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 at age 60 have the initial signals of changes in joint cartilage and 14% already have osteoarthritis manifestations.The most common version of this disease is knee joint osteoarthritis.

Still, "arthrosis" or "arthritis"?

Do not mix these two concepts.Arthrosis is the process of alteration mainly the structure of the joints, and arthritis is an inflammation that can occur at the bottom of the "untouched" structure and against the bottom of arthrosis.

Changes in bone with arthrosis can be compared, for example, with growths tied in a tree trunk, which grow near the concrete fence and presses this fence with all its weight.

Normally, the bone surface facing the other is separated by two layers of cartilage and menisci (additional cartilaginous plates).In addition to the role of the "buffer" between the bones, the cartilage provides the sliding of the bones and the mechanical correspondence with each other.Meniscque, which, due to large or small (but frequent) injuries, and also loses its elasticity, can break completely or partially even more.

With age, and especially in the presence of a hereditary predisposition, joint cartilage is thinner.This is why the bones of the hips and legs, which make up the knee articulation with their ends, are approaching dangerously, friction can even arise between them.

Generally, in parallel to cartilage thinning over the years, another unpleasant event occurs: the amount of intra -articular fluid decreases.This liquid is not just a purely mechanical lubrication of the joint inside.It provides nutrition of bones, menisci and joint cartilage.Violation of the "supply" of all these structures is a real disaster for the articulation!

If there is a physical overload of the joint, bone terms will appear on bone surfaces and begin to grow, more like pointing or peaks.For the articulation of the knee, these overloads will be the lifting of weights (including the overweight of your own body!), Physical work with emphasis on the knees (for example, herb in the garden), walking constant on the stairs, running, wearing uncomfortable shoes, boring feet and many others.It is now easy to imagine what is happening within the knee articulation during the development of arthrosis and how it manifests itself in appearance.

How does the set works?

Each of us saw the cartilage articulate many times at the end, for example, chicken bone.It covers small areas of contact with bones.Under joint cartilage, there is a subcondral or perverted bone.The human musculoskeletal system is similarly organized.

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

What happens to the articulation with arthrosis?

Under the influence of all the loads that have already been mentioned, there is a compaction and growth of the slender bone, as a result, increased the trauma of the joint cartilage.

Cartridge products formed due to microtrauma fall into synovial fluid.It is so organized by nature that they are strange substances for the synovial shell and cause its inflammation.Synovial fluid formation is disturbed, which is usually a kind of "carrier", similar to a continuous cycle of blood enrichment and purification.In addition, joint fluid becomes smaller than hyaluronic acid.It is worth saying about this acid.

Hyaluronic acid provides the viscosity of synovial fluid, creates the "buffer effect" and the "lubrication effect" between bones, reducing their friction against each other.It is thanks to this substance that consistency liquid resembles egg protein, not water.Another important role of hyaluronic acid is to ensure the delivery of nutrients from the liquid deeply in joint cartilage, as there is nowhere to bring nutrition: blood vessels are not suitable directly to cartilage.Similarly, "spent" substances from cartilage to joint fluid are removed: using hyaluronic acid molecules.

Therefore, an improved bone sealing occurs and unbearable conditions are created for joint cartilage.

Cartilage receives a signal to adapt to these extreme conditions, and its change begins, otherwise it is called remodeling.This is manifested mainly by a decrease in cartilage elasticity.

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

Symptoms

The development of arthrosis begins with slight knee pain, appearing after walking through the stairs, physical activity, long walking on foot.So much pain may appear for several months or even years.Then they become more pronounced.At the early stage of disease development, knee bones are not deformed, but a small swelling of the joint itself can be observed.

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

In the third stage of the disease, knee pain becomes severe and constant, not even passing even in the rest period.Knee mobility becomes minimal, usually does not double more than 90 degrees and does not extend to the end.The deformation of the bones of the joint becomes so strong that there is a valgus curvature (in x) or variation (in the form of O legs.

Diagnosis

Inspection

In the early stages of the disease, the joint is not altered, mobile, the surrounding muscles are preserved and strong enough.Only by palpation (pressure) of certain points, with more frequently on the inner surface of the joint, the local (local) pain is determined.The doctor asks the patient to perform various squats, fold, straighten his leg in his knee, put his face on the couch and lead the flexion extensions (this is called "passive" movements).In this case, in addition to pain and limit the volume of movements, you can determine the crisis by clicking on the joints.With a pronounced inflammatory component, the joint is increased by size, it seems that it is "pumped" with liquid.With a distant regression process, knee flexion may be partial or completely absent, when examined, the joint surface seems unequal, tuberous, the limb can be bent (limb axis displacement, "conjured").

