One of the most common complaints doctors hear from patients is knee pain. What causes this pain is not always possible to say right away. The knees can be affected by various diseases, for example, osteoarthritis of the knee joint. It is also known as gonarthrosis.
Gonarthrosis is a non-inflammatory joint injury that often leads to cartilage destruction, bone deformity, and limited movement. This disease has the code M17 in the International Classification of Diseases (ICD-10).
All patients can be divided into two groups. The first group includes young, more often young men, with damage to one, less often both knee joints. Have a knee injury or surgery in their medical history.
The second group includes obese, middle-aged or elderly people, more often women, in whom gonarthrosis has developed simultaneously in several parts of the body.
Symptoms of knee osteoarthritis
Symptoms of knee osteoarthritis gradually increase. Patients may not be aware that they have been sick for years until they notice obvious knee deformity or severe pain.
At the same time, arthritis of the knee joint in the initial stage of the disease is often accompanied by unpleasant and painful sensations in the knees, and few people seek medical advice.
Women prone to obesity, especially after the age of 40, are predisposed to this disease.
Varicose veins also contribute to the development of the disease. At this stage, it is possible to cure the disease at home without the use of tablets and ointments.
The pain is not sudden, it appears gradually over several years. They usually occur during sports, walking, and other physical activities.
Sharp pain may not be a symptom of gonarthrosis, but a consequence of a crack, meniscus tear, or bruise. It is the intense pain that becomes the motivation to go to a specialist.
The pain often gets worse in the following cases:
- when walking;
- in a long-standing position;
- during the descents;
- when lifting the body from a sitting position;
- when carrying heavy objects.
When performing these actions, the maximum load acts on the joints, therefore, if the patient feels severe discomfort, then arthritis of the knee joint of the second stage can already be diagnosed. A person tries to move less, take a static position to avoid pain, but with continued physical activity, the discomfort returns.
Deforming osteoarthritis of the knee joint accompanies a symptom such as deformity. It becomes evident as early as the second or third stage of the disease. His first signs: the knee was slightly swollen, but retained its shape. In the later stages, there is a change in the shape of the knee, making a leg shorter or longer.
One of the most characteristic symptoms is a creaking of the joints, evident in the second and third stages. The main thing is to distinguish the sonorous creaking of the joints of a healthy person from the dull, dry creaking of the patient. This sound causes weakness of the ligament apparatus or high mobility of the joints.
To ensure the immobility of the knee joint, it is recommended to wear knee pads.
Forms of gonarthrosis
There are two forms of the disease:
- Primary: appears as a result of congenital abnormal joint development.
- Secondary: appears as a result of illness and injury.
The primary form of knee joint osteoarthritis often develops in childhood and is caused by improper ligament and joint formation. They are subjected to heavy loads and deform during physical activity.
The secondary form of the disease is caused by the following factors:
- Injuries (bruises, sprains, displacements, fractures), involving violations of the structure of the bones, ligaments and cartilage. All this is a post-traumatic form of the disease.
- Operations when the meniscus is displaced violate the integrity of the knee structure.
- Too much load on the legs (typical for weightlifters).
- Obesity. Excess weight causes pressure on the cartilage in the knee joints.
- Passive lifestyle.
- Diabetes.
- Age.
- Arthritis (inflammatory process of the joints). Prolonged disease is accompanied by the formation of excess fluid in the joint cavity and causes complications.
- Metabolic disorders lead to the deposition of salts.
- knee transplant.
- Diseases that cause prolonged muscle cramps in the legs or vasospasm.
The development of the disease can take a unilateral or bilateral form. Trauma often causes left-sided or right-sided gonarthrosis, and obesity is bilateral.
Stages of the disease
There are three stages of gonarthrosis:
- From the onset of the first stage to the visible manifestations of the disease, it can take several months or even years. The person complains of intermittent pain in the legs, especially when walking up or down stairs and getting out of bed in the morning. The pictures usually show a narrowing of the connection between the joints, and, as a rule, instead of going to the doctor, patients use traditional medicine - ointments and tinctures.
