One of the most common complaints doctors hear from patients is pain in the knees. It is not always possible to say immediately what causes this pain. Knee can be affected by various diseases, such as osteoarthritis of the knee joint. Also known as gonarthrosis.
Gonarthrosis is a non-inflammatory joint injury that often results in cartilage destruction, bone deformity, and limited mobility. The disease is coded M17 in the International Classification of Diseases (ICD-10).
All patients can be divided into two groups. The first group includes young people with one, less often both knee injuries, and more young men. They have an injury or knee surgery in their medical history.
The second group included obese, middle-aged or older people, mostly women, who also developed gonarthrosis in several parts of the body.
Symptoms of osteoarthritis of the knee
The symptoms of osteoarthritis of the knee gradually increase. Patients may not be aware that they have been ill for years until they experience an obvious deformity or severe pain in the knee.
At the same time, in the early stages of the disease, arthritis of the knee joint is often accompanied by unpleasant and painful sensations in the knees, and few people see a doctor.
Obese women are more prone to this disease, especially after the age of 40.
Varicose veins also contribute to the development of the disease. At this stage, it is possible to treat the disease at home without the use of tablets and ointments.
The pain does not appear suddenly, but gradually, over several years. They usually occur during sports, walking and other physical activities.
Acute pain may not be a sign of gonarthrosis, but it may be the result of a fracture, meniscus injury, or bruising. It is a severe pain that becomes a motivation to consult a specialist.
The pain often intensifies in the following cases:
- while walking;
- in the long run;
- during slopes;
- lifting the body from a sitting position;
- when carrying heavy objects.
The maximum load during these exercises affects the joints, so if the patient feels severe discomfort, it can already be diagnosed with stage II knee arthritis. A person tries to move less and take a static position to avoid pain, but with constant physical activity, the anxiety returns.
Osteoarthritis, which deforms the knee joint, is accompanied by a symptom such as deformity. It is already visible in the second or third stage of the disease. Its first signs: the knee is slightly swollen, but retains its shape. In later stages, there is a change in the shape of the knee, which makes one leg shorter or longer.
One of the most characteristic symptoms is a crisis in the joints, which is noticeable in the second and third stages. The main thing is that a healthy person has a deaf, dry crackle in the joints of a patient with a noisy crackle. This noise causes weakness of the garden apparatus or high mobility of the joints.
It is recommended to wear a knee brace to ensure immobility of the knee joint.
Forms of gonarthrosis
There are two forms of the disease:
- Primary: Occurs as a result of congenital abnormal development of the joints.
- Secondary: Occurs as a result of illness or injury.
The primary form of osteoarthritis of the knee joint often develops in childhood and occurs as a result of 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 (collapses, sprains, dislocations, fractures) that cause damage to the structure of bones, ligaments and cartilage. All this is a post-traumatic form of the disease.
- Operations performed during meniscus displacement disrupt the integrity of the knee structure.
- Too much load on the legs (typical for weightlifters).
- Obesity. Excess weight puts pressure on the cartilage of the knee joints.
- Passive lifestyle.
- Diabetes.
- Age.
- Arthritis (inflammatory process in the joints). Prolonged disease is accompanied by the formation of excess fluid in the joint space and causes complications.
- Metabolic disorders cause the deposition of salts.
- knee transplantation.
- Diseases that cause prolonged muscle cramps or vasospasm in the legs.
The development of the disease can be unilateral or bilateral. Trauma often causes left or right-sided gonarthrosis, and obesity is bilateral.
Stages of the disease
There are three stages of gonarthrosis:
- It can take months or even years from the onset of the first stage to the visible manifestations of the disease. The person complains of intermittent pain in the legs, especially in the morning when descending or descending stairs and getting out of bed. The pictures usually show a narrowing of the connection between the joints, and as a rule, patients use traditional medicine - ointments and tinctures - instead of going to the doctor.
