Have you ever had knee pain? It is extremely uncomfortable when you suddenly start limping or cannot get down without feeling knee pain. Arthrosis of the knee joint is not fatal, but it dramatically worsens its quality.
What is knee osteoarthritis?
Knee arthrosis(gonarthrosis, osteoarthritis, osteoarthritis of the knee joint). Gonarthrosis is the arthrosis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing but surgery helps. You need this? So don't run into that state.
Causes of osteoarthritis of the knee joint.Distinguish between primary and secondary knee joint arthrosis. If the cause of the disease is not established, then this arthrosis is called primary, it is inherited by the maternal line. If the grandmother suffers from osteoarthritis of the knee joints, the daughter and granddaughter may have this disease at a younger age.
Secondary arthrosis 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 a decrease in female sex hormones, with menopause, all joints start to "collapse". Therefore, overweight elderly women suffer from more severe and frequent osteoarthritis of the knee joint.
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 extra cartilaginous spacers between the bones are called menisci and are cushioning. 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, necessary for smooth sliding of joint surfaces. Ligaments, muscles and their tendons guide and restrict movement in the joint.
General description.With osteoarthritis of the knee joint, joint cartilage is destroyed. There are three stages of knee arthrosis. In the first phase, the nutrition of the articular cartilage and meniscus is interrupted. Cartilage loses its elasticity and cracks. Abnormal friction occurs between the bones. The overload in the joints 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 walking exercise.
In the third stage, pronounced bone deformity of the knee joint is revealed with a marked restriction of natural movements.
Symptoms of osteoarthritis of the knee joint.The main symptoms of arthrosis are pain, limited mobility and deformity of the knee joints. Arthrosis of the knee joints is long lasting, with a slow and irreversible increase in symptoms. If knee pain came on abruptly, suddenly, for the first time, then it is probably not osteoarthritis.
Arthrosis of the knee joint gradually begins with discomfort or mild pain in the knee during overload, long walk, when descending stairs, getting up from a squat position. At rest, the pain goes away quickly.
In the second stage, knee pain appears with normal efforts. 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 pain becomes chronic, occurring 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 increased inflammation. The mobility of the knee joint is reduced to a minimum.
The joint is significantly deformed, the legs become O or X-shaped. In severe cases, complete destruction of the joint occurs with the development of ankylosis (immobility).
In arthrosis of the knee joint, there are 4 types of pain:
- the type of mechanical pain arises under the influence of daytime physical activity and subsides during the night rest period. These knee pains are associated with a decrease in the shock absorption capacity of cartilage and bone structures. Knee pain is, as a rule, located in the anterior and internal region of the knee joint and in the upper leg.
- night pains are associated with stagnation of venous blood, increased intraosseous pressure in the joint and inflammation.
- The "initial" pain occurs after a period of rest, disappears 15-20 minutes after movement in the joint. These knee pains are caused by the friction of the joint surfaces, in which fragments of cartilage are deposited.
- Persistent knee pain is caused by muscle spasm, as well as by the development of synovitis.
Complications of knee arthrosis.Synovitis is an inflammation of the synovial membrane, which covers the joint cavity from the inside. Signs of inflammation: swelling, fever, redness, pain, joint dysfunction.
Typically, the knee joint contains 3-5 ml of synovial fluid. With diseases in the joint, there is an increase in the production of inflammatory fluid. The amount of effusion (pathological fluid) can reach 30-70 and even more than 100 ml. The effusion in the knee first fills the cavity in the inner part of the patella (medial fossa). As the volume increases, the upper volvo fills up, with a large swelling above the patella ("horse saddle").
Baker's cyst occurs with a significant increase in the volume of intra-articular fluid. An elastic, round protuberance forms in the popliteal region. This is not a tumor, it is not cancerous and 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 2 to 6 cm. With even larger sizes, the cyst can compress the nearby fibular nerve with the development of weakness and numbness 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 arthrosis, blood count indicators without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. The level of uric acid is within the normal range.
X-ray shows bone changes in the joint, excludes traumatic causes of joint pain. In our country, the radiographic classification of arthrosis by stages is used.
Stage 1 - presence of marginal bone growth with slight narrowing of the joint space;
Stage 2 - the joint space is narrowed more clearly, subchondral sclerosis occurs;
Stage 3 - marked narrowing of the joint space, flattening of the joint surfaces, development of cysts;
Magnetic resonance imaging of the knee is indicated at the initial stage of the disease, when 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, meniscus, ligaments, tendons. Ultrasound of the knee joint helps to visualize the soft tissues (menisci, muscles, ligaments), to assess the volume of the stroke.
