Deformation of osteoarthrosis of the knee joints (AKA Gonartrose or abbreviated DOA) is a dystrophic degenerative disease of the knee joint, which is characterized by a gradual chronic evolution, damage to all movements and often handicap.
The disease begins with changes in joint cartilage, due to which the joint surfaces of the bones occur.The disturbance and loss of elasticity lead to its dystrophy (thinning) and to resorption, while the bone tissue of the joint surfaces is exposed, the shift is disturbed, the joint space is narrowed, the joint biomechanics change.The synovial shell bordering the articulation and the production of synovial fluid is irritated (which nourishes cartilage and plays the role of physiological lubrication), which leads to an increase in its quantity in the joint (synovitis).In the context of the narrowing of the joint space, the volume of the joint decreases, the synovial fluid leaves the posterior wall of the joint capsule, the Becker cyst is formed (which, reaching large sizes, can cause pain in fossa poplitee).The thin and delicate fabric of the joint capsule is replaced by a rough connective tissue, the shape of the joint changes.Periosurpetal bone tissue is developing, osteophytes (pathological bone growths) are formed.Blood circulation in periarticular tissues is disturbed and underestimated metabolic products, irritating chemioreceptors, develops persistent pain syndrome.In the context of a change in the anatomy of the articulation, there is a violation of the work of the surrounding muscles, hypotrophy and spasm appear, an approach is disturbed.There is a persistent restriction of the volume of movements in the articulation (contracture), sometimes so pronounced that only swinging 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 over 60 years, this affects every third person.
The causes of gonarthrosis
- Bones and joint injuries.
- Inflammatory joint diseases (rheumatoid, chlamydia arthritis, drop).
- Violation of mineral metabolism with various endocrinopathies (diabetes mellitus, parathyroid disease, hemochromatosis).
- Muscle apparatus and neuropathy diseases (Charcot disease).
In addition to the main reasons, the unfavorable substantive factors for the development of gonarthrosis are also distinguished, in particular:
- overweight (literally exerts pressure on the lower limbs);
- Age (the disease is mainly subject to the elderly);
- Female genre (according to a woman's statistics, they fall sick more often);
- Increased sports and professional physical effort.
Symptoms of osteoarthrosis of the knee joints
- The pain that increases when walking and weakening alone.
- Difficulty in physiological movements familiar in the joints.
- A characteristic "crunch" in the joints.
- The increase in the amount of the amount and their visible deformation.
Gonartrose stages
Clinical stages of osteoarthritis of the knee joint
The disease goes through several stages.
- In the first step, a person only feelsA little feeling of discomfortOr the "gravity" in the knee that disturbs during long distance walking or increased physical effort.The radiological examination will not be informative: it is possible to identify only a small narrowing of the joint difference, there will be no other changes.
- The second step is characteristicTangible pains, whose severity is reduced to rest.There is a difficulty in the joints in the joints, on the move, a characteristic "grinth" is understood (of the patient that you can hear a conventional sentence in daily life - "the knee crest").During radiography, a clearly distinguished narrowing of the joint gap and unique osteophytes are found.
- When the transition from gonarthrosis to the next third step,The pain will constantly disturb the patientIncluding at rest, there is a violation of the configuration of the joints, that is to say an intensification of the deformation due to an edema at the time of the connection of the inflammation.The radiographs determine the narrowing of the joint difference of a moderate degree and multiple osteophytes.In the third step, many are already asking for medical help, because quality of life suffers significantly due to normal pain and difficulties.
- The fourth step is accompaniedSurrounding and exhausting pain.Minimum displacement attempts become a difficult test for humans, the deformation of the joints is visually visible, walking is extremely difficult.The X scratch reveals significant changes: the joint difference in the images is practically not determined, several coarse osteophytes, "joint mice" (fragments of the destructive bone that fall into the joint cavity) are detected.This stage of gonarthrosis almost always implies a handicap.
Who treats osteoarthritis of the knee joint?
The therapist, the rheumatologist and the general practitioner (family doctor) can provide qualified medical care for gonarthrosis (family doctor), but these experts treat the knee joint with uncomplicated osteoarthritis.When a synovitis occurs or the treatment prescribed by the therapist does not give the right effect, you cannot do without an orthopedist.In situations where surgical care is necessary, the patient is sent to a specialized orthopedic-trauma service.
How and what to treat osteoarthritis of the knee joint?
The methods of treatment of osteoarthritis in the knee joint, known today, are divided into non -drug, drugs and surgical preservatives.
Non -drug methods
Many patients wonder: "How to cure osteoarthritis of the knee joint without pills?"Responding to him, with regret that it is necessary to declare that gonartrose is a chronic disease, it is impossible to eliminate it forever.However, many existing methods today can considerably slow down its progression and improve the quality of the patient, especially when used in the first stages of the disease.
With a timely search for a doctor and the patient's sufficient motivation for healing, it is sometimes enough to eliminate negative factors.For example, it is proven thatOverweight reductionReduces the manifestation of the main symptoms of the disease.
