Have you ever had a knee pain? It is extremely uncomfortable when you suddenly start to limp or cannot go downstairs without pain in your knee. Arthrosis of the knee joint is not life-threatening, but it dramatically worsens its quality.
What is knee arthrosis?
Knee arthrosis(gonarthrosis, osteoarthritis, osteoarthritis of the knee joint). Gonarthrosis is arthrosis 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 yourself into that state.
Causes of arthrosis of the knee joint.Distinguish between primary and secondary arthrosis 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 arthrosis of the knee joints, then 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 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 arthrosis 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 turns and bursae.
The joint cavity is filled with synovial fluid, which nourishes the articular cartilage. The synovial fluid contains hyaluronic acid, which is necessary for the smooth sliding of the articular surfaces. Ligaments, muscles and their tendons guide and restrict movement in the joint.
General description.With arthrosis of the knee joint, the destruction of the articular cartilage occurs. There are three stages of knee arthrosis. At 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 ("thorns"). The amount of intra-articular fluid decreases, the narrowing of the joint space increases. As a result, knee pain occurs already during normal exercise, walking.
In the third stage, pronounced bone deformity of the knee joint with a sharp restriction of natural movements is revealed.
Symptoms of arthrosis of the knee joint.The main symptoms of arthrosis are pain, limitation of mobility and deformity of the knee joints. Arthrosis of the knee joints is long-term, with a slow, irreversible increase in symptoms. If knee pain occurs abruptly, suddenly, for the first time, then it is most likely not arthrosis.
Arthrosis of the knee joint begins gradually with discomfort or minor pain in the knee during overload, long walking, when going downstairs, rising from a squatting position. At rest, the pain quickly disappears.
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, pains become chronic, occur not only during movements, 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 knee joint 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 (immobility).
With arthrosis of the knee joint, there are 4 types of pain:
- the mechanical type of pain arises 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 pains are localized, as a rule, in the anterior and inner region of the knee joint and the upper part of the lower leg.
- night pains are associated with stagnation of venous blood, 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 of the articular surfaces, on which fragments of cartilage decay are deposited.
- persistent knee pain is caused by muscle spasm, as well as the development of synovitis.
Complications of arthrosis of the knee joint.Synovitis is an inflammation of the synovial membrane that covers the articular 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 in the joint, an 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 in the cavity on the inside of the patella (medial fossa). With an increase in volume, the upper volvulus fills, with a 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 region. This is not a tumor, not oncology, and it does not need to be operated on. A 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 sizes, the cyst can squeeze the nearby peroneal nerve with the development of weakness and numbness in the foot.
Diagnosis of arthrosis of the knee joint.Laboratory tests are not useful for diagnosis, but are used to rule out other conditions with knee pain. With arthrosis, blood count indicators without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. The uric acid level is within 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 - the presence of marginal bone growths with a slight narrowing of the joint space;
Stage 2 - the joint space is narrowed more clearly, subchondral sclerosis occurs;
Stage 3 - a sharp narrowing of the joint space, flattening of the articular surfaces, the development of cysts;
MRI of the knee is indicated at an early 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, menisci, ligaments, tendons. Ultrasound of the knee joint helps to visualize soft tissues (menisci, muscles, ligaments), to assess the volume of effusion.
Arthroscopy is the most accurate method for diagnosing arthrosis 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.
Knee arthrosis treatmentpresents a difficult task. In each case, you have to select an individual treatment program.
When you start to say banal things during the consultation, the patients look with surprise at the first moment. Is this what we came for? Give a miraculous injection so that my knee never hurts again. We have to explain that there is no such only method that can eliminate arthrosis. 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", seize the problem with a bunch of drugs and be healthy. But alas !!! In this case, 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, by relieving pain, contribute to further destruction of cartilage. Healing ointments do not heal for arthrosis of the knee, but they do 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 need to be taken for a long time. I consider them "dummies" and practically do not appoint them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this drug in my clinical practice and have no personal opinion about its effectiveness.
For the treatment and prevention of arthrosis of the knee joint, it is necessary to engage in proper physiotherapy exercises in a sitting or lying position. Squats and jumps are strictly prohibited. Cycling, swimming or exercise in the water, skiing are useful. And labor exploits in the country often leads to increased pain in the knees. With arthrosis of the knee joints, running, brisk walking uphill, lifting weights are not recommended.
Diet for arthrosis 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 need 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 need to change eating behavior for the rest of your life, just "stop loving" all harmful products (sweet, starchy foods, beer, etc. ). Eating right 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 food that alkalizes the blood and intra-articular fluid. To this end, it is necessary to sharply limit the consumption of meat, and to increase the amount of vegetables and fruits in the diet.
It is believed that sausages, sausages, smoked meats, fast food enhance the inflammatory processes in 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 pick up the patella. 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 adhesive tapes made of natural cotton 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 arthrosis. In combination with hirudotherapy (leech therapy) and pharmacopuncture, VTES gives very good results. I will give a case from practice.
A 54-year-old man with arthrosis of the right knee joint of stage II turned to me for help. Knee pains bothered him for 6 years. Over the years, he underwent numerous courses of drug therapy, physiotherapy, blockade with corticosteroids, 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 agree to a joint replacement operation or to try something else conservatively. I didn't have to persuade him for a long time, he immediately agreed to the treatment I proposed.
In the first session, I gave him 6 leeches, which helped to cope with the swelling of the joint and eliminate night pains. The knee has become easier and freer to move. The man felt a little relief. Then we performed 3 procedures of interstitial electrical stimulation and almost completely stopped the pain syndrome.
After that, the success was consolidated by the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effect into the acupuncture points. After 3 weeks from the start of therapy, the patient threw away the cane and began to move freely, without limping. 3 years have passed since then. The knee pains did not return. Once a year, we conduct one session of VTES 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 do blockade with corticosteroids in the "dry joint"! They temporarily relieve pain, but such injections do not cure arthrosis itself, and the cartilage after them is destroyed even more. They should be done by a specially trained doctor who is well aware of the indications, contraindications, drugs, and points 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 the shock-absorbing functions of the cartilage. But hyaluronic acid preparations are expensive, and they only last 6-8 months. There is no point in administering hyaluronic acid preparations with complete loss of the 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.
Endoprosthetics of joints should be performed only in case of serious 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 agree to an operation! Take care of your joints!