- The second stage is characterized by a more acute pain, which does not stop at the immobility of the limb. A creak appears. Fluid accumulates in the joint cavity, X-rays show the deformation and growth of the bone. The patient in this phase tries in every possible way not to move the affected limb. The attending physician prescribes injections and chondroprotectors - medicines that help restore cartilage tissue.
- In the last third stage, the pain becomes constant and often worsens as weather conditions change. The x-ray shows a significant deformity of the knee, which can only be corrected with surgery, the patient must take a complex of chondroprotectors. The patient's gait changes: he walks on half-bent legs or rolls from side to side.
Causes of disease. Groups at risk
Overweight
Most often, deforming osteoarthritis affects the elderly. In a special risk group are women who are overweight after 40 years. The likelihood of pathology in obese people is 4 times higher than in people with normal body weight. The scheme is simple: the heavier a person, the faster the disease develops and the more severe it is. In this case, the form of the disease can be called acquired. It is the joints of the lower limbs that fall under the blow, because they are forced to bear the greatest load.
Overweight people also face hormonal imbalances and metabolic disorders, which contribute to the development of obesity and osteoarthritis.
Age
Older people can be called those who have reached the age of over 60-65 years. In this population, osteoarthritis occurs in 65-85% of people.
The reason is age-related changes that negatively affect the structure of the joints. Even normal walking can become a significant burden and stimulate the development of the disease, while worn cartilage can no longer recover on its own.
Congenital pathologies and hereditary factors
The disease can affect both young people and those who do not suffer from overweight. As a rule, in such situations, the disease occurs due to congenital defects of the knee joints, for example, lack of intra-articular lubrication. Heredity also plays an important role.
Yet most of the patients suffering from knee pain are people of a respectable age. Osteoarthritis is rare among young people. Unfortunately, young patients do not always receive the necessary care, because not all doctors find it necessary to give them the necessary attention.
High loads
People who make a living from hard physical work and athletes of varying levels are also at risk of contracting osteoarthritis in the knees. In this case, the disease becomes an occupational pathology.
Operations, injuries and other illnesses
Surgery, trauma, various diseases of the joints can provoke the appearance of gonarthrosis.
When the cause remains unknown, osteoarthritis of the knee joint is commonly referred to as idiopathic.
Diagnosis of osteoarthritis of the knee joint
This diagnosis is made on the basis of patient complaints, examination data, palpation of the diseased joint and X-ray examination.
Radiography is a standard research method that allows you to confirm the diagnosis, establish the degree of pathological changes, monitor the dynamics of the process, and also allow you to exclude other pathological processes (for example, tumors) in the tibia and femur.
It should be noted that the primary changes in the structures of the knee joint on radiographs may be absent. Subsequently, the narrowing of the joint space and the compaction of the subchondral zone are determined. The articular ends of the femur and especially the tibia expand, the edges of the condyles become pointed.
Auxiliary diagnostic methods are CT (computed tomography) and magnetic resonance imaging (magnetic resonance imaging), which allow a more detailed study of pathological changes in bone structures and identify changes in soft tissues.
How to treat gonarthrosis of the knee joint
The more acute the stage of the disease, the more complex the treatment of gonarthrosis becomes. The chronic nature of the pathology can remain in the phase of remission, when the active manifestations of the disease are minimized or completely absent.
Physiotherapeutic treatment in combination with chondroprotective drugs gives positive results.
Treatment options include:
- drug therapy (chondroprotectors);
- Surgical intervention;
- rehabilitation path (physiotherapy, massage, etc. ).
Treatment with drugs
With drug therapy, the use of non-steroidal analgesics is prescribed. These drugs help relieve the pain and symptoms of synovitis (inflammation). If the pain is particularly severe or the synovium of the knee joint is severely inflamed, corticosteroids can be used. These medicines have a more powerful analgesic and anti-inflammatory effect than non-hormonal pain relievers. Muscle relaxants and antispasmodics will help the periarticular muscles get rid of spasms.
Antioxidants and vasodilators improve cartilage nutrition. The main drugs for the conservative treatment of the disease are chondroprotectors which contain chondroitin and glucosamine sulfate (natural components of cartilage).
