Have you ever had knee pain? It’s extremely embarrassing when you suddenly start limping or you can’t go down without knee pain. Osteoarthritis of the knee joint is not life-threatening, but it dramatically worsens its quality.
What is knee osteoarthritis?
Knee osteoarthritis(gonarthrosis, osteoarthritis, osteoarthritis of the knee joint). Gonarthrosis is an arthrosis of the knee joint (this disease has nothing to do with gonorrhea). In advanced cases, nothing but surgery helps. Do you need it? Then don’t run into that state.
Causes of osteoarthritis of the knee joint.Distinguish between primary and secondary arthrosis of the knee joint. If the cause of the disease is not determined, such arthrosis is called primary, it is inherited through the maternal line. If the grandmother suffers from osteoarthritis of the knee joints, the daughter and granddaughter may have this disease at a younger age.
Secondary arthrosis develops as a result of trauma, congenital anomalies of the knee joint, physical overload (sports, professional), endocrine disorders.
Risk factors are overweight, female gender, age. Cartilage is very sensitive to the reduction of female sex hormones, with menopause all joints begin to "crumble". Therefore, overweight older women suffer more and more often from osteoarthritis of the knee joint.
Knee anatomy.The knee joint consists of the femur, tibia and patella. The articular surfaces of the bones are covered with a layer of cartilage. Additional cartilaginous spacers between the bones are called menisci and are amortized. The knee joint has the largest synovium, which forms large bends and bursae.
The joint cavity is filled with synovial fluid that feeds the articular cartilage. Synovial fluid contains hyaluronic acid, which is necessary for smooth sliding of joint surfaces. The ligaments, muscles and their tendons restrict movement in the joint.
General description.In osteoarthritis of the knee joint, the articular cartilage is destroyed. There are three stages of knee osteoarthritis. In the first phase, the nutrition of the articular cartilage and meniscus is disturbed. Cartilage loses elasticity and cracks. Abnormal friction between the bones occurs. Joint overload is accompanied by inflammation and pain in the knee.
In the second phase, the destruction of the articular cartilage and meniscus begins. Bone responds to the burden of marginal growths - osteophytes ("thorns"). The amount of intra-articular fluid decreases, the narrowing of the joint space increases. As a result, knee pain occurs during normal exercise and walking.
In the third phase, a pronounced bone deformity of the knee joint with a sharp restriction of natural movements is revealed.
Symptoms of osteoarthritis of the knee.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, irreversible increase in symptoms. If the knee pain came on suddenly, suddenly, for the first time, then it’s most likely not osteoarthritis.
Osteoarthritis of the knee joint begins gradually with discomfort or minor pain in the knee during overload, long walks, descending, lifting from a squat position. At rest, the pain passes quickly.
In the second stage, knee pain appears already at normal exertion. The volume of active movements in the knee joint decreases. The shape of the joint changes due to bone deformation and accumulation of abnormal fluid in the joint.
In the third phase, the pain becomes chronic, occurring not only during movement, but also at rest. Night pains disrupt sleep. The knee is difficult to place in bed without pain. Swelling of the joint indicates the addition of inflammation. The mobility of the knee joint is reduced to a minimum.
The joint is significantly deformed, the legs become O- or X-shaped. In severe cases, there is a complete destruction of the joint with the development of ankylosis (immobility).
There are 4 types of pain in osteoarthritis of the knee joint:
- the mechanical type of pain occurs under the influence of daily physical activity and subsides during the period of night rest. These knee pains are associated with a decrease in the ability to absorb shock to cartilage and bone structures. Knee pain is localized, as a rule, in the anterior and inner part of the knee joint and the upper part of the lower leg.
- nocturnal pain is associated with stagnation of venous blood, increased intraosseous pressure in the joint, and inflammation.
- "Initial" pain occurs after a period of rest, disappears 15-20 minutes after movement in the joint. These knee pains are caused by friction of the articular surfaces on which cartilage fragments are deposited.
- persistent knee pain occurs due to muscle spasms as well as the development of synovitis.
Complications of knee osteoarthritis.Synovitis is an inflammation of the synovial membrane that covers the joint cavity from the inside. Signs of inflammation: swelling, fever, redness, pain, joint dysfunction.
Usually the knee joint contains 3-5 ml of synovial fluid. In joint disease, 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 effusion from the knee first fills the cavity on the inside of the patella (medial fossa). As the volume increases, the upper volvulus fills, with a massive swelling above the patella ("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 region. This is not a tumor, it is not oncology and it does not need surgery. 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 an even larger size, the cyst can compress the nearby peroneal nerve with the development of weakness and numbness of the feet.
Diagnosis of osteoarthritis of the knee joint.Laboratory tests are not useful for diagnosis, but are used to rule out other conditions with knee pain. In osteoarthritis, blood counts without inflammatory changes, leukocytes and ESR are within normal limits. Rheumatic tests are negative. Uric acid levels are within normal limits.
