Deforming osteoarthrosis of the knee joints (aka gonartrosis or abbreviated DOA) is a degenerative-dystrophic disease of the knee joint, which is characterized by a chronic steadily progressive course, damage to all structural elements (hyalin cartilage, periastal bone structures, a synovial shell, a capsule and a joint of joint) and leadsarticular deformation, reduction of movements and often disability.
The disease begins with changes in articular cartilage, due to which the joint surfaces of the bones occurs.Disruption and loss of elasticity lead to its dystrophy (thinning) and resorption, while the bone tissue of the articular surfaces is exposed, sliding is disturbed, the joint gap is narrowed, the joint biomechanics changes.The synovial shell lining the joint and producing the synovial fluid is irritated (which nourishes the cartilage and plays the role of physiological lubrication), which leads to an increase in its amount in the joint (synovitis).Against the background of narrowing of the joint gap, the volume of the joint decreases, the synovial fluid sticks out the posterior wall of the articular capsule, the Becker cyst is formed (which, reaching large sizes, can cause pain in the popliteal fossa).The thin and delicate fabric of the articular capsule is replaced by a rough connective tissue, the shape of the joint changes.The periosurpital bone tissue is growing, osteophytes (pathological bone growths) are formed.Blood circulation in the periarticular tissues is disturbed, and underestimated metabolic products, irritating chemoreceptors, develops persistent pain syndrome.Against the background of a change in the anatomy of the joint, there is a violation of the work of the surrounding muscles, hypotrophy and spasm appear, a gait is disturbed.There is a persistent restriction of the volume of movements in the joint (contracture), sometimes so pronounced that only rocking movements (rigidity), or a complete absence of movements (ankylosis) are possible.
Gonarthrosis is a fairly common disease: they suffer from 10% of the total population of the planet, and at the age of older than 60 years it affects every third person.
The causes of gonarthrosis
- Injuries of bones and joints.
- Inflammatory joint diseases (rheumatoid, chlamydia arthritis, gout).
- Violation of mineral metabolism with various endocrinopathies (diabetes mellitus, parathyroid disease, hemochromatosis).
- Diseases of muscle apparatus and neuropathy (Charcot disease).
In addition to the main reasons, adverse background factors of the development of gonarthrosis are also distinguished, which include:
- overweight (literally exerts pressure on the lower limbs);
- age (the disease is mainly subject to the elderly);
- female gender (according to statistics in a woman, they get sick more often);
- Increased sports and professional physical exertion.
Symptoms of osteoarthrosis of the knee joints
- The pain that increases when walking and weakening alone.
- Difficulty of familiar, physiological movements in the joints.
- A characteristic "crunch" in the joints.
- The increase in joints in the amount and their visible deformation.
Stages of gonartrosis
Clinical stages of arthrosis of the knee joint
The disease goes through several stages.
- In the first stage, a person only feelsA small feeling of discomfortor “severity” in the knee that bothering during long -distance walking or increased physical exertion.The radiological examination will be uninformative: it is possible to identify only a small narrowing of the joint gap, there will be no other changes.
- The second stage is characteristicTangible pains, the severity of which is reduced at rest.There is a difficulty in joints in the joints, when walking, a characteristic “creak” is heard (from the patient you can hear a conventional phrase in everyday life - “the knees creak”).When conducting radiography, a clearly distinguishable narrowing of the joint gap and single osteophytes are found.
- When the transition of gonarthrosis to the next, third stage,pain will bother the patient constantlyIncluding at rest, there is a violation of the configuration of the joints, i.e.Deformation intensifying due to edema at the time of connection of inflammation.The radiographs determine the narrowing of the joint gap of a moderate degree and multiple osteophytes.In the third stage, many are already applying for medical help, becauseThe quality of life suffers significantly due to pain and difficulty in normal walking.
- The fourth stage is accompaniedSurrounding, exhausting pain.The minimum attempts to move become a difficult test for humans, the deformation of the joints is visually noticeable, walking is extremely difficult.X -ray reveals significant changes: the joint gap in the pictures is practically not determined, multiple rude osteophytes, “articular mice” (fragments of the destructive bone that fall into the joint cavity) are detected.This stage of gonarthrosis almost always entails disability.
Who treats arthrosis of the knee joint?
Therapist, rheumatologist and general practitioner (family doctor) can provide qualified medical care for gonartrosis (family doctor), but these experts are treating the knee joint with uncomplicated arthrosis.When a synovitis occurs or the treatment prescribed by the therapist does not give the proper effect, you can not do without the help of an orthopedist.In situations where surgical care is required, the patient is sent to a specialized orthopedic-traumatological department.
How and what to treat arthrosis of the knee joint?
The methods of treating arthrosis of the knee joint, known on the present day, are divided into non -drug conservative, medication and surgical.
Non -drug methods
Many patients are wondering: "How to cure arthrosis of the knee joint without pills?"Responding to him, with regret it is necessary to state that gonartrosis is a chronic disease, it is impossible to eliminate it forever.However, many methods existing today can significantly slow down its progression and improve the quality of the patient, especially when used in the early stages of the disease.
With timely seeking a doctor, and the patient’s sufficient motivation for healing, sometimes it is enough to eliminate negative factors.For example, it is proved thatreduction of overweightreduces the manifestation of the main symptoms of the disease.