- The second stage is characterized by more severe pain, which does not stop with the inactivity of the joint. A crack appears. Fluid collects in the joint cavity, and radiography shows bone deformation and growth. At this stage, the patient makes every effort not to move the affected limb. The attending physician prescribes injections and chondroprotectors - drugs that help restore 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 be corrected only by surgery, the patient must receive a complex of chondroprotectors. The patient's gait changes: he walks on half-bent legs or rolls sideways.
Causes of the disease. Risk groups
Overweight
Osteoarthritis, which often deforms, affects the elderly. There are women who are overweight after 40 years in the special risk group. The probability of pathology in obese people is 4 times higher than in people of normal weight. The example is simple: the heavier a person is, the faster the disease develops and the more severe it becomes. In this case, the form of the disease can be called acquired. It is the joints of the lower extremities that fall under the impact, because they are forced to carry the greatest load.
Overweight people also suffer from hormonal imbalances and metabolic disorders that contribute to the development of obesity and osteoarthritis.
Age
Those over the age of 60-65 can be called old. Osteoarthritis occurs in 65-85% of people in this population.
The reason is age-related changes that adversely affect the structure of the joints. Even ordinary walking can become a significant burden and stimulate the development of the disease, the old cartilage can no longer repair itself.
Congenital pathologies and hereditary factors
The disease can affect both young people and those who are not overweight. As a rule, the disease in such cases occurs due to congenital defects of the knee joints, for example, lack of intraarticular lubrication. Heredity also plays an important role.
However, the majority of patients with knee pain are people of respectable age. Osteoarthritis is rare among young people. Unfortunately, young patients do not always receive the necessary treatment, because not all doctors consider it necessary to pay attention to them.
High loads
People who earn a living through strenuous physical labor and athletes of all levels are also at risk for osteoarthritis of the knee joint. In this case, the disease becomes an occupational pathology.
Operations, injuries and other diseases
Surgery, trauma, various diseases of the joints can provoke the appearance of gonarthrosis.
When the cause is unknown, osteoarthritis of the knee joint is commonly referred to as idiopathic.
Diagnosis of osteoarthritis of the knee joint
This diagnosis is made on the basis of the patient's complaints, examination data, palpation of the patient's 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, as well as exclude other pathological processes (eg, tumors) in the tibia and femur. .
It should be noted that radiography may not show initial changes in the structures of the knee joint. Then the narrowing of the joint space and the compression of the subchondral zone are determined. The articular ends of the femur, and especially the tibia, dilate, and the edges of the condyles become pointed.
Auxiliary diagnostic methods are CT (computed tomography) and MRI (magnetic resonance imaging), which allow to study in more detail the pathological changes in bone structures and identify changes in soft tissues.
How to treat gonarthrosis of the knee joint
The more acute the disease, the more complicated the treatment of gonarthrosis. The chronic nature of the pathology may remain in remission when the active manifestations of the disease are minimized or completely eliminated.
Physiotherapy treatment with chondroprotective drugs gives positive results.
Treatment options include:
- drug treatment (chondroprotectors);
- surgical intervention;
- rehabilitation course (exercise therapy, massage, etc. ).
Medication treatment
The use of non-steroidal analgesics is prescribed with drug therapy. These medications help relieve pain and symptoms of synovitis (inflammation). Corticosteroids may be used if the pain is particularly severe or if the synovium of the knee joint is severely inflamed. These drugs have a stronger analgesic and anti-inflammatory effect than non-hormonal painkillers. Muscle relaxants and antispasmodics will help relieve periarticular muscle spasms.
Antioxidants and vasodilators improve cartilage nutrition. The main drugs for conservative treatment of the disease are chondroprotectors containing chondroitin and glucosamine sulfate (natural components of cartilage).
The use of pathogenetic drugs should be systematic and long-term.
Physiotherapy
Physiotherapy treatments (UHF, ultrasound or phototherapy) are considered additional tools to accelerate the healing process.
