Have you ever had knee pain? It is extremely uncomfortable when you suddenly start to limp or can not go down without knee pain. Osteoarthritis of the knee joint is not life-threatening, but dramatically deteriorates its quality.
What is knee osteoarthritis?
Osteoarthritis of the knee(gonarthrosis, osteoarthritis, osteoarthritis of the knee). Gonarthrosis is osteoarthritis of the knee (this disease has nothing to do with gonorrhea). In advanced cases, nothing helps except surgery. You need? Then do not get into that state.
Causes of Knee Osteoarthritis.Distinguish between primary and secondary osteoarthritis of the knee joint. If the cause of the disease is not determined, then such arthrosis 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 joints, physical overload (sports, professional), endocrine disorders.
Risk factors are overweight, female sex, old age. Cartilage is very sensitive to the decrease of female sex hormones, with menopause, all the joints begin to "crumble". Therefore, overweight older women suffer from osteoarthritis of the knee joints more severely and more often.
Anatomy of the knee.The knee joint is formed by the femur, tibia and patella. The articular surfaces of the bones are covered with a layer of cartilage. The extra cartilaginous spaces between the bones are called the meniscus and are relaxing. The knee joint has the largest synovium, which forms large curves and bursae.
The joint cavity is filled with synovial fluid, which nourishes the articular cartilage. Synovial fluid contains hyaluronic acid, which is necessary for the smooth sliding of articular surfaces. Their ligaments, muscles, and tendons direct and restrict movement in the wrist.
General description.With osteoarthritis of the knee, destruction of the articular cartilage occurs. There are three stages of knee osteoarthritis. In the first stage, feeding of the articular cartilage and meniscus is interrupted. Cartilage loses elasticity and cracks. Abnormal friction occurs between the bones. Joint overload is associated with inflammation and pain in the knee.
In the second stage, the destruction of the articular cartilage and meniscus begins. Bone reacts to marginally increased load - 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, pronounced deformation of the bones of the knee joints with a sharp restriction of natural movements is detected.
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-term, with a slow, irreversible increase in symptoms. If the knee pain was born suddenly, suddenly, for the first time, then it is most likely not osteoarthritis.
Osteoarthritis of the knee begins gradually with discomfort or slight pain in the knee during overload, long walking, when descending, rising from the sitting position. At rest, the pain passes quickly.
In the second stage, the knee pain already appears with normal strain. The volume of active movements in the knee joint decreases. The shape of the joint changes due to the deformation of the bones and the accumulation of abnormal fluid in the joint.
In the third stage, the pain becomes chronic, occurring not only during movement but also at rest. Night pains disturb sleep. The knee is difficult to get into bed without pain. Ankle sprain indicates increased inflammation. Knee mobility is reduced to a minimum.
The joint is significantly deformed, the legs become O or X-shaped. In severe cases, there is complete destruction of the joint with the development of ankylosis (immobility).
With osteoarthritis of the knee joints, there are 4 types of pain:
- the mechanical type of pain arises under the influence of daytime physical activity and subsides during the night rest period. These knee pains are associated with a decrease in the absorption capacity of cartilage and bone structures. Knee pain is localized, as a rule, in the anterior and inner region of the knee joint and the upper part of the lower leg.
- night pains are associated with venous blood stasis, increased intraosseous pressure in the joints, and inflammation.
- The "initial" pain occurs after a period of rest, disappears 15-20 minutes after movement in the joints. These knee pains are caused by rubbing the articular surfaces, on which fragments of cartilage rot 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 covers the cavity of the article 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 of the joints, an increased production of inflammatory fluid occurs. The amount of spill (pathological fluid) can reach 30-70 and even more than 100 ml. The kneecap initially fills the cavity in the inner part of the patella (medial fossa). With an increase in volume, the upper volvulus fills, with a massive swelling over the patella ("horse saddle").
Baker cyst occurs with a significant increase in intra-articular fluid volume. A round, elastic bulge forms in the popliteal region. This is not a tumor, nor oncology and does not need surgery. A Baker’s cyst can cause discomfort, pressure, and pain in the knee when moving. The diameter of the cyst is from 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 leg.
Diagnosis of knee osteoarthritis.Laboratory tests are not useful for diagnosis, but are used to rule out other conditions with knee pain. With osteoarthritis, blood count indicators without inflammatory changes, leukocytes, and ESR are within normal limits. Rheumatic tests are negative. The uric acid level is within normal limits.
X-rays show bone changes in the joint, exclude the traumatic causes of joint pain. In our country, an X-ray classification of osteoarthritis according to 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 - a sharp narrowing of the joint space, flattening of articular surfaces, development of cysts;
MRI of the knee is indicated at an early stage of the disease, when radiological changes are not yet noticeable, but the patient has typical knee pain. With the help of MRI, you can assess the condition of the cartilage, meniscus, ligaments, tendons. Ultrasound of the knee joint helps to visualize soft tissues (menisci, muscles, ligaments), to estimate the volume of ejaculation.
