Knee arthrosis: symptoms, treatment

Among the diseases of the musculoskeletal system, osteoarthritis is a frequency leader.It is believed that the vast majority of the planet's population up to the age of 60 has the initial signs of changes in the articular cartilage and 14% already have manifestations of osteoarthrosis.The most common version of this disease is the osteoarthritis of the knee joints.

Still "arthrosis" or "arthritis"?

Do not mix these two concepts.Arthrosis is the process in which the structure of the joints mainly changes, and arthritis is inflammation that can occur both against the background of the "untouched" structure and against the background of osteoarthritis.

Bone changes with osteoarthritis can be compared, for example, with knotted growth on a tree trunk that grows close to the concrete fence and exerts pressure on this fence with all its weight.

Usually the surface of the mutual bones is separated by two layers of cartilage and meniscus (additional cartilage plates).In addition to the role of the "buffer" between the bones, the cartilage provides the glide of the bones and the mechanical correspondence.Meniscus, which can lose due to large or small (but more often) injuries and also their elasticity, can break up even more.

With increasing and above all in the presence of an inherited disposition, articular cartilage is thinner.Therefore, the hips and the lower legs from which the knee joint consists of their ends approach dangerously, the friction can even occur between them.

Usually, in parallel to thinning the cartilage, another unpleasant event occurs over the years: the amount of the intra -karticular liquid decreases.This liquid is not just a purely mechanical "lubrication" of the connection from the inside.It offers the diet of bones, menisci and cartilage together.The violation of the "supply" of all these structures is a real disaster for the joint!

If there is a physical overload of the joint, bone failures appear on the surfaces of the bones and begin to grow, more than showing or spikes.For the knee joint, such overloads will raise weights (including the overweight of your own body!), Physical work with a focus on knees (e.g. now it is easy to imagine what happens during the development of osteoarthritis in the knee joint and how it is manifested in appearance.

How does that work together?

Each of us often saw the articular cartilage, for example chicken bones.It covers small areas with contact bones.There is a subchondral or excited bone under the articular cartilage.The human musculoskeletal system is arranged in a similar way.

Most joints of the person consist of bones, synovial (articular) shell and intra -karticular liquid.

What happens to the joint with osteoarthritis?

Under the influence of all these loads already mentioned, there is a compression and growth of the slim bone, as a result, increased trauma of the articular cartilage.

Products of the cartilage of the cartilage, which were formed due to microtrauma, fall into the synovial fluid.It is naturally arranged that they are foreign substances for the synovial bowl and provoke their inflammation.The formation of synovial fluid is disturbed, which is usually a kind of "sponsor", similar to a continuous cycle of enriching and cleaning blood.In addition, the articular fluid becomes less than hyaluronic acid.It is worth telling about this acid.

Hyaluronic acid provides the viscosity of the synovial fluid and creates the "buffer effect" and the "lubrication effect" between the bones, which reduces their friction against each other.This substance is that the articular fluid in consistency is similar to egg protein and not water.Another important role of hyaluronic acid is to ensure the delivery of nutrients from the articular fluid deeply into the articular cartilage, since it cannot take the diet anywhere: blood vessels are not suitable for cartilage.The "consumed" substances are also removed from the cartilage into the articular fluid: use of hyaluronic acid molecules.

Therefore, an increased bone seal occurs and unbearable conditions are generated for the articular cartilage.

The cartilage receives a signal to adapt to these extreme conditions, and its change begins in a different way, which is referred to as the conversion.This is mainly shown by a decrease in the elasticity of the cartilage.

In the late stage of the development of osteoarthritis, the bone becomes rigid, but at the same time more fragile, the cartilage itself is partially impregnated with calcium.

Symptoms

The development of osteoarthritis begins with slight pain in the knee after walking the stairs, physical activity and walking for a long time.Such mild pain can occur for several months or even years.Then they become more pronounced.In the early stages of the development of the disease, the knee bones are not deformed, but a slight swelling of the joint itself can be observed.

In the second stage of the development of the disease, the pain becomes more intense and occurs after a slight stress.In addition to pain occurs in the knee joint, which differs with pain from the usual soft abuse of a healthy joint.In addition, the deformation of the joint becomes noticeable, the bones for touch become wider and rude.Wearing the knee more than 90 degrees becomes problematic.

In the third stage of the disease, the knee pain becomes difficult and constant and not even happen in the remaining period.The mobility of the knee becomes minimal, often it bends no more than 90 degrees and does not extend to the end.The deformation of the articular bones becomes so strong that there is a valgus (x-shaped) or variability (o-shaped) curvature of the legs.