Arthroscopy is the most accurate method to diagnose 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 knee arthrosispresents a difficult task. In each case, you must select an individual treatment program.
When you start talking banal things during the consultation, patients are surprised at first. Is that what we came for? Give a miraculous injection so that my knee never hurts 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", grasp the problem with a lot of drugs and be healthy. But then !!! In that case, medicine is powerless.
Painkillers do not cure, they just relieve pain. Anti-inflammatories are prescribed only during the period of exacerbation of pain in the knee joints. Some of the non-steroidal drugs, by relieving pain, contribute to further destruction of cartilage. Healing ointments do not cure knee arthrosis, but they do help to slightly relieve knee pain. With edema, redness of the joints, ointments and heated compresses are contraindicated, it is better to use local remedies with non-steroidal anti-inflammatory drugs.
Chondroprotectants do not relieve pain, are expensive and need to be used for a long time. I consider them "mannequins" and hardly name them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this medicine in my clinical practice and I have no opinion of its effectiveness.
For the treatment and prevention of osteoarthritis of the knee joint, it is necessary to practice appropriate physical therapy exercises, sitting or lying down. Squats and jumps are strictly prohibited. Cycling, swimming or exercising in the water, skiing are helpful. And labor exploitation in the country usually leads to increased knee pain. With arthrosis of the knee joints, running, walking fast on hills and lifting weights is not recommended.
Diet for osteoarthritis of the knee joint.The knee joints support a load in the form of their own weight. Therefore, overweight people need to 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 type 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 the harmful products (sweets, 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 inflammation in the joints, homeopaths recommend foods that alkalize blood and intra-articular fluid. For this, it is necessary to drastically limit meat consumption and increase the amount of vegetables and fruits in the diet.
Sausages, sausages, smoked meats, fast food are believed to potentiate the inflammatory processes in the joints. Instead of pharmaceutical chondroprotectors, I recommend eating properly prepared gelled meat.
Orthopedic correction reduces stress on the knee joints. If you experience pain in the knee joints, you will need to lift the patella. In advanced cases, walking with a cane is recommended. 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, they do not limit your mobility, but they help to relieve the joint and reduce muscle spasm.
I consider interstitial electrical stimulation to be the most effective method of treating pain in arthrosis. In combination with hirudotherapy (leech therapy) and pharmacopuncture, VTES gives very good results. I will give a case of the practice.
A 54-year-old man with stage II right knee joint arthrosis asked me for help. Knee pains bothered him for 6 years. Over the years, he has undergone several courses of drug therapy, physiotherapy, blockade with corticosteroids and repeated courses at a rehabilitation center. But the patient's condition only got worse. He came to me for a consultation to get advice on whether to agree to joint replacement surgery or to try something else conservatively. I didn't have to persuade him for long, he immediately agreed to the treatment I proposed.
In the first session, I gave him 6 leeches, which helped to deal with swelling in the joints and to eliminate night pains. The knee became easier and freer to move. The man felt a little relief. Then, we performed 3 interstitial electrical stimulation procedures and stopped the painful syndrome almost completely.
From then on, success was consolidated with the introduction of homeopathic medicines with anti-inflammatory and chondroprotective effects in acupuncture points. After 3 weeks of starting therapy, the patient threw the cane away and began to move freely, without limping. 3 years have passed since then. The knee pains have not returned. Once a year, we hold a VTES session for preventive purposes.
Intra-articular injections with hormones are very effective in an emergency to relieve severe pain, swelling and inflammation. The indication is spillage, it is forbidden to block with corticosteroids in the "dry joint"! They temporarily relieve pain, but these injections do not cure the arthrosis itself, and the cartilage after them is further destroyed. They must be done by a doctor specially trained and well informed about the indications, contraindications, medications, places of administration. In total, no more than 3 blocks are required per joint.
After removing the swelling and inflammation, hyaluronic acid preparations, called liquid prostheses, are injected into the joint. They act on the joint as a natural lubricant, improve the sliding of bone surfaces and restore cartilage shock-absorbing functions. But hyaluronic acid preparations are expensive and last only 6 to 8 months. It does not make sense to administer hyaluronic acid preparations with complete loss of joint space and in patients over 65 years of age.
Treatment with folk remedies.You can use cinquefoil tincture or decoction, radish, horseradish or ginger compresses, turpentine baths.
The joint endoprosthesis should be performed only in case of severe knee joint dysfunction, because after 10-15 years this joint will have to be changed again. Will there be sufficient strength and health every 10-15 years for an operation under general anesthesia and subsequent rehabilitation? So don't rush to agree to an operation! Take good care of your joints!