The use of pathogenic drugs should be systemic and prolonged.
Physiotherapy
Physiotherapeutic methods of treatment (UHF, ultrasound or phototherapy) are considered additional means of accelerating the healing process.
They also include:
- Acupuncture. This method relieves muscle spasm near the affected joint, normalizes metabolic processes in them, thereby restoring damaged cartilage tissues.
- Hirudotherapy. Treatment with leeches has the same effect as injections, as it improves blood circulation.
- laser therapy. Such procedures relieve inflammation, swelling, improve metabolism and neutralize pain.
- cryotherapy. Both liquid nitrogen treatment and regular ice at home are effective.
- Magnetotherapy. The influence of the magnetic field not only improves blood circulation in the tissues, but also relieves swelling and inflammation.
- Electromyostimulation. With the help of current micro-discharges of different frequencies, the muscles are restored and strengthened, and the blood circulation in the limbs improves.
Treatment of knee osteoarthritis with physiotherapy is effective, as it reduces pain. The attending physician usually prescribes such treatment based on the stage of the disease.
Physiotherapy
Physical therapy for osteoarthritis of the knee joint is one of the main means of restoring atrophied muscles and must be done very carefully and slowly. If the patient feels that the pain is returning, the exercise should be stopped.
During therapeutic exercises, special knee brace fixators should be worn. The rehabilitation process also includes the use of these orthopedic devices, their goal is to reduce the load from the affected knee to the stick or prosthesis. Patients with gonarthrosis are often prescribed to wear knee pads to relieve pain when walking.
Therapeutic gymnastics for gonarthrosis reduces the load on the damaged joint, developing the muscles of the legs. Exercises that load the joint are strictly contraindicated. Water gymnastics and swimming are ideal activities.
Orthopedic therapy
To reduce the load on the affected joints, the patient must use a cane. A good helper for knee osteoarthritis are orthopedic shoes that provide a natural foot position and even load distribution.
Massage
The massage relieves muscle spasms, reduces pain and increases freedom of movement. This procedure also improves blood circulation and supplies nutrients to the joint.
Surgical intervention
A pronounced decrease in working capacity (especially up to 45 years) requires surgical treatment. The choice between corrective (osteophyte removal) and radical (knee arthroplasty) methods of treatment depends on the stage of the disease, the patient's age, symptoms and other factors.
Nutrition
As for the special diet for gonarthrosis, it is often aimed at reducing the weight of the patient, because it is overweight that leads to overload of the joints. It is recommended to have small meals every 3 hours, eat lean meat (chicken, turkey, rabbit) and exclude fatty pork and get the necessary proteins from legumes.
Refined oil should be replaced with unrefined oil, salt intake should be limited. The therapeutic diet also implies the rejection of canned, fried and smoked foods. To restore the destroyed cartilage, it is necessary to supply the body with carbohydrates, which are found in cereals and wholemeal flour.
Also, it is recommended to drink freshly squeezed juices, such as carrot, beetroot, and apple, to remove toxins and reduce inflammation in the body.
Fish and various jellies act as chondroprotectors and help restore cartilage not only in the initial stages, but also during periods of exacerbation.
Folk methods of treatment
There are many ointments, compresses, tinctures that are used by lovers of traditional medicine. These remedies are usually herbal, medical bile and help improve circulation in the joints.
Compresses and ointments also relax the muscles, their effectiveness is very high, but in the third stage of gonarthrosis without the use of drugs they are practically useless.
Traditional medicine should not be neglected, as it helps relieve discomfort and reduce many of the symptoms of the disease. But in any case, you should consult a doctor and not self-medicate.
There are contraindications, it is necessary to consult a specialist.
Prevention
It is recommended to adhere to the following principles of a healthy lifestyle:
- balanced diet;
- giving up bad habits (smoking, alcohol);
- sports;
- maintaining a healthy weight;
- prevention of sports injuries (bruises, displacements, fractures).
Osteoarthritis of the knee has different treatment options depending on the age and physical condition of the patient. To prevent and control the disease in the early stages, sports and timely treatment are required.