Knee joint

Degenerative knee deformity (also known as gonarthrosis or DOA for short)- degenerative-dystrophic disease of the knee joint, which is characterized by a chronic, steadily progressive process that damages all structural elements (hyaline cartilage, periarticular bone structure, synovial membrane, capsule, joints and ligaments) and lead to joint deformity, reduced range of motion, and often disability.

The disease begins with changes in the articular cartilage, as a result of which the articular surfaces of the bones slip. Malnutrition and loss of elasticity lead to dystrophy (thinning) and bone resorption, while the bone tissue of the joint surface is exposed, the slip is disturbed, the knee joint space narrows, the biomechanics of the joint surface are exposed. match changes. The synovial membrane that surrounds joints and produces synovial fluid (which nourishes cartilage and acts as a physiological lubricant) becomes irritated, leading to an increased amount of joint fluid (synovitis). In the context of joint space narrowing, joint volume is reduced, synovial fluid protrudes into the posterior wall of the joint capsule and forms a Becker cyst (large size can cause pain in the fossa). The thin and fragile tissue of the joint capsule is replaced by coarse connective tissue, the shape of the joint changes. Peripheral bone tissue develops, osteoblasts (pathological bone growth) are formed. Blood circulation in the peristaltic tissues is impaired, under-excited metabolic products accumulate in them, and persistent pain syndrome develops. Against the background of anatomical changes of the joints, a violation of the surrounding muscles occurs, muscle atrophy and spasm appear, and gait is disturbed. There is a persistent limitation of range of motion in the joint (spasticity), sometimes so marked that only swaying movements (stiffness) can be performed or no motion at all (ankylosing spondylitis). ).

Regarding knee osteoarthritis, it can be said that this is a fairly common disease: it affects 10% of the population on the planet, and over the age of 60, it affects every third person.

Causes of gonarthrosis

• Osteoarthritis injury.
• Inflammatory diseases (rheumatism, chlamydial arthritis, gout).
• Violation of mineral metabolism in various endocrine diseases (diabetes mellitus, parathyroid disease, hemoglobinopathy).
• Diseases of the musculoskeletal system and neurological diseases (Charcot's disease).

In addition to the main reasons, there are also underlying factors that are unfavorable for the development of gonarthrosis, including:

• overweight (literally puts pressure on the lower extremities);
• age (mainly the elderly are susceptible);
• female gender (according to statistics, women get the disease more often);
• enhance sports and professional physical activity.

Symptoms of knee osteoarthritis

• Pain increases with walking and decreases with rest.
• Difficulty with habitual and physiological movements in joints.
• A characteristic "creak" sound in the joints.
• Joint enlargement and visible deformity.

Stages of gonarthrosis

There are several stages of joint disease:

1. In the first stage, a person only experiences symptoms such asmild discomfortor "heavy" in the knees, causing disturbances during long walks or increased exertion. X-rays will be less informative: only mild narrowing of the joint will be detected, no other changes. At the beginning of the defeat of the paresis of the knee joint, a person does not turn to specialists, without paying attention to the symptoms that have already appeared.
2. For the second stage of arthritis of the knee joint,tangible pain, its severity decreases at rest. Difficulty moving the joints appears, when walking, a characteristic "creak" sound (from the patient can hear a common phrase in everyday life - "creaky knee"). When performing radiographs, it is possible to clearly distinguish joint space narrowing and solitary osteomas.
3. With the transition of gonarthrosis to the next, third, stage, painful symptoms will bother the patient constantly, including at rest, there is a violation of the configuration of the joints, i. e. deformity, aggravated by edema at the time of inflammatory involvement. On radiographs, a moderate degree of stenosis of the joint cavity was determined and there was a lot of bone-forming substance. At the third stage, many people seek medical help, because quality of life is significantly affected by pain and difficulty walking normally.
4. The fourth stage of arthritis of the knee joint is accompanied byinsurmountable pain, fatigue. . . Minimal efforts to move become a difficult test for a person, deformity of the joints is noticeable to the naked eye, walking is extremely difficult. Radiographs show significant changes: joint spaces are practically undetectable on imaging, many rough bone cells, "joint rat" (collapsed bone fragments falling into the joint cavity) are revealed. This stage of gonarthrosis is almost always accompanied by disability: often the result of the disease is a complete fusion of the joint, its instability and the formation of a "pseudo-joint".