Arthroscopy is the most accurate method for diagnosing osteoarthritis of the knee. A special probe is inserted into the joint cavity and the doctor assesses the degree of cartilage destruction under a microscope.
Treatment of knee osteoarthritispresents a difficult task. In each case, you must choose an individual treatment program.
When you start saying banal things during the consultation, patients look on in amazement at first. Is this what we came for? Make a great injection so that my knee never hurts again. We must explain that there is no single method that can eliminate osteoarthritis. To recover, you need to move, lose weight, register in the pool. And a person wants to lie on the couch, grow a "beer belly", catch the problem with a bunch of medicines and be healthy. But alas !!! In this case, the medicine is powerless.
Pain relievers are not curable, they simply relieve pain. Anti-inflammatory drugs are prescribed only during the period of worsening pain in the knee joints. Some of the non-steroidal medications, by relieving the pain, contribute to the further destruction of the cartilage. Healing ointments do not cure osteoarthritis of the knee, but they do help to relieve a little knee pain. With edema, joint redness, oils and heat compresses are contraindicated; it is better to use local remedies with non-steroidal anti-inflammatory drugs.
Chondroprotectors do not relieve pain, they are expensive and should be taken for a long time. I consider them "dummy" and practically do not assign them. Currently, avocado and soy extracts have been shown in pharmacies, but I have not yet used this medicine in my clinical practice and have no opinion on its effectiveness.
To treat and prevent osteoarthritis of the knee joints, it is necessary to engage in proper physiotherapy exercises in a sitting or lying position. Squats and jumps are strictly forbidden. Cycling, swimming or water exercises, skiing are helpful. And on-site job exploitation often leads to increased knee pain. With osteoarthritis of the knee joints, running, brisk walking, lifting weights is not recommended.
Diet for knee osteoarthritis.The knee joints carry a load in the form of their own weight. Therefore, overweight people should lose at least 3-5 kg. And some patients have 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 habits for the rest of your life, just "stop loving" all harmful products (sweet foods, starchy, beer, etc. ). Proper nutrition 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 food that alkalizes the blood and fluid inside the joint. To this end, it is necessary to severely 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 improve inflammatory processes in the joints. Instead of pharmaceutical chondroprotectors, I recommend eating properly prepared meat.
Orthopedic correction reduces stress on the knee joints. If you have pain in the knee joints, you should get the patella. In advanced cases, cane walking is indicated. When trimming the leg, a heel insole is recommended. Recently, it is fashionable to use kinesio tapes. These are adhesive strips made of natural cotton that are glued around the affected knee, do not restrict its movement, but help relieve joints and reduce muscle spasm.
I consider interstitial electrical stimulation as the most effective method for treating osteoarthritis pain. In combination with hirudotherapy (caterpillar therapy) and pharmacopuncture, VTES gives very good results. I will give an issue from practice.
A 54-year-old man with osteoarthritis in the right stage II knee joint turned to me for help. Knee pain bothered him for 6 years. Over the years, he underwent numerous courses of drug therapy, physiotherapy, corticosteroid blockade and repeated courses at a rehab center. But the patient's condition only got worse. He came to me for a consultation for advice on whether I should accept for a joint surgery or try something else conservatively. I did not have to convince him for a long time, he immediately agreed to the treatment I proposed.
In the first session, I gave her 6 caterpillars, which helped to cope with the swelling of the joints and eliminate the pain of the night. The knee has become easier and cheaper to move. The man felt a little relief. Then we performed 3 interstitial electrical stimulation procedures and almost completely stopped the pain syndrome.
After that, the success was consolidated with the introduction of homeopathic preparations with anti-inflammatory and chondroprotective effect in acupuncture points. After 3 weeks from the start of therapy, the patient threw the stick and began to move freely, without limping. It has been 3 years since then. The knee pain did not return. Once a year, we conduct a VTES session with a preventative purpose.
Intra-articular injections of hormones are very effective in an emergency to relieve severe pain, swelling and inflammation. The indicator is a leak, it is forbidden to do corticosteroid blockade on the "dry joint"! They temporarily relieve pain, but such injections do not cure osteoarthritis itself, and the cartilage behind them is destroyed even more. They should be done by a specially trained doctor, who is aware of the indications, contraindications, medications, points of administration. In total, no more than 3 blocks are required for joining.
After removing the swelling and inflammation, hyaluronic acid preparations, called liquid prostheses, are injected into the joints. They act on the joints as a natural lubricant, improve the sliding of bone surfaces and restore cartilage absorption functions. But hyaluronic acid preparations are expensive and they only last 6-8 months. There is no point in administering hyaluronic acid preparations 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 wicker, compresses with radish, horseradish or ginger, turpentine baths.
Arthroplasty of the joints should be performed only in case of serious 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 agree on an operation! Take care of your joints!