Have you ever had knee pain? It is extremely uncomfortable when you suddenly start to limp or cannot go down stairs without knee pain. Osteoarthritis of the knee joint is not life-threatening, but it drastically worsens its quality.
What is knee osteoarthritis?
Knee osteoarthritis(gonarthrosis, osteoarthritis, osteoarthritis of the knee joint). Gonarthrosis is osteoarthritis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing but surgery helps. Do you need it? So don't run into that 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 osteoarthritis is called primary, it is inherited through the maternal line. If the grandmother suffers from osteoarthritis of the knee joints, then the daughter and 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, occupational), endocrine disorders.
Risk factors are being overweight, female, old age. Cartilage is very sensitive to a decrease in female sex hormones, with menopause all joints begin to "fall apart". Therefore, older overweight women suffer from osteoarthritis of the knee joint with greater severity and frequency.
Anatomy of the knee.The knee joint is made up of 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 shock absorbers. The knee joint has the largest synovium, which forms large twists and pockets.
The joint cavity is filled with synovial fluid, which nourishes the articular cartilage. Synovial fluid contains hyaluronic acid, which is necessary for smooth gliding of joint surfaces. Ligaments, muscles, and their tendons guide and restrict joint movement.
General description.With osteoarthritis of the knee joint, the destruction of articular cartilage occurs. There are three stages of knee osteoarthritis. In the first stage, the nutrition of the articular cartilage and menisci is disrupted. Cartilage loses its elasticity and cracks. There is abnormal friction between the bones. Joint overload is accompanied by swelling 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 ("spines"). 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 deformity of the knee joint is revealed with a strong restriction of natural movements.
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-lasting, with a slow and irreversible increase in symptoms. If the pain in the knee has come on abruptly, suddenly, for the first time, it is most likely not osteoarthritis.
Osteoarthritis of the knee joint begins gradually with a slight discomfort or pain in the knee during overload, prolonged walking, going down stairs, getting up 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.
In the third stage, the pains become chronic, they occur not only during movement, but also at rest. Night pains disturb sleep. It is difficult to place the knee on the bed without pain. The swelling of the joint indicates the addition of inflammation. Mobility of the knee joint is minimized.
The joint is significantly deformed, the legs take the shape of an O or X. 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:
- 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 absorption capacity of bone structures and cartilage. Knee pain is localized, as a rule, in the anterior and internal region of the knee joint and in the upper part of the lower leg.
- night pains are associated with stagnation of venous blood, increased intraosseous pressure in the joint, and inflammation.
- The "initial" pain occurs after a period of rest, disappears 15-20 minutes after movement of 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 knee osteoarthritis.Synovitis is an inflammation of the synovial membrane, which lines the joint 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, there is an increased production of inflammatory fluid. The amount of effusion (pathological fluid) can reach 30-70 and even more than 100 ml. The knee effusion first fills the cavity inside the patella (medial fossa). With an increase in volume, the upper volvulus fills up, with a massive swelling above the patella ("saddle").
Baker's cyst occurs with a significant increase in intra-articular fluid volume. A round, elastic bump forms in the popliteal region. This is not a tumor, it is not cancer and 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. At even larger sizes, the cyst can compress 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 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.
Radiography shows bony changes in the joint, excludes traumatic causes of joint pain. In our country, a radiological 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 narrows more clearly, subchondral sclerosis occurs;
Stage 3 - a sharp narrowing of the joint space, flattening of the joint surfaces, 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, and tendons. Ultrasound of the knee joint helps to visualize the soft tissues (menisci, muscles, ligaments) to assess the volume of effusion.
Arthroscopy is the most accurate method of diagnosing osteoarthritis of the knee joint. A special probe is inserted into the joint cavity, and the doctor evaluates the degree of cartilage destruction under a microscope.
Treatment of knee osteoarthritispresents a difficult task. In each case, you must select an individual treatment program.
When you start saying banal things during the consultation, patients look at the first moment in surprise. Is this what we came for? Give a miracle injection so my knee will never hurt again. We have to explain that there is no single method that can eliminate osteoarthritis. To recover, you need to move, lose weight, join the pool. And a person wants to lie on the couch, grow a "beer belly", tackle the problem with a bunch of drugs, and be healthy. But oh! In this case, the medicine is powerless.
Pain relievers do not cure, they only 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 do help to relieve knee pain slightly. With edema, redness of the joint, hot ointments and compresses are contraindicated; it is better to use local remedies with non-steroidal anti-inflammatory drugs.
Chondroprotectants do not relieve pain, are expensive, and must be taken for a long time. I consider them "dumb" and practically do not name them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this drug in my clinical practice and I do not have my own opinion on its effectiveness.
For the treatment and prevention of osteoarthritis of the knee joint, it is necessary to perform appropriate physiotherapy exercises in a sitting or lying position. Squats and jumps are strictly prohibited. Cycling, swimming or exercising in the water, skiing are helpful. And labor exploits in the country often lead to increased pain in the knees. With osteoarthritis of the knee joints, running, brisk walking uphill, or 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 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 your eating behavior for the rest of your life, simply "stop loving" all harmful products (candy, starchy foods, beer, etc. ) Eating right should become a habit. To lose weight, you must eat the right foods every 3 hours.
To reduce inflammation in the joints, homeopaths recommend foods that alkalize the blood and intra-articular fluid. For this, it is necessary to drastically limit the consumption of meat and increase the amount of vegetables and fruits in the diet.
Sausages, cold cuts, smoked meats, fast food are believed to enhance inflammatory processes in the joints. Instead of pharmaceutical chondroprotectants, I recommend eating properly prepared jellied meat.
Orthopedic correction reduces stress on the knee joints. If you have pain in your knee joints, you need to lift your kneecap. 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 stick around the affected knee, do not limit its mobility, but help to 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 came to me for help. Knee pains bothered him for 6 years. Over the years, he underwent numerous courses of drug therapy, physical therapy, corticosteroid blockade, and repeated courses at a rehabilitation center. But the patient's condition only got worse. He came to me for advice on whether to accept joint replacement surgery or to try something else conservatively. I did not 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 deal with joint swelling and eliminate night pains. The knee has become easier and free to move. The man felt a bit of relief. We then performed 3 interstitial electrical stimulation procedures and almost completely stopped the pain syndrome.
Later, the success was consolidated with the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effect on acupuncture points. After 3 weeks from the start of therapy, the patient dropped 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 hold a VTES session for preventive purposes.
Intra-articular hormone injections are very effective in an emergency to relieve severe pain, swelling, and inflammation. The indication is an effusion, it is forbidden to block with corticosteroids in the "dry joint"! They temporarily relieve pain, but such injections do not cure osteoarthritis itself, and the posterior cartilage is further destroyed. They must be performed by a specially trained doctor who is well aware of the indications, contraindications, medications, administration points. In total, no more than 3 blocks are required per joint.
After removing 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 gliding of bone surfaces and restore the shock absorption functions of cartilage. But hyaluronic acid preparations are expensive and only last 6 to 8 months. It does not make sense to administer hyaluronic acid preparations with complete loss of joint space and in patients over 65 years of age.
Treatment with home remedies.You can use tincture or decoction of cinquefoil, compresses with radish, horseradish or ginger, turpentine baths.
Endoprosthesis of the joints should be performed only in case of severe 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 accept a trade! Take care of your joints!