Any type of arthrosis occurs with degenerative and dystrophic processes in the joint tissue. The disease always becomes chronic in nature and does not heal completely, it can only slow down or stop its progression.
According to ICD-10, gonarthrosis (damage to the knee joints) belongs to the group under the code "M17". In treatment, the emphasis is on drug therapy, and surgery is applied only when the course is advanced.
What happens to the knee joint in arthrosis?
Knee arthrosis is accompanied by degenerative and dystrophic processes that develop continuously without treatment. In this case, inflammatory processes are not observed, except in rare cases.
Joint degeneration and dystrophy at first have virtually no effect on knee function. Over time, these processes lead to damage to the structure of the joint, stop "slipping", bumps appear on its surface (due to deforming changes).
Blood circulation decreases, local metabolism (metabolic processes) deteriorates, which only increases the rate of disease progression. The degenerative process of hyaline cartilage begins very quickly, with thinning and stratification, and later the appearance of cracks on it.
The end result of the disease is the complete destruction (destruction) of hyaline cartilage by exposure to the adjacent bone. But the problem doesn’t end there: due to bone exposure, the latter begins to thicken and bone growths appear on it (often in the form of thorns).
All this also leads to deformation of the affected limb, followed by its curvature. This is why the disease is also called "deforming arthrosis. "With a pre-existing deformity of the limb, the disease cannot be cured without surgery.
Causes of the disease
The onset of knee arthrosis is most often preceded by the appearance of a number of predisposing factors. No congenital risk factors are needed at all, the disease is very often developed with acquired factors (trauma, infection, inflammation).
Main reason:
- Severe disorders of the body's metabolism / metabolism (any acute or chronic disease of the thyroid gland, adrenal glands).
- Circulatory disorders and tendency to capillary bleeding (due to their fragility).
- Overweight (Stage II-III Obesity), with a severe increase in the load on the musculoskeletal system as a whole.
- Injuries to the knee joints (including direct injuries, penetrating wounds, ligament ruptures, meniscus injuries, fractures, dislocations and subluxations, cracks).
- Recent inflammatory pathologies (primarily arthritis or rheumatism).
- Excessive physical activity (people at risk include athletes, gymnasts, tennis players, footballers, basketball players).
- Consequences of a long-standing, poorly treated knee injury.
- Congenital disorders and abnormalities in the structure of joint tissues, hereditary risk factors (genetic mutations).
There is a direct link between the cause and severity of arthrosis. When caused by metabolic abnormalities or severe injuries, the prognosis is worse than when arthrosis develops against the background of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically, osteoarthritis of the knee joint is very common; it usually occupies one of the leading positions among all forms of arthrosis. About 20% of patients admitted to specialty health care facilities suffer from gonarthrosis.
If all diseases of the knee joints are taken into account, the rate of arthrosis falls in about 53% of cases. Recently, the number of cases of gonarthrosis in the population has increased, especially in developed countries.
This is associated with an increase in average life expectancy (the older a person is, the greater the risk of this form of arthrosis) and the predominance of a sedentary lifestyle. And that’s really a problem because doctors are still not able to completely cure gonarthrosis.
Why is gonarthrosis dangerous?
The main risk of gonarthrosis is a disability caused by the development of complications that are not suitable for conservative therapy. First, it is a deformation of the joint and bone of the affected limb. Disability is already possible in the third stage of the disease.
The second danger is the development of chronic severe pain, which can disturb the patient so much that he cannot sleep normally. Constant awakening due to knee pain is one of the most common problems in stages 3-4 of gonarthrosis.
Fatal consequences do not occur precisely because of gonarthrosis. Theoretically, serious injury can occur due to a sudden joint jam. This is a so-called symptom of joint blockade, most commonly observed in stages 3-4 of the disease.
The degree of gonarthrosis and the difference between them
The disease is divided into four stages, which differ in the severity of the course, the severity and number of symptoms, and the final prognosis. In addition, all stages of arthrosis are treated in a special way (although differences in treatment regimen may seem small to a non-physician).
Degree of gonarthrosis:
- first degree: the disease does not manifest in any way, only a slight discomfort is possible, but in general the patient feels well and therefore it is very problematic to diagnose the disease in the first stage;
- second degree: severe painful feelings, especially after a long walk or standing; during physical activity a characteristic cracking develops, the process of atrophy of the quadriceps femur can already begin;
- third degree: the pain becomes excruciating, the patient is constantly disturbed, deformation changes expressed in the joint appear, becomes hot to the touch, normal walking or even more running is impossible;
- fourth degree: very difficult with severe deformities of the joint and constant pain that does not even allow the patient to sleep; joint dysfunction is so pronounced that ankylosis (complete immobilization of the affected joint) is possible.
The first two degrees of gonarthrosis are considered conditionally favorable because they do not interfere with a person’s normal life. The last two stages are very severe and lead to disability.