They also include:
- Acupuncture. This method eliminates muscle spasms near the affected joint, normalizes metabolic processes in them, and thus restores damaged cartilage tissue.
- Hirudotherapy. Leech treatment has the same effect as injections because it improves blood circulation.
- laser therapy. Such procedures eliminate inflammation, swelling, improve metabolism and neutralize pain.
- Cryotherapy. Treatment with both liquid nitrogen and ordinary ice at home is effective.
- Magnetotherapy. The effect of the magnetic field not only improves blood circulation in the tissues, but also eliminates swelling and inflammation.
- Electromyostimulation. With the help of micro-discharges of currents of different frequencies, muscles are restored and strengthened, and blood circulation in the extremities is improved.
Treatment of knee gonarthrosis with physiotherapy is effective because it reduces pain. The attending physician usually prescribes such treatment depending on the stage of the disease.
Physiotherapy
Exercise therapy for osteoarthritis of the knee joint is one of the main means of recovery of atrophied muscles, and it should be done very carefully and slowly. If the patient feels the pain return, exercise should be stopped.
Special knee braces should be worn during therapeutic exercises. The rehabilitation course also includes the use of these orthopedic devices, the purpose of which is to reduce the load from the injured knee to the cane or prosthesis. Patients with gonarthrosis are often prescribed to wear knee braces to relieve pain while walking.
Therapeutic gymnastics for gonarthrosis reduces the load on the damaged joint by developing the muscles of the legs. Joint loading exercises are strictly contraindicated. Water gymnastics and swimming are ideal activities.
Orthopedic therapy
The patient should use a cane to reduce the load on the affected joints. A good helper for osteoarthritis of the knee are orthopedic shoes that provide natural foot position and even load distribution.
Massage
Massage relieves muscle spasms, reduces pain and increases range of motion. This procedure also improves blood circulation and provides joint nutrients.
Surgical intervention
Significant reduction in ability to work (especially up to 45 years) requires surgical treatment. The choice between corrective (osteophyte removal) and radical (knee arthroplasty) treatment depends on the stage of the disease, the patient's age, symptoms and other factors.
Nutrition
When it comes to a special diet for gonarthrosis, it is mostly aimed at reducing the weight of the patient, because it is overweight, which leads to overload of the joints. It is recommended to eat small portions every 3 hours, eat lean meat (chicken, turkey, rabbit) and exclude fatty pork, get the necessary protein from legumes.
Refined oil should be replaced with unrefined oil, salt intake should be limited. The therapeutic diet also includes the rejection of canned foods, fried and smoked foods. To restore damaged cartilage, the body needs to be supplied with carbohydrates from cereals and whole grain flour.
In addition, it is recommended to drink freshly squeezed juices such as carrots, beets, apples to remove toxins and reduce inflammation in the body.
Fish and various jelly act as chondroprotectors and help to restore cartilage not only in the initial stage, but also during periods of inflammation.
Folk remedies
There are many ointments, compresses, tinctures used by lovers of traditional medicine. These remedies are usually made from herbs, medicinal bile and help to improve circulation in the joints.
Compresses and ointments also relax the muscles, their effectiveness is very high, but they are practically useless in the third stage of gonarthrosis without the use of drugs.
Traditional medicine should not be neglected, as they help to alleviate anxiety and reduce many of the symptoms of the disease. But in any case, you should consult a doctor and do not self-medicate.
There are contraindications, you need to consult a specialist.
Prevention
It is recommended to follow the following principles of a healthy lifestyle:
- balanced diet;
- giving up bad habits (smoking, alcohol);
- sports;
- maintain a healthy weight;
- prevention of sports injuries (collapses, displacements, fractures).
Knee osteoarthritis has several treatment options depending on the patient's age and physical condition. To prevent and control the disease in the early stages, it is necessary to exercise, as well as timely treatment.