One of the most common complaints doctors hear from patients is pain in the knees. What causes this pain is not always possible to say right away. The knees can be affected by various diseases, for example, arthrosis 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 people, more often young men, with damage to one, less often both knee joints. They have an injury or knee surgery in their medical history.
The second group includes people who are obese, middle-aged or elderly, more often women, in whom gonarthrosis has developed in several parts of the body at the same time.
Symptoms of osteoarthritis of the knee
Symptoms of osteoarthritis of the knee increase gradually. Patients may not be aware that they are sick for years until they notice an obvious deformity of the knee or severe pain.
At the same time, arthritis of the knee joint at the initial stage of the disease is most often accompanied by unpleasant and painful sensations in the knees, and few people seek medical advice.
Women prone to obesity, especially after 40 years, are predisposed to this disease.
Varicose veins also contribute to the development of the disease. At this stage, it is possible to treat the disease at home without the use of tablets and ointments.
Pain is not sudden, it appears gradually, over several years. They usually occur during sports, walking and other physical activity.
Acute pain may not be a symptom of gonarthrosis, but a consequence of a crack, meniscus injury or bruise. It is severe pain that becomes the motivation to turn to a specialist.
The pain often gets worse in the following cases:
- when walking;
- in a long standing position;
- during slopes;
- when lifting the body from a sitting position;
- when carrying heavy objects.
During the performance of these actions, the maximum load acts on the joints, therefore, if the patient feels severe discomfort, he can already be diagnosed with arthritis of the knee joint of the second stage. A person tries to move less, take a static position in order to avoid pain, but with continued physical activity, the discomfort returns.
Deforming osteoarthritis of the knee joint accompanies such a symptom as deformity. It becomes noticeable already at the second or third stage of the disease. Her first signs: the knee was slightly swollen, but retained its shape. In later stages, there is a change in the shape of the knee, making one leg shorter or longer.
One of the most characteristic symptoms is a crunch in the joints, noticeable in the second and third stages. The main thing is to distinguish the sonorous crunch in the joints of a healthy person from the deaf, dry crunch of the patient. This sound causes weakness of the ligamentous apparatus or high mobility of the joints.
To ensure the immobility of the knee joint, it is recommended to wear knee braces.
Forms of gonarthrosis
There are two forms of the disease:
- Primary: Appears as a result of congenital abnormal development of the joints.
- Secondary: Appears as a result of illness and injury.
The primary form of osteoarthritis of the knee joint often develops in childhood and is caused by improper formation of ligaments and joints. They are subjected to heavy loads and deformed during physical activity.
The secondary form of the disease is caused by the following factors:
- Injuries (bruises, sprains, displacements, fractures), which entail violations of the structure of 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 provokes pressure on the cartilage of the knee joints.
- Passive lifestyle.
- Diabetes.
- Age.
- Arthritis (inflammatory process in the joints). Prolonged illness 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 beginning of the first stage to the visible manifestations of the disease, it may take several months or even years. The person complains of intermittent pain in the legs, especially when starting 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 more acute pain, which does not stop with the immobility of the limb. A crunch appears. Fluid accumulates in the joint cavity, X-ray shows the deformation and growth of the bone. The patient at this stage 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 with changing weather conditions. 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 illness. At-risk groups
Overweight
Most often, deforming osteoarthritis affects the elderly. In a special risk group are overweight women after 40 years. The likelihood of pathology in obese people is 4 times higher than in people with normal body weight. The pattern is simple: the greater the weight of 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 extremities 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 arthrosis.
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 percent of people.
The reason is age-related changes that negatively affect the structure of the joints. Even ordinary walking can become a significant load 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, a lack of intra-articular lubrication. Heredity also plays an important role.
Yet the majority of patients suffering from knee pain are people of respectable age. Arthrosis is rare among young people. Unfortunately, young patients do not always receive the necessary treatment, because not all doctors consider it necessary to give them the necessary attention.
High loads
People who earn a living by hard physical labor, and athletes of various levels, are also at risk of experiencing osteoarthritis of 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 arthrosis 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.
X-ray 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 allows 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, narrowing of the joint space and 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 MRI (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 may remain in the remission phase, when the active manifestations of the disease are minimized or absent altogether.
Physiotherapy treatment in combination with chondroprotective medications gives positive results.
Treatment options include:
- drug therapy (chondroprotectors);
- surgical intervention;
- rehabilitation course (exercise therapy, massage, etc. ).
Treatment with drugs
With drug therapy, the use of non-steroidal analgesics is prescribed. These drugs help relieve pain and symptoms of synovitis (inflammation). If the pain is especially intense or the synovium of the knee joint is severely inflamed, then corticosteroids may be used. These medicines have a more powerful analgesic and anti-inflammatory effect than non-hormonal painkillers. Muscle relaxants and antispasmodics will help the periarticular muscles get rid of spasms.
Antioxidants and vasodilators improve cartilage nutrition. The main medicines for the conservative treatment of the disease are chondroprotectors that contain chondroitin and glucosamine sulfate (natural components of cartilage).
The use of pathogenetic drugs should be systemic and prolonged.
Physiotherapy
Methods of physiotherapy 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 treatment with liquid nitrogen and ordinary 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 microdischarges of current of different frequencies, muscles are restored and strengthened, and blood circulation in the limbs improves.
Treatment of gonarthrosis of the knee with physiotherapy is effective, as it reduces pain. The attending physician usually prescribes such treatment according to the stage of the disease.
Physiotherapy
Exercise therapy for osteoarthritis of the knee joint is one of the main means of restoring atrophied muscles, and it must be carried out very carefully and slowly. If the patient feels that the pain is returning, the exercise should be stopped.
During therapeutic exercises, it is necessary to wear special knee pads-fixators. The rehabilitation course also includes the use of these orthopedic devices, their goal is to reduce the load from the affected knee to the cane or prosthesis. Patients with gonarthrosis are often prescribed to wear knee braces 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 should use a cane. A good helper for knee osteoarthritis is orthopedic shoes that provide a natural foot position and even load distribution.
Massage
Massage relieves muscle spasms, reducing pain and increasing range of motion. This procedure also improves blood circulation and provides the joint with nutrients.
Surgical intervention
A pronounced decrease in working capacity (especially up to 45 years) requires surgical treatment. The choice between corrective (removal of osteophytes) and radical (knee arthroplasty) methods of treatment depends on the stage of the disease, the age of the patient, symptoms and other factors.
Nutrition
As for the special diet for gonarthrosis, it is most often aimed at reducing the patient's weight, because it is overweight that leads to overload of the joints. It is recommended to eat 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 food, fried and smoked foods. In order to restore destroyed cartilage, it is necessary to provide the body with carbohydrates, which are found in cereals and whole grain flour.
In addition, it is recommended to drink freshly squeezed juices, such as carrot, beet 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 made from herbs, medical bile, and they 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, because they help relieve discomfort and reduce many of the symptoms of the disease. But in any case, you should consult a doctor and do 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).
Knee osteoarthritis has several treatment options depending on the age and physical condition of the patient. To prevent and control the disease in the early stages, sports are necessary, as well as timely treatment.