Symptoms of gonarthrosis at different stages
The clinical picture of gonarthrosis depends on the stage of the disease. In the first stage, there may be no symptoms, while in the fourth stage, they are very pronounced and do not stop bothering the patient even during strong medication.
Symptoms of the first stage:
- Mild discomfort or pain with a heavy load on the joint.
- Barely noticeable crackling.
- Subtle increase in joint size.
Symptoms of the second stage:
- moderate pain, which usually occurs during exacerbations and remissions;
- the joint warms up to the touch;
- redness of the affected joint is possible;
- moderate knee disorders (walking and running are still possible, but with some difficulty);
- increased pain in the morning and after long standing.
Symptoms of stage 3:
- severe pain that bothers the patient day and night, but during the exacerbation periods (causes of exacerbation in all patients) the pain intensifies several times;
- visible deformation changes in the knee, increase in size;
- the affected joint becomes hot to the touch;
- normal movement is impossible due to partial immobilization of the joint;
- possibly the curvature of the lower leg.
Symptoms of stage 4:
- the pain becomes unbearable, not allowing the patient to do everyday things (including intellectual things, as the pain impairs cognitive functions);
- the appearance of arthritis due to the accumulation of effusion in the cartilage cavity of the knee;
- the deformation changes are now visible not only in the joint but also in the limb as a whole;
- feeling of fluctuation when touching the patella and surrounding tissues;
- almost complete or even complete immobilization of the knee joint (in this case, only surgery helps to restore limb function).
If pain cannot be eliminated or significantly reduced in stages 3-4 of arthritis, doctors resort to painkillers, but blockages cannot be performed daily.
Diagnostics
In the diagnosis of knee arthrosis, the emphasis is on imaging techniques, while laboratory tests usually show nothing.
Diagnostic methods used:
- Orthopedic examination by palpation of the affected joint, linear measurement of bones, angiometry.
- Clinical blood tests (whole and erythrocyte sedimentation / ESR), determination of fibrinogen levels in blood and urine, and in particular urea, and other biochemical parameters.
- X-rays (narrowing of the joint space, deformities, cartilage sclerosis, accumulation of salts and even bone osteophytes are revealed).
- Ultrasound examination (for differential diagnosis only).
- Magnetic resonance imaging or computed tomography (most informative, in terms of imaging, diagnostic methods).
In general, an X-ray is sufficient to make a diagnosis, especially if the disease is advanced. In relatively rare cases, computed or magnetic resonance imaging is required.
Treatment of gonarthrosis: methods
The treatment of osteoarthritis of the knee is only complex, as no treatment is separated from others with a good effect (not even with drugs). The treatment is long, can take years, and is sometimes prescribed for the rest of your life.
Treatment methods used:
- drug therapy - the basis of treatment;
- physiotherapy exercises;
- diet therapy;
- physiotherapy treatment;
- surgical intervention.
The most important thing in the treatment of arthrosis is the systematic nature of the process and the unquestionable adherence to the recommendations of the treating physician. Attempts to treat gonarthrosis on their own, including disregarding a doctor’s prescription, usually end in a disability.
Practice therapy
Physiotherapy practices are best suited for the treatment of stages 1-2 of knee arthrosis. At such stages, this is almost the main method of treatment, as physical education can slow the progression of the disease and eliminate most of the symptoms.
However, there is no particular sense from classical physical education, it can be harmful. Therefore, special exercises are prescribed to the patient and individually (since gonarthrosis may develop differently in each patient).
There is no time frame for treatment with practice therapy methods - ideally you should perform the prescribed exercises throughout your life, from time to time you should see a doctor for dynamic joint control. It is very helpful to combine training therapy with exercises in the pool (where the strain on the joints is much lower).
Diet
Although nutritional correction can be very helpful, it is not a mandatory treatment method. Diet therapy gives noticeable results in only 40% of cases, and usually in people whose development of arthrosis has been provoked by endocrine pathologies.
The patient is instructed to give up fatty, fried, salty and smoked foods. The use of alcoholic beverages is banned, and sometimes smoking is also prohibited. At the same time, large quantities of vegetables, fruits and meat products are required to be consumed.
In this case, the sausage, sausage or Viennese cannot be called a meat product. The patient is instructed to eat lean meats, especially cooked chicken (due to its relatively low calorie content and high protein content).
Physiotherapy
Physiotherapy procedures are only useful in relieving the symptoms of arthrosis, but do not directly affect the disease. That is, it is impossible to cure even the first stage of arthrosis with the help of physiotherapy, regardless of what some "professionals" say there.
Physiotherapy is good for relieving pain, but only if it is mild. In severe pain (stage 3-4 of arthrosis), physiotherapy does not help, as do most medications (especially oral).