X-rays show changes in the bones in the joint, excluding traumatic causes of joint pain. In our country, the X-ray classification of arthrosis by stages is used.
Stage 1 - the presence of marginal growths on the bones with a slight narrowing of the joint space;
Stage 2 - the joint space narrows more clearly, subchondral sclerosis occurs;
Stage 3 - sharp narrowing of the joint space, smoothing 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 cartilage, meniscus, ligaments, tendons. Ultrasound of the knee joint helps to visualize the soft tissues (meniscus, muscles, ligaments), to assess the volume of the 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 evaluates the degree of cartilage destruction under a microscope.
Treatment of osteoarthritis of the kneerepresents a difficult task. In any case, you must choose an individual treatment program.
When you start saying banal things during a consultation, patients look surprised at first. Is that why we came? Give me a miraculous injection so my knee never hurts again. We must explain that there is no such single method that can eliminate osteoarthritis. To recover, you need to move, lose weight, sign up for the pool. And a person wants to lie on the couch, grow a "beer belly, " solve a problem with a pile of drugs, and be healthy. But alas !!! In this case, medicine is powerless.
Pain relievers do not cure, but only relieve pain. Anti-inflammatory drugs are prescribed only in the period of worsening pain in the knee joints. Some of the non-steroidal drugs, by relieving the pain, contribute to the further destruction of the cartilage. Medicinal ointments do not cure knee osteoarthritis, but they help to alleviate knee pain slightly. In edema, redness of the joints, heating ointments and compresses are contraindicated; it is better to use topical medications with nonsteroidal anti-inflammatory drugs.
Chondroprotectors do not relieve pain, are expensive and must be taken for a long time. I consider them "puppets" and practically do not name them. Currently, avocado and soy extracts have appeared in pharmacies, but I have not yet used this medicine 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 engage in proper physiotherapy exercises in a sitting or lying position. Squats and jumps are strictly forbidden. Useful are cycling, swimming or exercising in the water, skiing. And labor exploitation in the country often leads to increased knee pain. With osteoarthritis of the knee joints, running, brisk walking uphill, lifting weights are not recommended.
Diet against osteoarthritis of the knee joint.The knee joints carry the load in the form of their own weight. Therefore, overweight people must lose at least 3-5 kg. And some patients need to lose more than a dozen pounds. 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 loving" all the harmful products (sweet, starchy foods, beer, etc. ). Eating properly should become a habit. To lose weight, you need to 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 purpose, 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 meat, fast food intensify inflammatory processes in the joints. Instead of pharmaceutical chondroprotectors, I recommend eating properly prepared jelly meat.
Orthopedic correction reduces stress on the knee joints. If you have pain in your knee joints, you need to pick up a patella. In advanced cases, walking with a cane is indicated. When shortening the leg, a heel pad is recommended. It has recently become fashionable to use kinesio tapes. These are natural cotton adhesive tapes that are glued around the affected knee, do not limit its mobility, but help to soothe 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 chiropractic (leech therapy) and pharmacopuncture, VTES gives very good results. I will give a case from practice.
A 54-year-old man with stage II osteoarthritis of the right knee turned to me for help. Knee pain plagued him for 6 years. Over the years, he has undergone numerous courses of drug therapy, physiotherapy, corticosteroid blockade, and repeated courses at a rehabilitation center. But the patient's condition only got worse. He came to me for a consultation for advice on whether to agree to joint replacement surgery or conservatively try something else. I didn’t have to persuade him for long, he immediately agreed to the treatment I suggested.
In the first session, I gave him 6 leeches that helped him deal with swollen joints and eliminate night pains. The knee became easier and freer to move. The man felt a little relieved. Then we performed 3 procedures of interstitial electrical stimulation and almost completely stopped the pain syndrome.
Subsequently, the success was cemented by the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effect in 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 pain did not return. Once a year, we conduct one session of VTES for preventive purposes.
Intra-articular injections with hormones are very effective in emergencies to relieve severe pain, swelling and inflammation. The indication is an effusion, it is forbidden to do blockades with corticosteroids in the "dry joint"! They temporarily relieve pain, but such injections do not cure osteoarthritis itself, and the cartilage after them is even more destroyed. They should be performed by a specially trained doctor who knows the indications, contraindications, medications and places of application. In total, no more than 3 blocks per connection are required.
After removing the 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 sliding of bone surfaces and restore cartilage functions that absorb impact. But hyaluronic acid preparations are expensive and last only 6-8 months. It makes no sense to give hyaluronic acid preparations with complete loss of joint space even in patients older than 65 years.
Treatment with folk remedies.You can use tincture or decoction of pentacles, dressings with radish, horseradish or ginger, turpentine baths.
Joint endoprosthetics should be performed only in the case of serious dysfunction of the knee joint, because after 10-15 years that joint will have to be changed again. Will there be enough strength and health every 10-15 years for surgery under general anesthesia and subsequent rehabilitation??? Therefore, do not rush to agree to surgery! Watch your wrists!