Who treats knee effusion?

Specialists, rheumatologists, and general practitioners (family doctors) can provide qualified medical care to patients with osteoarthritis of the knee, but specialistsThis section deals with the treatment of the knee joint for uncomplicated joint disease.

When bursitis occurs or the treatment prescribed by a specialist does not give the desired effect, one cannot do without the help of a chiropractor. In situations requiring surgical care, patients with knee osteoarthritis are referred to specialized trauma and orthopedic departments.

How and how to treat knee osteoarthritis?

Currently known methods of treating patients with osteoarthritis of the knee are divided into conservative, non-pharmacological, medical and surgical.

Non-drug method

Many patients ask themselves the question: "How to cure knee osteoarthritis without drugs? Answering it, we have to say with regret that gonarthrosis is a chronic disease, it is impossible to get rid of it forever. However, many of the currently available non-pharmacological (i. e. non-pharmacological) approaches to dealing with this disease can significantly slow disease progression and improve patients' quality of life, especiallywhen used in the early stages of the disease.

With a timely visit to the doctor, and enough motivation to cure the patient's illness, sometimes it is enough to eliminate negative factors. For example, it has been shown that losing excess weight reduces the manifestation of the main symptoms of the disease.

Eliminate pathological physical activities and vice versa,therapeutic gymnasticsWith the proper use of physical programs, they reduce the intensity of pain. Exercises that strengthen the quadriceps have been shown to be as effective as anti-inflammatory drugs.

If we treat knee osteoarthritis, we need to striveproper nutrition: improving the elastic properties of joint cartilage will help products containing a large amount of animal collagen (meat and fish diet) and cartilage components (shrimp, crab, krill), fresh vegetables containingrich in plant collagen and antioxidants, and indulging in smoked, marinated, preserved meats, sweet and savory dishes, on the contrary, it also disrupts the body's metabolism and accumulates weight. Excess leads to obesity.

Reflecting on the most effective treatment for knee effusion, we should keep in mind an effective treatment and prevention method such as:orthopedic: immobilization of knee pads, orthotics, elastic bands and orthopedic pads reduce and accurately distribute the load on the joint, thus reducing the intensity of pain in the joint. The use of canes is also recommended as an effective way to relieve knee pain. It should be in the hand opposite the affected limb.

Comprehensive treatment of knee disease also implies very effective indications, even with advanced forms of the diseasephysical therapy. . . With its wide use in different types of patients suffering from any degree of joint disease, it has proven its effectiveness.acupuncture therapy: after several courses, pain intensity gradually decreases, due to improved blood circulation, reduced edema and elimination of muscle spasticity, increased joint mobility. The effect of magnetic therapy is especially pronounced with the development of active inflammation in the joints: the degree of edema is significantly reduced, the symptoms of bursitis subside. Not too common but equally effective in the treatment of knee osteoarthritis are physical therapy methods such as:laser therapyandcryotherapy(exposed to cold), has a pronounced analgesic effect.

Medicines for treatment

In effective treatment regimens for knee effusion, the following drugs are used.

Non-steroidal anti-inflammatory drugs (NSAIDs), produced in the form of external use (various gels, ointments) and systemic use (tablets, suppositories, solutions), has long proven effective in the treatment of osteoarthritis and is prescribed by doctors. wide menu. By suppressing inflammation at the enzymatic level, they eliminate joint pain and swelling, and slow the progression of the disease. With early manifestations of the disease, the local use of these drugs in combination with non-drug methods (therapeutic exercises, hydro-acupuncture) is effective. But with advanced knee osteoarthritis, oral medications and sometimes injectable NSAIDs are indispensable. It must be remembered that prolonged systemic use of NSAIDs can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract, and in addition, negatively affect the function of the kidneys and liver. . Therefore, patients who have used NSAIDs for a long time should also be prescribed drugs that protect the gastric mucosa, and regularly monitor the activity of internal organs in the laboratory.