The most preferred treatments for arthrosis are magnetotherapy, quantum therapy, mud therapy, acupuncture and hirudotherapy (leech therapy). Physiotherapy techniques for shock are prohibited due to the risk of further joint damage.
Operation
Surgery is only needed in stages 3-4 of the disease, when conservative methods are no longer needed. Different types of procedures can be used: drainage of the joint cavity, removal of bone osteophytes, replacement of the joint (prosthetics).
Transplantation is best for restoring joint function, but the problem is that it is a very expensive procedure. As a result, only 10-15% of patients can afford such surgery. But even with the amount of money required, it is not always possible to change the bond.
The fact that such a procedure is contraindicated in patients with severe conditions or in patients older than 65-70 years. Keep in mind that all knee surgeries have complications (even fatal complications are possible, but are very rare).
Medicine
In addition to physiotherapy practices, it is the basis and mandatory element of treatment. If other procedures can still not be used, load therapy is impossible without drug therapy (traditional medicine cannot replace drug therapy).
The patient is prescribed painkillers (with severe pain - blockade), decongestants, muscle relaxants, antihistamines. Chondroprotectors are often prescribed, hyaluronic acid injection is possible (replaces physiological lubrication of the joints).
Indeed, drugs can only affect the disease in stages 1-2 of arthrosis. In stages 3-4 of the disease, drug therapy is only used to treat the symptoms, while nothing but surgery can affect the disease.
Shades of treatment in the stages of exacerbation and remission
Approaches to treat knee inflammation differ slightly during exacerbation and remission. In the exacerbation phase, aggressive therapy is used to restore joint function as quickly as possible and to eliminate symptoms.
Pain culminates precisely at the stage of disease exacerbation, so drug blockades may be prescribed in such cases.
Non-steroidal anti-inflammatory drugs may be prescribed. Although arthrosis usually progresses without inflammation, it can occur in the acute stage. The patient prescribes bed rest, minimal strain on the affected joint, and avoiding overheating of the limb.
On the contrary, in the remission phase, physical exercises are prescribed and an increase in physical activity is usually prescribed. This is because normal gait is possible in the remission stage, as joint function improves and the pain is usually of moderate intensity.
Remission should be used skillfully - this is the period when pool hours, rehabilitation therapist hours, and attempts to restore joint function are possible. You cannot be without medication at this stage.
Chondroprotectors, oral analgesics, are most often prescribed (at the patient's discretion, because if the pain is barely noticeable, it is not necessary to take them). Ointments, gels and creams, including those with a warming effect, may be prescribed (which is better not to be used during aggravation).
In addition, massage may be prescribed, including manual therapy (only if the disease is in stage 1-2). With the permission of your doctor, special gymnastic techniques may be used.
Remission is the ideal time for physiotherapy, but the choice of special physiotherapy should be made by the doctor, not the patient. Finally, hyaluronic acid preparations may be injected during remission, if necessary.
As arthrosis worsens, hyaluronic acid is not prescribed because such injections lead to severe consequences in the background of inflammation. Please note: the injection should only be given by a properly trained person.
Ordinary doctors, and even more so mid-level medical personnel (ambulances, nurses), should not administer such injections. Self-injection into the joint is associated not only with disability but also with death (due to the risk of anaphylactic shock or a blood clot if the needle accidentally enters the vessel).
Prognosis of treatment
The prognosis for the treatment of gonarthrosis varies depending on the stage of the disease and the patient's general health. If this is 1-2. Stage, and treatment is started immediately, the prognosis is very good, especially in people of working age.
In stages 3-4 of arthrosis, the prognosis is extremely poor, both in young patients and the elderly. Although it has been noticed that young people tolerate arthrosis much more easily at such stages, it inevitably leads to disability.
However, arthrosis stage 3-4 is not equal to the sentence. In fact, with the help of surgery, you can try to restore the full functionality of the knee, if not all of its functions, then most of it. Implanting an artificial joint can give excellent results.
Prevention of knee arthrosis
Arthritis is a group of diseases that can be completely prevented by following fairly simple preventive measures. Of course, such measures do not guarantee 100% protection, but can reduce the risk of disease (especially in vulnerable people).
Preventive measures:
- It is necessary to avoid unnecessary strain on the joints (such loads include professional sports).
- Rational diet with a predominance of fruits and vegetables in your daily diet.
- Maintaining good physical shape, regular gymnastics.
- Prevention or elimination of obesity (more weight - more stress in the joints of the body).
- Preventive treatment with chondroprotectors after the age of 45 (only after consultation with your doctor).
- Adequate daily fluid intake (approximately 1. 5 liters of water per day), minimizing salt intake.
The most important thing is not to overdo physical activity, as it is only moderately useful (if there is no musculoskeletal system). Physical education is beneficial, sports are not, especially for the joints and the cardiovascular system.