindication for some treatments.

- walking with support. A universal rule for unloading a joint with a support is: a cane, 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.

- correction of flatfoot. It would seem, how can flatfoot and arthrosis of the knee joint be connected? It turns out directly. При неправильной установке стопы (сейчас говорим о продольном или смешанном плоскостопии, не о поперечном) происходит перераспределение нагрузки и в коленном суставе. В этом случае тяжесть тела при шаге приходится не на центр сустава, а на правую или левую его часть. Соответственно, больше страдает правый или левый мениск, а поскольку больше страдает – быстрее изнашивается. Далее приходит «очередь» суставного хряща там, где мениск не справляется со своей функцией. Завершается этот процесс формированием типичных односторонних «артрозных» изменений коленного сустава (появление костных выростов).


16 Январь 2014 | 5 212 | Uncategorized
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