Have you ever had knee pain? It is extremely uncomfortable when you suddenly start to limp or cannot descend without knee pain. Osteoarthritis of the knee joint is not life threatening, but it significantly worsens its quality.
What is osteoarthritis of the knee?
Osteoarthritis of the knee(gonarthrosis, osteoarthritis, osteoarthritis of the knee joint). Gonarthrosis is arthritis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing but surgery helps. You need it? So don't rush into this 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, such arthrosis is called primary, it is inherited through the maternal line. If the grandmother has osteoarthritis of the knee joints, both the daughter and the granddaughter may have this disease at a younger age.
Secondary osteoarthritis develops as a result of trauma, congenital anomalies of the knee joint, physical overload (sports, professional), endocrine disorders.
The risk factors are overweight, female sex, old age. Cartilage is very sensitive to a decrease in female sex hormones, with menopause all the joints begin to "crumble". As a result, older overweight women suffer from osteoarthritis of the knee joint more severely and more often.
Anatomy of the knee.The knee joint is formed by the femur, tibia and kneecap. The articular surfaces of the bones are covered with a layer of cartilage. The extra cartilage spacers between the bones are called menisci and provide 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 joint cartilage. Synovial fluid contains hyaluronic acid, which is necessary for the smooth sliding of joint surfaces. Ligaments, muscles and their tendons guide and restrict movement of the joint.
General description.With osteoarthritis of the knee joint, destruction of the articular cartilage occurs. There are three stages of osteoarthritis of the knee. At the first stage, the nutrition of the articular cartilage and menisci is disturbed. The 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 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 already occurs during normal exercise, walking.
In the third stage, a pronounced bone deformation of the knee joint with a strong restriction 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 knee pain has come on suddenly, suddenly, for the first time, it probably isn't osteoarthritis.
Osteoarthritis of the knee joint gradually begins with discomfort or minor pain in the knee when overloading, walking for a long time, descending, passing from a squatting position. At rest, the pains pass quickly.
In the second stage, knee pain already appears 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.
At the third stage, the pain becomes chronic, occurs not only during movement, but also at rest. Nighttime pain disrupts sleep. The knee is difficult to put to bed without pain. Swelling of the joint indicates the addition of inflammation. Mobility of the knee joint is reduced to a minimum.
The joint is significantly deformed, the legs become O-shaped 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:
- pain of a mechanical type occurs under the influence of daytime physical activity and disappears during the period of night rest. These knee pains are associated with a decrease in the shock absorption capacity of cartilage and bone structures. Knee pain is usually localized in the anterior and inner region of the knee joint and in the upper part of the leg.
- nocturnal pain is associated with stagnation of venous blood, increased intraosseous pressure in the joint and inflammation.
- The "starting" pain occurs after a period of rest, disappears 15-20 minutes after movement of the joint. These knee pains are caused by the friction of the joint 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 osteoarthritis of the knee.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.
Normally, the knee joint contains 3 to 5 ml of synovial fluid. With diseases of 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 the cavity inside the kneecap (medial fossa). With an increase in volume, the upper volvulus fills, with massive swelling above the kneecap ("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 area. It is neither a tumor nor an 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 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 osteoarthritis of the knee joint.Laboratory tests are not helpful for diagnosis, but are used to rule out other conditions with knee pain. With osteoarthritis, the indicators of blood count without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. The level of uric acid is within the normal range.
The x-ray shows bone changes in the joint, excludes traumatic causes of joint pain. In our country, a radiographic classification of osteoarthritis 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 - sudden narrowing of the joint space, flattening of joint surfaces, 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 cartilage, menisci, ligaments, tendons. Ultrasound of the knee joint makes it possible to visualize the soft tissues (menisci, muscles, ligaments), to assess the volume of 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 cartilage destruction under a microscope.
Treatment of osteoarthritis of the kneepresents a difficult task. In each case, you need to select an individual treatment program.
When you start to say mundane things during the consultation, patients stare in 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 single method for eliminating osteoarthritis. To recover, you have to move, lose weight, register for the swimming pool. And a person wants to lay down on the couch, grow a "beer belly, " grab the problem with a bunch of drugs, and be healthy. But unfortunately !!! 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 nonsteroidal drugs, by relieving pain, contribute to further destruction of cartilage. Healing ointments do not cure osteoarthritis of the knee, but they help to relieve knee pain slightly. With edema, redness of the joint, warming ointments and compresses are contraindicated; it is better to use local remedies with nonsteroidal anti-inflammatory drugs.
Chondroprotectors do not relieve pain, are expensive, and need to be taken for a long time. I consider them to be "models" and I hardly 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 own opinion on its effectiveness.
For the treatment and prevention of osteoarthritis of the knee joint, it is necessary to engage in appropriate physiotherapy exercises while sitting or lying down. Squats and jumps are strictly prohibited. Cycling, swimming or exercising in the water, skiing is useful. And the feats of work in the country often lead to increased pain in the knees. With osteoarthritis of the knee joints, running, walking quickly uphill, lifting weights 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 should lose at least 3-5 kg. And some patients must 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 your eating behavior for the rest of your life, just "stop liking" all harmful products (sugary, 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 sharply limit the consumption of meat and increase the amount of vegetables and fruits in the diet.
It is believed that sausages, sausages, smoked meats, fast food improve 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 have pain in the knee joints, you need to pick up the kneecap. In advanced cases, walking with a cane is indicated. When shortening the leg, an insole at the heel is recommended. Recently, it has become fashionable to use kinesio tapes. These are natural cotton adhesive strips that are stuck around the affected knee, do not limit its mobility, but help relieve the joint and reduce muscle spasms.
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 very good results. I will give a case of practice.
A 54-year-old man with stage II osteoarthritis of the right knee joint turned to me for help. Knee pain bothered him for 6 years. Over the years, he has taken numerous courses in drug therapy, physiotherapy, blocking with corticosteroids and repeated courses in a rehabilitation center. But the patient's condition only worsened. He came to me for a consultation to find out 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 my treatment.
In the first session, I gave her 6 leeches, which helped cope with the swelling in the joints and get rid of nighttime pain. The knee has become easier and more free to move. The man felt a little relieved. Then we performed 3 interstitial electrical stimulation procedures 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 in acupuncture points. After 3 weeks of starting treatment, the patient threw away the cane and began to move freely, without limping. 3 years have passed since. The knee pain did not come back. Once a year, we organize a VTES session for preventive purposes.
Intra-articular hormone injections are very effective in emergencies in relieving severe pain, swelling, and inflammation. The indication is an effusion, it is forbidden to block with corticosteroids in the "dry joint"! They provide temporary pain relief, but such injections do not cure the osteoarthritis itself, and the cartilage that follows them is even more destroyed. They must be carried out by a specially trained doctor who is well informed 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 prostheses, are injected into the joint. They act on the joint like a natural lubricant, improve the sliding of bone surfaces and restore the cushioning functions of the cartilage. But preparations of hyaluronic acid are expensive and last only 6-8 months. It is unnecessary to administer preparations of hyaluronic acid 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 radishes, horseradish or ginger, turpentine baths.
Joint endoprostheses should only be performed in case of severe dysfunction of the knee joint, because after 10 to 15 years this joint will have to be changed again. Will there be enough strength and health every 10 to 15 years for an operation under general anesthesia and subsequent rehabilitation??? So do not rush to accept a transaction! Take care of your joints!