Have you ever had knee pain? It's extremely uncomfortable when you suddenly start limping or can't walk down stairs without knee pain. Osteoarthritis of the knee joint is not life-threatening, but it significantly worsens its quality.
What is knee osteoarthritis?
Osteoarthritis of the knee(gonarthrosis, arthrosis, arthrosis of the knee joint). Gonarthrosis is osteoarthritis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing but surgery helps. You need it? Then don't run into that 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 has osteoarthritis of the knee joints, the daughter and granddaughter may have this disease at a young age.
Secondary arthrosis develops as a result of trauma, congenital anomalies of the knee joint, physical overload (sports, professional), endocrine disorders.
Risk factors are overweight, female sex, old age. Cartilage is very sensitive to a decrease in female sex hormones, with menopause, all joints begin to "crumble". Therefore, overweight older women suffer from osteoarthritis of the knee joint more severely and more often.
Knee anatomy.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 extra cartilaginous spacers between the bones are called menisci and are cushioning. The knee joint has the largest synovium, which forms large curves and bags.
The joint cavity is filled with synovial fluid, which nourishes the joint cartilage. The synovial fluid contains hyaluronic acid, which is necessary for the smooth sliding of the joint surfaces. Ligaments, muscles and their tendons guide and limit movement in the joint.
General description.With osteoarthritis of the knee joint, destruction of the articular cartilage occurs. There are three stages of knee osteoarthritis. In the first stage, the nutrition of the articular cartilage and menisci is disrupted. Cartilage loses its elasticity and cracks. Abnormal friction occurs between the bones. Joint overload is accompanied by inflammation and pain in the knee.
In the second stage, the destruction of the articular cartilage and menisci begins. The bone reacts to the load with marginal growths - osteophytes ("spines"). The amount of intra-articular fluid decreases, the narrowing of the joint space increases. As a result, knee pain already occurs during normal exercise, walking.
In the third stage, a pronounced bone deformity of the knee joint with a sharp limitation of natural movements is revealed.
Symptoms of osteoarthritis of the knee joint.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 and irreversible increase in symptoms. If the pain in the knee has arisen abruptly, suddenly, for the first time, it is most likely not arthrosis.
Osteoarthritis of the knee joint gradually begins with discomfort or mild pain in the knee during overload, a long walk, when descending the stairs, rising from a squatting position. At rest, the pains pass quickly.
In the second stage, knee pain appears already with normal exertion. The volume of active movements in the knee joint decreases. The shape of the joint changes due to bone deformity and the accumulation of abnormal fluid in the joint.
In the third stage, the pains become chronic, they occur not only during movement, but also at rest. Night pains disturb sleep. The knee is difficult to fit in bed without pain. Swelling of the joint indicates the addition of inflammation. The mobility of the knee joint is minimized.
The joint is noticeably deformed, the legs become O or X-shaped. In severe cases, there is complete destruction of the joint with the development of ankylosis (immobility).
With osteoarthritis of the knee joint, there are 4 types of pain:
- the mechanical type of pain manifests itself under the influence of daytime physical activity and subsides during the period of night rest. These knee pains are associated with a decrease in the shock-absorbing capacity of cartilage and bone structures. Knee pain is localized, as a rule, in the anterior and inner region of the knee joint and in the upper part of the lower leg.
- night pains are associated with stagnation of venous blood, increased intraosseous pressure in the joint and inflammation.
- The "initial" pain occurs after a rest period, disappears 15-20 minutes after movement in the joint. These knee pains are caused by the friction of the joint surfaces, on which fragments of cartilage caries are deposited.
- persistent knee pain is caused by muscle spasms and the development of synovitis.
Complications of knee osteoarthritis.Synovitis is inflammation of the synovial membrane, which covers the joint cavity from the inside. Signs of inflammation: swelling, fever, redness, pain, joint dysfunction.
Normally, the knee joint contains 3-5 ml of synovial fluid. With diseases of the joint, increased production of inflammatory fluid occurs. The amount of effusion (pathological fluid) can reach 30-70 and even more than 100 ml. Knee effusion first fills the cavity within the patella (medial fossa). With an increase in volume, the superior volvulus fills up, with a huge bulge 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 region. This is not a tumor, it is not cancer, and it does not need to be operated on. 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. With even larger dimensions, the cyst can squeeze the nearby peroneal nerve with the development of weakness and numbness of the foot.
Diagnosis of osteoarthritis of the knee joint.Laboratory tests are not helpful in diagnosis, but are used to rule out other conditions with knee pain. With osteoarthritis, blood count indicators without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. The uric acid level is in the normal range.
X-ray shows bone changes in the joint, excludes traumatic causes of joint pain. In our country, an X-ray classification of arthrosis by stages is used.
Stage 1: 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 - a sharp narrowing of the joint space, flattening of the joint surfaces, the development of cysts;
MRI of the knee is indicated at an early stage of the disease, when the radiological changes are not yet visible, but the patient has typical knee pain. With the help of MRI, you can assess the condition of the cartilage, menisci, ligaments, tendons. Ultrasound of the knee joint helps 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 destruction of the cartilage under a microscope.