Exclusion of pathological physical effort and on the contrary,Therapeutic gymnastics lessonsWith the use of rational physical programs, they reduce the intensity of the pain.It is proven that the exercises to strengthen the strength of the hip muscles to four leaders are comparable indeed with anti-inflammatory drugs.
If we treat osteoarthritis of the knee joint, then we must strivegood nutrition: To improve the elastic properties of articular cartilage, help products containing a large amount of animal collagen (food varieties of meat and fish) and chondroitin (shrimp, crabs, kril), saturated with vegetable collagen and antioxidants, fresh vegetables and fruit, and passion for smoking menas, sweet conservatives and polesSweet and paved on dishes and pavers.The opposite, a violation of metabolic processes in the body and the accumulation of an excess weight until obesity are potentile.
The complex treatment of osteoarthritis of the knee joint also involves the appointment of very effective even with advanced forms of the diseasePhysiot.With generalized use in different categories of patients suffering from this disease, has proven its effectivenessMagnetotherapy: After several procedures, the intensity of pain decreases, due to the improvement of blood circulation, the reduction of edema and the elimination of muscle spasms increases the mobility of the joint.The effect of magnetotherapy is particularly alive during the development of an active inflammation in the joint: the severity of edema is considerably reduced, the phenomena of synovitis regress.Not so popular, but no less effective in treating knee joint with osteoarthritis are physiotherapy methods thatLaser therapy and cryotherapy(Exposure to cold), having a pronounced analgesic effect.
Drugs
In the effective treatment patterns of the knee joint, the drugs below are used.
Non-steroidal anti-inflammatory drugsProduced in the forms for external (various gels, ointments) and systemic (tablets, candles, solutions) uses, have long proven their effectiveness in the treatment of osteoarthrosis and are largely prescribed by doctors.By blocking inflammation at an enzymatic level, they eliminate joint pain and swelling, slow down the progression of the disease.It should 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 kidneys and liver.Consequently, patients, taking the medication for a long time, should also prescribe drugs that protect the gastric mucosa and regularly monitor laboratory indicators for internal organs.
Glucocorticosteroids (GKS)- Hormonal drugs with a pronounced anti-inflammatory effect.Being a powerful anti-inflammatory agent, GCs have certain contraindications, as they are able to call a certain number of important side effects.In the system of gonarthrosis, they are practically not prescribed.As a rule, effective treatment of osteoarthritis involves GC injections in points of peri-human pain, which increases the intensity of the fight against inflammation and minimizes the risk of undesirable side effects of the drug.With a single introduction to the GCS, the effect of its use lasts up to 1 month.In accordance with the national recommendations for the treatment of osteoarthritis, you should not make more than three injections of the drug per year in the same joint.
With osteoarthritis "neglected", "neglected", when a person experiences unbearable pains that do not even calm down, violating normal sleep, prescription is possibleOpioid pain relievers.These drugs are only used in accordance with the doctor's prescription, which considers the feasibility of their appointment in each case.
Chondroprotector(with a literal translation - "cartilage protection").This name is understood as various drugs united by a property-a structural modifying effect, that is to say the ability to slow degenerative changes in the cartilage and the narrowing of the joint deviation.They are produced in forms for both oral administration (glucosamine, chondroitin sulfate, piastaline) and for the introduction of the joint cavity (hyaluronats).Of course, these drugs do not carry out a miracle and do not "cultivate" new cartilage, but they can suspend its destruction.To obtain a persistent effect, they must be used for a long time, regular lessons several times a year.
Surgical treatment of joint knee osteoarthritis
The most popular type of surgical care for gonarthrosis isEndoprosthetics, that is to say by removing your own articulation with a simultaneous installation of a metaloprosis which replaces it, whose design 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 raw deformations of the charter, formed "false joints", muscle contractures and pronounced muscular atrophy.With severe osteoporosis (a significant decrease in the mineral density of the bones), the endoprothetics does not show either: the bone of "sugar" will not resist the introduction of metal pins, and instead of the installation, the rapid renewal (absorption) of the bone tissue will begin, pathological fractures can occur.Consequently, a timely solution to the question of the need to install an endoprosthesis is so important - it must be accepted when the age and general condition of the human body always allow you to carry out surgery.
Despite the generalized prevalence of the endoprothetics of the knee joint, the results of these operations are often not satisfactory and the percentage of complications is high.This is due to the design characteristics of endoprostheses and the complexity of the surgical intervention itself (replacing the hip joint is much easier in technical terms).
Artromedullary shunt- Connecting the femur bone marrow channel with the knee joint cavity using a shunt - a hollow metallic tube.For this reason, the fatty bone marrow of the lower third of the femur enters the knee joint, nourishing cartilage and lubricant, which reaches a significant decrease in pain.
In summary the above, I would like to note that the treatment of gonarthrosis is a complex social task.And although today medicine is unable to offer a medication that eliminates it forever, or other ways to fully cure this disease, a healthy lifestyle, a timely medical aid and the implementation of the doctor's recommendations can suspend its progression.