Have you ever had knee pain? It is extremely uncomfortable when you suddenly start to limp or you cannot go down without knee pain. Osteoarthritis of the knee joint is not life-threatening, but drastically worsens its quality.
What is osteoarthritis of the knee?
Osteoarthritis of the knee(gonarthrosis, arthrosis, osteoarthritis of the knee joint). Gonarthrosis is an arthrosis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing but surgery helps. Do you need it? Then do not fall into this state.
Causes of osteoarthritis of the knee joint.Distinguish between primary and secondary osteoarthritis of the knee joint. If the cause of the disease is not established, then such arthrosis is called primary, it is inherited through the maternal line. If the grandmother suffers from osteoarthritis of the knee joints, then the daughter and granddaughter may have this disease at a younger age.
Secondary osteoarthritis develops as a result of trauma, congenital anomalies of the knee joint, physical overload (sports, occupational), endocrine disorders.
Risk factors are overweight, female gender, old age. Cartilage is very sensitive to the reduction of female sex hormones, with menopause all joints begin to "collapse". Therefore, overweight older women suffer from osteoarthritis of the knee joint more severely and more often.
Anatomy of the knee.The knee joint is formed by the femur, tibia and patella. The articular surfaces of the bones are covered with a layer of cartilage. The additional cartilage spacers between the bones are called menisci and soften. The knee joint has the largest synovium, which forms large curves and bursae.
The joint cavity is filled with synovial fluid, which nourishes the articular cartilage. Synovial fluid contains hyaluronic acid, which is needed for the smooth sliding of joint surfaces. Ligaments, muscles and their tendons direct and restrict movement in the joint.
General description.In osteoarthritis of the knee joint, the destruction of the articular cartilage occurs. There are three stages of osteoarthritis of the knee. In the first stage, the nutrition of the articular cartilage and menisci is disturbed. The cartilage loses its elasticity and cracks. Unusual friction occurs between the bones. Joint congestion is accompanied by inflammation and pain in the knee.
In the second stage, the destruction of articular cartilage and menisci begins. The bone reacts to the load with marginal growths - osteophytes ("spikes"). The amount of intra-articular fluid decreases, the narrowing of the joint space increases. As a result, knee pain occurs during normal exercise, walking.
The third stage reveals a pronounced bone deformity of the knee joint with a sharp restriction of natural movements.
Symptoms of osteoarthritis of the knee.The main symptoms of osteoarthritis are pain, limited mobility and deformity of the knee joints. Osteoarthritis of the knee joints is long-term, with a slow, irreversible increase in symptoms. If the knee pain occurred suddenly, suddenly, for the first time, then most likely it is not osteoarthritis.
Osteoarthritis of the knee joint begins gradually with discomfort or slight pain in the knee during overload, prolonged walking when you go down, rising from a squatting position. At rest, the pain passes quickly.
In the second stage, the knee pain appears already under normal load. The volume of active movements in the knee joint decreases. The shape of the joint changes due to bone deformation and accumulation of abnormal fluid in the joint.
In the third stage, the pain becomes chronic, occurring not only during movement but also at rest. Night pains disrupt sleep. The knee is difficult to fit in bed without pain. Swelling of the joint indicates the addition of inflammation. Knee mobility is reduced to a minimum.
The joint is significantly deformed, the legs become O- or X-shaped. In severe cases, there is complete destruction of the joint with the development of ankylosis (immobilization).
In osteoarthritis of the knee joint there are 4 types of pain:
- the mechanical type of pain occurs under the influence of daytime physical activity and subsides during the period of night rest. These knee pains are associated with a reduction in the absorptive capacity of cartilage and bone structure. The pain in the knee is localized, as a rule, in the front and inner area of the knee joint and the upper part of the lower leg.
- nocturnal pain is associated with venous blood stagnation, increased intraosseous pressure in the joint, and inflammation.
- "Starting" pain occurs after a period of rest, disappears 15-20 minutes after movement in the joint. These knee pains are caused by friction on the joint surfaces, on which fragments of cartilage decay are deposited.
- constant knee pain is caused by muscle spasm as well as the development of synovitis.
Complications of osteoarthritis of the knee.Synovitis is an inflammation of the synovial membrane that covers the inside of the joint cavity. Signs of inflammation: swelling, fever, redness, pain, joint dysfunction.
The knee joint usually contains 3-5 ml of synovial fluid. In diseases of the joint there is increased production of inflammatory fluid. The amount of effusion (pathological fluid) can reach 30-70 and even more than 100 ml. The knee effusion first fills the cavity on the inside of the patella (medial fossa). As the volume increases, the upper volvula fills, with massive swelling above the patella ("horse saddle").
Baker's cyst occurs with a significant increase in the volume of intra-articular fluid. A round, elastic bulge forms in the popliteal area. This is not a tumor, it is not oncology and it is not necessary to have surgery. Baker's cyst can cause discomfort, pressure and pain in the knee when moving. The diameter of the cyst is from 2 to 6 cm. At even larger sizes, the cyst can compress the nearby peroneal nerve with the development of weakness and tingling in the foot.
Diagnosis of osteoarthritis of the knee joint.Laboratory tests are not useful for diagnosis, but are used to rule out other conditions with knee pain. In osteoarthritis, the indicators for blood picture without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. Uric acid levels are within normal limits.
Radiography shows bone changes in the joint, excludes traumatic causes of joint pain. In Bulgaria, X-ray classification of osteoarthritis by stages is used.