Exclusion of pathological physical exertion and on the contrary,Classes of therapeutic gymnasticsWith the use of rational physical programs, they reduce the intensity of pain.It is proved that exercises to strengthen the strength of the four -headed hip muscle are comparable in effect with anti -inflammatory drugs.
If we treat arthrosis of the knee joint, then we must strive forproper nutrition: to improve the elastic properties of articular cartilage will help products containing a large amount of animal collagen (dietary varieties of meat and fish) and chondroitin (shrimp, crabs, kril), saturated with vegetable collagen and antioxidants, fresh vegetables and fruits, and passion for smoked meenas, conservatives, sweet and perechen dishes, sweet and paved dishes, sweet and paved dishesOn the contrary, a violation of metabolic processes in the body and the accumulation of excess weight up to obesity are potentized.
The complex treatment of arthrosis of the knee joint also involves the appointment of very effective even with advanced forms of the diseasePhysiot -Procedure.With widespread use in different categories of patients suffering from this disease, has proved its effectivenessMagnetotherapy: After several procedures, the intensity of pain decreases, as a result of improving blood circulation, reducing edema and eliminating muscle spasm increases the mobility of the joint.The effect of magnetotherapy is especially vivid during the development of active inflammation in the joint: the severity of edema is significantly reduced, the phenomena of synovitis regress.Not so popular, but no less effective in treating the knee joint with arthrosis are such methods of physiotherapy asLaser therapy and cryotherapy(Cold exposure), possessing a pronounced painkiller effect.
Drug treatment
In the schemes of effective treatment of arthrosis of the knee joint, the drugs below are used.
Non -steroidal anti -inflammatory drugsproduced in the forms for the external (various gels, ointments) and systemic use (tablets, candles, solutions), have long proved their effectiveness in the treatment of osteoarthrosis and are widely prescribed by doctors.Blocking inflammation at an enzymatic level, they eliminate joint pain and their swelling, slow down the progression of the disease.It must be remembered that a prolonged systemic technique can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract, and also negatively affect the functions of the kidneys and liver.Therefore, patients, taking the drug for a long time, should also prescribe drugs that protect the gastric mucosa and regularly monitor the laboratory indicators of the work of internal organs.
Glucocorticosteroids (GKS)- Hormonal drugs with a pronounced anti -inflammatory effect.Being a powerful anti -inflammatory agent, the GCS have certain contraindications, because they are able to call a number of significant side effects.In system forms for gonarthrosis, they are practically not prescribed.As a rule, effective treatment of arthrosis involves injections of GCS into peri -human pain points, which increases the intensity of the fight against inflammation and minimizes the risk of undesirable side effects of the drug.With a single introduction of the GCS, the effect of its use lasts up to 1 month.In accordance with national recommendations for the treatment of osteoarthritis, you should not perform more than three injections of the drug per year in the same joint.
With the far -go, “neglected” osteoarthritis, when a person experiences unbearable pains that do not even subside at rest, violating normal sleep, prescription is possibleopioid painkillers.These drugs are used only according to the prescription of the doctor, who considers the feasibility of their appointment in each case.
Chondroprotectors(with a literal translation - “protecting cartilage”).This name is understood as various medications united by one property - a structural -modifying effect, i.e.the ability to slow down degenerative changes in cartilage and narrowing of the joint gap.They are produced in forms both for oral administration (glucosamine, chondroitin sulfate, piastaline), and for introduction to the joint cavity (hyaluronates).Of course, these medicines do not perform a miracle and do not “grow” a new cartilage, but they can suspend its destruction.To achieve a persistent effect, they must be used for a long time, regular courses several times a year.
Surgical treatment of knee joint arthrosis
The most popular type of surgical care for gonarthrosis isEndoprosthetics, i.e.Removing your own joint with a simultaneous installation of a metalloprosthesis replacing it, the design of which is similar to the anatomy of the knee joint of a person.At the same time, a prerequisite for this type of surgical treatment is: the absence of gross deformations of the charter, formed “false joints”, muscle contractures and pronounced muscle atrophy.With severe osteoporosis (a significant decrease in the mineral density of bones), the endoprosthetics also does not show: the “sugar” bone will not withstand the introduction of metal pins, and at the place of installation, the rapid renewal (resorption) of bone tissue will begin, pathological fractures may occur.Therefore, a timely solution to the issue of the need to install an endoprosthesis is so significant - it should be accepted when the age and general condition of the human body still allow you to perform surgery.
Despite the widespread prevalence of endoprosthetics of the knee joint, the results of such operations are often unsatisfactory, and the percentage of complications is high.This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (replacing the hip joint is much easier in technical terms).
Artromedullary shunting- connection of the bone marrow canal of the femur with the cavity of the knee joint using a shunt - a hollow metal tube.Due to this, fat bone marrow from the lower third of the femur enters the knee joint, nourishing cartilage and lubricating it, which achieves a significant decrease in pain.
Summing up the above, I would like to note that the treatment of gonarthrosis is a complex social task.And although today medicine is not able to offer a drug that eliminates it forever, or other ways to completely cure this ailment, a healthy lifestyle, timely seeking medical help and the implementation of the doctor’s recommendations can suspend its progression.