Diagnosis

inspection

In the early stages of the disease, the joint is not changed, mobile, the muscles around them are preserved and strong enough.Local (local) pain is determined only by palpation (pressure) of certain points, more often on the inner surface of the joint.The doctor asks the patient to carry out several squats, to bend, to smooth his leg in the knee, to put his face onto the couch and lead even flexion triggers (this is referred to as "passive" movements).In this case, you can also determine the crunch click on the joints to pain and limit the movement volume.With a pronounced inflammatory component, the joint is increased and seems to be “pumped” with liquid.In a far -reaching process, bending in the knee can be partially or completely missing.During the examination, the surface of the connection seems uneven, tuberous, the limb can be curved (shift of the axis of the limbs, "conjured up").

Laboratory and instrumental research

• The mandatory laboratory survey program includesGeneral, biochemical and immunological blood tests, urine analysis.In general, attention is paid: the increased level of leukocytes and the increased rate of erythrocyte settlement, which indicates inflammation.In the biochemical blood analysis, the metabolic metabolic indicators are important, the level of the "liver" Ezymes.In the immunological analysis, the presence or lack of signs of systemic inflammation is determined by the degree of C-reactive protein.The urine analysis shows the content of "sand" - uric acid crystals.
• Analysis of the synovial (articular) liquidIn the case, it is prescribed in which this liquid is in sufficient quantities.That means when the joint is swollen.Under the conditions of sterility, the doctor pierces the joint capsule in a strictly defined place, inserts the needle into the joint cavity and then removes excess liquid.Part of the material obtained enters the laboratory for analysis.At the end of the procedure, the anti -inflammatory medicine from the glucocorticosteroid group is most frequently administered into the joint cavity (e.g. diprospan).
• Radiography.A picture of both knee joints is mandatory.This is necessary to compare a sick knee with a healthy.In the picture, the width of the common gap (it is assessed according to the condition of meniscus and cartilage), the presence or absence of bone spikes osteophytes, signs of destruction (destruction) of bones.
• Ultrasound of the knee jointsHe will answer questions about the preservation of meniscus, the presence of a bakery cyst, the severity of the inflammation, the presence or the lack of uric acid crystals (in the presence of gout).
• MRI (magnetic resonance imaging).This study is prescribed if an ultrasound does not give a comprehensive answer to questions from a specialist.The MRI is mandatory for patients who want to carry out arthroscopy.
• Arthroscopy.Allows you to personally assess the condition of the joint, ie to be evaluated personally.The method is indispensable for controversial diagnoses, suspected traumatic damage to meniscus and ligaments (then it is possible to quickly remove torn meniscus or ligaments during the study).

Treatment of the arthrosis of the knee joint

The principles of comprehensive treatment should be followed, including:

1. Detailed awareness of the patient for the disease

2. The use of physiotherapy exercises, including: specific exercises for the joints in the lying position, swimming
3. Maintaining an optimal body weight
4. Wear an orthosis (soft bandage or at least an elastic bandage) during an increased load on the connection - on the street, during a walk and so on.
5. Non -cerative methods (physiotherapy).This type of treatment provides excellent results with the osteoarthritis of the knee joint (gonarthrosis).Apparently this is due to the fact that the joint is available for the influence of factors such as magnetic and laser radiation.To treat the knee joint, you can use magnetic currents, UHF and cryo exposure (translated from Greek means the effect of the cold).Physiotherapeutic interventions are widespread, the treatment courses are usually short -lived - 10, maximum sessions daily or every other day.It should only be remembered by possible contraindications that include tumor processes, diseases of the thyroid and pelvic organs as well as systemic (autoimmune) inflammatory diseases.
6. Pharmaceutical therapy.

Principles of osteoarthritis therapy:

• Relieve the pain
• Delay the further destruction of common structures
• Restore the lost joint function.

Non -steroidal anti -inflammatory medication

For pain relief, medication from the NSAID Lee NSAID -Nicht -steroidal anti -inflammatory medication is used.They are used in and in the form of applications (application to the skin).Applications (local therapy) are a very effective method, especially in the early stages of the disease.Before using a gel or cream with NSAIDs, you have to make sure that there are no changes to the skin, be it rash, pustules or cracks.The general rule of the local treatment is to use the selected cream or the gel at least twice a day, and when unpleasant sensations occur -to cancel the complete disappearance of these manifestations.The intramuscular administration of painkillers is currently not recommended, since the risk of side effects does not decrease as a result of the administration using a syringe, but the opposite.In the case of pronounced inflammation, the accumulation of a large amount of liquid, intra -articular glucocorticosteroid medication is permitted, but it should be noted that this procedure should not be carried out every 3 months more than 1 time.

Chondroprotectors

A higher anti -inflammatory "step" with osteoarthritis are chondroitine or glucosamine preparations.They struggle with inflammation on the level of thin joint structures, but have fewer side effects and, above all, retain their anti -inflammatory effects several months after cancellation.