Treatment of osteoarthritis of the kneepresents a difficult task. In any case, you have to select an individual treatment program.
When you start saying trivial things during the consultation, patients look in surprise at the first moment. Is that what we came for? Give a miracle injection so my knee never hurts again. We must explain that there is no single method that can eliminate osteoarthritis. To recover, you need to move, lose weight, sign up for the pool. And a person wants to lie down on the sofa, grow a "beer belly", grab the problem with a bunch of drugs and be healthy. But alas !!! In this case, the medicine is powerless.
Pain relievers don't cure, they just relieve pain. Anti-inflammatory drugs are prescribed only during the period of exacerbation of pain in the knee joints. Some of the non-steroidal drugs, relieving pain, contribute to the further destruction of cartilage. Healing ointments do not cure osteoarthritis of the knee, but they help to slightly relieve knee pain. With edema, redness of the joint, warming ointments and compresses are contraindicated; it is better to use local remedies with non-steroidal 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 name them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this drug in my clinical practice and do not have my opinion on its effectiveness.
For the treatment and prevention of osteoarthritis of the knee joint, it is necessary to engage in adequate physiotherapy exercises in a sitting or lying position. Squats and jumps are strictly prohibited. Cycling, swimming or water exercise, skiing are useful. And the exploits of work in the country often lead to increased pain in the knees. With osteoarthritis of the knee joints, running, brisk walking uphill, weight lifting is not recommended.
Diet for osteoarthritis of the knee joint.The knee joints bear a load in the form of their own weight. Therefore, overweight people need to lose at least 3-5 kg. And some patients have to lose more than a dozen kilograms. Otherwise, no treatment will be effective. It is not necessary to "sit" on some kind of diet, it is harmful to the body.
You have to change your eating behavior for the rest of your life, simply "stop loving" all harmful products (sweet, starchy foods, beer, etc. ). Eating well should become a habit. To lose weight, you need to eat the right foods every 3 hours.
To reduce joint inflammation, homeopaths recommend foods that alkalize the blood and intra-articular fluid. To this end, it is necessary to drastically limit the consumption of meat and increase the amount of fruits and vegetables in the diet.
It is believed that sausages, sausages, smoked meats, fast food potentiate the inflammatory processes of the joints. Instead of pharmaceutical chondroprotectors, I recommend eating properly prepared jellied meat.
Orthopedic correction reduces the stress on the knee joints. If you have pain in the knee joints, you need to lift the kneecap. In advanced cases, walking with a cane is indicated. When shortening the leg, a heel insole is recommended. Recently, it is fashionable to use kinesio tapes. These are natural cotton adhesive tapes that are glued around the affected knee, do not limit its mobility, but help relieve the joint and reduce muscle spasm.
I consider interstitial electrical stimulation to be the most effective method of treating pain in osteoarthritis. In combination with hirudotherapy (leech therapy) and pharmacopuncture, VTES gives excellent results. I will give a case from practice.
A 54-year-old man with stage II right knee joint osteoarthritis approached me for help. Knee pains have bothered him for 6 years. Over the years he has undergone numerous cycles of drug therapy, physiotherapy, corticosteroid blockade and repeated courses in a rehabilitation center. But the patient's condition only worsened. He came to me for a consultation for advice on whether to accept joint replacement surgery or try something else conservatively. I didn't have to persuade him for a long time, he immediately accepted the treatment I offered him.
In the first session, I gave him 6 leeches, which helped to cope with joint swelling and eliminate night pains. The knee became easier and freer to move. The man felt a little relieved. So we performed 3 interstitial electrical stimulation procedures and we almost completely stopped the pain syndrome.
Subsequently, the success was consolidated by the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effect in the acupuncture points. After 3 weeks of starting therapy, the patient threw away the cane and began to move freely, without limping. 3 years have passed since then. Knee pains did not return. Once a year, we conduct a VTES session with a preventive purpose.
Intra-articular injections with hormones are very effective in an emergency to relieve severe pain, swelling and inflammation. The indication is an effusion, it is forbidden to block with corticosteroids in the "dry joint"! Temporarily relieves pain, but such injections do not cure osteoarthritis itself, and the cartilage after them is destroyed even more. They should be performed by a specially trained doctor who is well aware of the indications, contraindications, drugs, points of administration. In total, no more than 3 blocks are needed per joint.
After removing the swelling and inflammation, preparations of hyaluronic acid, called liquid implants, are injected into the joint. They act on the joint as a natural lubricant, improve the sliding of the bone surfaces and restore the shock-absorbing functions of the cartilage. But hyaluronic acid preparations are expensive and only last 6-8 months. There is no point in giving hyaluronic acid preparations with complete loss of joint space and in patients over 65 years of age.
Treatment with folk remedies.You can use tincture or decoction of cinquefoil, compresses with radish, horseradish or ginger, turpentine baths.
Joint endoprosthesis should only be performed in case of severe dysfunction of the knee joint, because after 10-15 years this joint will have to be changed again. Will there be enough strength and health every 10-15 years for an operation under general anesthesia and subsequent rehabilitation??? Therefore, do not rush to accept a trade! Take care of your joints!