Stage 1 - the presence of marginal bone growths with a slight narrowing of the joint space;
Stage 2 - the joint space narrows more clearly, subchondral sclerosis occurs;
Stage 3 - sharp narrowing of the joint space, leveling of the joint surfaces, development of cysts;
MRI of the knee is indicated at an early stage of the disease, when no radiographic changes are yet visible, but the patient has typical knee pain. With the help of MRI you can assess the condition of cartilage, menisci, ligaments, tendons. Ultrasound of the knee joint helps to visualize the soft tissues (menisci, muscles, ligaments), to assess the volume of the effusion.
Arthroscopy is the most accurate method for diagnosing osteoarthritis of the knee joint. A special probe is inserted into the joint cavity and the doctor assesses the degree of cartilage destruction under a microscope.
Treatment of osteoarthritis of the kneepresents a difficult task. In any case, you must choose an individual treatment program.
When you start saying trivial things during the consultation, patients look surprised at first. Is that why we came? Make a miraculous injection so that my knee does not hurt again. We must explain that there is no single method to eliminate osteoarthritis. To recover, you need to move, lose weight, sign up for the pool. And a person wants to lie on the couch, grow a "beer belly", catch the problem with a bunch of drugs and be healthy. But alas !!! In this case, medicine is powerless.
Pain relievers do not cure, they simply relieve the pain. Anti-inflammatory drugs are prescribed only in the period of exacerbation of pain in the knee joints. Some of the non-steroidal drugs, by relieving the pain, contribute to the further destruction of the cartilage. Healing ointments do not cure osteoarthritis of the knee, but help to slightly relieve knee pain. In edema, redness of the joints, warming ointments and compresses are contraindicated; it is better to use topical medications with nonsteroidal anti-inflammatory drugs.
Chondroprotectors do not relieve pain, are expensive and must be taken for a long time. I consider them "mannequins" and practically do not prescribe them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this drug in my clinical practice and I do not have my own opinion on its effectiveness.
For the treatment and prevention of osteoarthritis of the knee joint it is necessary to engage in proper physiotherapy exercises in a sitting or lying position. Squats and jumps are strictly forbidden. Cycling, swimming or water exercises, skiing are useful. And labor exploits in the country often lead to increased knee pain. In osteoarthritis of the knee joints, running, brisk walking, lifting weights are not recommended.
Diet for osteoarthritis of the knee.The knee joints carry a load in the form of their own weight. Therefore, overweight people should lose at least 3-5 kg. And some patients need to lose more than a dozen pounds. Otherwise, no treatment will be effective. It is not necessary to "sit" on some kind of diet, it is harmful to the body.
You need to change your eating behavior for the rest of your life, just "stop loving" all harmful products (sweets, starchy foods, beer, etc. ). Proper nutrition should become a habit. To lose weight, you need toeat the right foods every 3 hours.
To reduce inflammation in the joints, homeopaths recommend foods that alkalize the blood and intra-articular fluid. To this end, it is necessary to sharply limit the consumption of meat and increase the amount of vegetables and fruits in the diet.
It is believed that sausages, sausages, smoked meats, fast food increase the inflammatory processes in the joints. Instead of pharmaceutical chondroprotectors, I recommend eating properly cooked jelly meat.
Orthopedic correction reduces stress on the knee joints. If you have pain in the knee joints, you should take the patella. In advanced cases, walking with a cane is indicated. When shortening the foot, a heel insole is recommended. Recently, it is fashionable to use kinesio tapes. These are self-adhesive strips of natural cotton that are glued around the affected knee, do not restrict its mobility, but help to relieve the joint and reduce muscle spasm.
I believe that interstitial electrical stimulation is the most effective method of treating osteoarthritis pain. In combination with hirudotherapy (leech therapy) and pharmacopuncture, VTES gives very good results. I will give a case study.
A 54-year-old man with osteoarthritis of the right knee from stage II turned to me for help. The pain in his knees bothered him for 6 years. Over the years, he has undergone numerous courses of drug therapy, physiotherapy, corticosteroid blockade, and multiple courses at a rehabilitation center. But the patient's condition is only getting worse. He came to me for advice on whether to agree to joint replacement surgery or try something else conservative. I didn't have to convince him for a long time, he immediately agreed to the treatment I offered.
In the first session I gave him 6 leeches, which helped to deal with swelling of the joints and eliminate night pain. The knee has become easier and freer to move. The man felt a little relieved. Then we performed 3 procedures of interstitial electrical stimulation and almost completely stopped the pain syndrome.
The success was then confirmed by the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effect in acupuncture points. After 3 weeks from the start of therapy, the patient dropped the cane and began to move freely without lameness. 3 years have passed since then. The knee pain did not return. Once a year we hold a session of VTES for preventive purposes.
Intra-articular injections of hormones are very effective in emergencies to relieve severe pain, swelling and inflammation. The indication is an effusion, it is forbidden to make a blockade with corticosteroids in the "dry joint"! They temporarily relieve the pain, but such injections do not cure the osteoarthritis itself and the cartilage after them is further destroyed. They should be performed by a specially trained physician who is well acquainted with the indications, contraindications, medications, sites of application. In total, no more than 3 joint blocks are required.
After removing the swelling and inflammation in the joint, preparations with hyaluronic acid, called liquid prostheses, are injected. They act on the joint as a natural lubricant, improve the sliding of bone surfaces and restore the cushioning functions of cartilage. But hyaluronic acid preparations are expensive and last only 6-8 months. It makes no sense to use hyaluronic acid preparations with complete loss of joint space in patients over 65 years of age.
Treatment with folk remedies.You can use tincture or decoction of cinquefoil, compresses with radishes, horseradish or ginger, turpentine baths.
Joint arthroplasty should be performed only in case of serious dysfunction of the knee joint, as after 10-15 years this joint must be replaced again. Will there be enough strength and health every 10-15 years for surgery under general anesthesia and subsequent rehabilitation??? So do not rush to agree to surgery! Take care of your joints!