Chondroprotectors are a collective name for a group of medication that also contains chondroitine sulfate and glucosamine - "building blocks" from cartilage.Despite the apparent cost treatment with chondroprotectors, their convenience for patients and the effectiveness is difficult to overestimate.First, these accepted substances are perfectly absorbed by the stomach, and the losses of the drug "along the street" to the cartilage are minimal.Second, they are able to suppress inflammation in the joint and to reliably slow down the process of destruction of the articular cartilage!Most of the time they are prescribed courses because they have a fairly long "ASS" that lasts several months and sometimes even up to six months.

Medicates based in hyaluronic acid are the so -called hyaluronates.These funds are sold in the form of prepared syringes for the intra -karticular administration.Hyaluronets are an artificial synovial fluid.The effect of treatment with this method can take up to 12 months.

Surgical treatment of osteoarthritis of the knee joint

As with the osteoarthritis of the hip joints, serious changes and persistent functional losses are possible.In the case of gonarthrosis, two types of interventions are currently carried out: arthrodesis (motionless connection) and endoprosthetics.According to special information, the first process is rarely carried out if the installation of an endoprosthesis is not possible for any reason.The result of this operation is that the knee becomes motionless.But it doesn't hurt.The endoprosthetic operation is much more profitable in terms of function.Remember that this operation is not carried out with a large body weight - the risk of complications in the postoperative period is too great.From the moment of the removal of the damaged sections of the connection and installation of the prosthesis, until the function is completely restored, no longer than three weeks.

How can ridiculous osteoarthritis threaten?

Over time, arthrosis does not revolve, but only worsens, especially when maintaining provocative factors.Consider the main sources of the danger to the health and life of a patient with osteoarthritis.

• Chronic pain of different intensity- A very important risk factor, especially in older people.Constantly unpleasant sensations can lead to sleep disorders, a reduced background of the mood and even depression.It is difficult to predict which chain of unwanted events pull the listed phenomena.
• Pathology of the veins.Constant inflammation in the knee area, the growth of bone spikes osteophytes that can mechanically violate popliteal vessels can lead to the development or progress of varicose veins of the veins of the legs.Sometimes orthopedic surgeons that use the knees until the varicose nodes are removed.However, phlebologists (venous specialists) only start with the operation in veins until the knee joints have pronounced changes.
• Reduced limbs function.In a far -reaching process, the joint can completely lose the ability to move, and in most cases this is a sign of disabilities.
• Participation of other joints.We have already found out how an apparently ordinary phenomenon like flat feet can "pull" the knee joint with the knee joint and lead to the development of osteoarthrosis.In the same way - along the chain - there is a participation in the painful process of the knee joint from the opposite side.If the patient neglects the recommendations, refuses to wear a stick and prefer to "lag on his two", an arthrosis of the hip joints will soon develop.The legs are twisted, the walk becomes a "duck".
• immobility.This serious complication of the disease takes place in cases where the bones of the joint are severely destroyed.There is no cartilage, the movement in the joint is very painful or impossible due to the fusion (this becomes "ankylose") of the bones.In this situation, only an operation can help the patient, but only if it is technically feasible.Overcoming is generally dangerous: it causes obesity, osteoporosis, muscle atrophy, the rapid development of diseases of internal organs.In addition, an immobilized person must of course constantly take care of themselves.
• Inoperability.Unfortunately, there are a number of conditions that make the operation impossible, and one of them is "neglected" in patients over 80 with serious illnesses with a wide "neglected" osteoarthritis.

prevention

• Exclude joint injuries.It seems: there is nothing easier.For a while it is not difficult to leave, run, run on the stairs, dance, high heels.In practice, it turns out that this point causes the most protests on the part of the patients.If you recently suffers, one person is usually not ready for the fact that an important point in his daily life is missing.However, if you do not follow these tips, there is a risk that the quality of life and disability will be a quick reduction in quality of life and disability.
• Reducing the weight and maintaining it within optimal limits is an extremely important recommendation!No matter how wonderful we have this or this tool, thick people will not be able to appreciate it.Because while the joints are overloaded with overweight, microtraumas are repeated every day.This can reduce all efforts to "no".In addition, obesity for some treatment methods is direct contraindication.
• Go with support.The universal rule for unloading the joint with the help is: A cane, a crutch or handrails should be in hand compared to the affected member.This means that if the right knee hurts, the stick should be kept on the left and vice versa.
• Correction of flat feet.It seems how can flat feet and osteoarthritis of the knee joint be connected?It turns out directly.If the foot is not properly installed (now we speak of longitudinal cut or mixed flat feet, not over the cross queres), the load in the knee joint is redistributed.In this case, the severity of the body with one step does not fall into the middle of the joint, but on the right or left side.Accordingly, the right or left meniscus suffers more, and since it suffers more, we wear ourselves faster.Next comes the "queue" of the articular cartilage, in which the meniscus cannot manage its function.This process ends with the formation of typical "arthrosis" changes in the knee joint (the appearance of bone failures).