Glucocorticosteroids (GCS)- Hormonal drugs have a pronounced anti-inflammatory effect. They are recommended when NSAIDs previously prescribed to a patient do not help to eliminate inflammatory manifestations. As a potent anti-inflammatory agent, GCS in the treatment of rheumatic diseases has certain contraindications, as they can cause some significant side effects. In systemic forms with gonarthrosis, they are practically not prescribed. As a rule, for the effective treatment of joint disease, the injection of GCS into the pain points around peristalsis is meant to increase the intensity of the anti-inflammatory fight and minimize the risk of unwanted side effects of the drug. This maneuver can be performed by a rheumatologist or trauma specialist. With concurrent bursitis or rheumatoid arthritis, these drugs are injected directly into the joint. With a single use of GCS, the effect of such treatment lasts up to 1 month. According to national guidelines for the treatment of osteoarthritis, do not give more than three injections per year into the same joint.

With severe, "neglected" degenerative joint disease, when a person experiences unbearable pain, which does not subside even with rest, disrupts normal sleep, and is not eliminated by NSAIDs, GCS and non-pharmacological methods, prescriptions can be made.opioid pain reliever. . . These drugs are only used with a doctor's prescription, the doctor will consider the appropriateness of the indication in each case.

Chondroprotectors(literally "protects cartilage"). This name is understood as different drugs, united by one property - a structural altering action, that is, the ability to slow down degenerative changes in cartilage and the narrowing of joint spaces. They are produced in both oral and intra-articular forms. Of course, these drugs don't work miracles and don't "grow" new cartilage, but they can stop its destruction. To achieve lasting results, they must be applied over a long period of time, with regular treatments several times a year.

Osteoarthritis of the knee surgery

There are frequent cases when, despite adequate complex treatment, the disease progresses, gradually reducing the quality of life of a person. In such situations, the patient begins to ask the question: "What if prescription drugs do not help with knee osteoarthritis? " Answering these questions, it should be made clear that the indication for surgery isOsteoarthritis of the knee is a syndrome of intractable pain and significant joint dysfunction that cannot be eliminated with complex conservative therapy, which can occur with the last, second degree case. fourth of the disease.

The most common type of surgical care for third and fourth degree arthropathy isEndoscopic, IE. disassembling your own joint with the simultaneous fitting of a replacement metal prosthesis, the design of which is similar to the anatomical structure of the human knee joint. In this case, the prerequisites for this type of surgical treatment are: the absence of overall deformity of the joint, the formation of a "pseudo-joint", muscle contractures and severe muscle atrophy. In cases of severe osteoporosis (significant reduction in bone mineral density), endoscopy is also not indicated: the "sugar" bone will not tolerate the insertion of metal pins, and the process of digestion (resorption ofcollection) bone tissue will rapidly begin at the site of their installation, pathological fractures may occur. Therefore, a timely decision about the need to install an endoscope seems to be very important - it should be made when the age and general condition of the human body still allows surgery. According to the results of long-term studies, the duration of action of arthroscopy in patients with advanced joint disease, i. e. , the temporary period without significant limitation of motion and maintaining a good quality of life isabout ten years. The best results of surgical treatment are observed in people 45-75 years old with low body weight (less than 70 kg) and a relatively high standard of living.

Although knee arthroplasty is widely used, the outcomes of these surgeries are often unsatisfactory and complication rates are high. This is due to the design characteristics of the endoscope and the complexity of the surgical intervention itself (hip replacement is technically much easier). This suggests the need to perform organ-preserving (joint-preserving) operations. These include bone marrow bypass surgery and orthopedic surgery.

Bypassing the spinal cord- connect the canal of the femur to the cavity of the knee joint using a shunt - a hollow metal tube. This facilitates the fatty bone marrow from the lower third of the femur to enter the knee joint, nourish and lubricate the cartilage, thereby reducing pain significantly.

Changing the axis of the lower extremities (but with limited range of motion) works.bone editing- transverse tibial with adjustment of its axis, followed by fixation with discs and screws in the desired position. At the same time, two goals are achieved - the normalization of biomechanics due to restoration of the limb axis, as well as the activation of blood circulation and metabolism during bone fusion.

Summing up the above, I would like to note that the treatment of gonarthrosis is a complex social task. And although today's medicine can't come up with a permanent cure or other ways to completely cure this disease, but living a healthy lifestyle, seeking timely medical help and doingFollowing a doctor's recommendation can stop its progression.