Laboratory and Instrumental Research

• The compulsory laboratory research program includesGeneral, biochemical and immunological examinations, urine analysis.In the general blood test, attention will be paid: the increase in the level of leukocytes and the increase in the erythrocyte settlement rate, which indicates inflammation.In blood biochemical analysis, metabolic metabolic indicators are important, the level of "liver" enzymes.In immunological analysis, the presence or absence of signs of systemic inflammation will be determined-This is evidenced by the reactive protein level.Urine analysis will reveal the "sand" content - uric acid crystals.
• Synovial fluid analysis (joint)It is prescribed in the case when this liquid is in sufficient quantities.That is, when the joint is swollen, swollen.Under conditions in accordance with sterility, the doctor drills the joint capsule in a strictly defined place, inserts the needle into the joint cavity and then removes excess fluid.Part of the obtained material enters the laboratory for analysis.At the end of the procedure, the anti -inflammatory drug of the glycocorticosteroid group is most often administered in the joint cavity (eg diposspan).
• radiography.An image of both knee joints is mandatory, this is necessary to compare a sick knee with a healthy.In the image, attention is paid to the width of the joint gap (is judged by the state of meniscus and cartilage), the presence or absence of bone-osteophyte peaks, signs of destruction (destruction) of bones.
• Ultrasound of knee jointsHe will answer questions about the preservation of the meniscus, the presence of a baker cyst, the severity of inflammation, the presence or absence of uric acid crystals (in the presence of gout).
• Magnetic Resonance (Magnetic Resonance).This study is prescribed if an ultrasound does not give an exhaustive answer to questions from an expert.Magnetic resonance imaging is mandatory for patients who plan to perform arthroscopy.
• Arthroscopy.Allows you to visualize, ie personally evaluate the condition of the joint.The method is indispensable for controversial diagnoses, suspected of traumatic damage to menisci and ligaments (then directly during study, it is possible to quickly remove meniscus or torn ligaments).

Treatment of knee articulation arthrosis

The principles of comprehensive treatment should be followed, including:

1. Detailed consciousness of the patient on the disease

2. The use of physical therapy exercises, which includes: specific exercises for joints in the lying position, swimming
3. Maintaining the ideal body weight
4. Wearing a lit (soft dressing or at least an elastic bandage) during an increase in the load in the joint - on the road, during a walk and so on.
5. Non -environment (physical therapy) methods.This type of treatment provides excellent results accurately with knee joint arthrosis (gonarthrosis).Apparently, this is due to the fact that the joint is available for the influence of factors such as magnetic radiation and laser.To treat knee joint, you can use magnetic currents, UHF, cryogenic exposure (translated from Greek means the effect of cold).Physiotherapeutic procedures are widespread, treatment courses are generally short - 10, maximum sessions daily or every two days.It should only be remembered about possible against -indications, which include tumor processes, thyroid gland diseases and pelvic organs, as well as systemic inflammatory diseases (autoimmunes).
6. Drug therapy.

Principles of osteoarthritis therapy:

• Encourage the pain
• delay the additional destruction of joint structures
• Restore the lost joint function.

Non -steroidal anti -inflammatory drugs

For pain relief, AINE Lee Aine -I -GROUND NON -STE -SHOES are used.They are used in the form of applications (skin application).Applications (local therapy) are a very effective method, especially when it comes to the early stages of the disease.Before using a gel or cream containing NSAIDs, it is necessary to ensure that there are no changes in the skin, whether rash, pustules or cracks.The general rule of local treatment is to use the cream or gel selected at least twice a day and if unpleasant sensations appear - cancel the full disappearance of these manifestations.Currently, intramuscular administration of painkillers is not recommended, since the risk of side effects as a result of administration using a syringe does not decrease, but the opposite.In the case of pronounced inflammation, a large amount of fluid is allowed, intraarticular glucocosteroid drugs, but it should be noted that this procedure should be performed no more than 1 time every 3 months.

Chondoprotectors

An anti -inflammatory effect of higher "step" with osteoarthritis is chondroitin or glucosamine preparations.They, like NSAIDs, fight with inflammation at the level of thin joint structures, but have fewer side effects and, most importantly, maintain their anti -inflammatory effect several months after cancellation.

CondoProtectors are a collective name for a group of medicines containing at the same time chondroitin sulfate and glucosamine - “construction bricks” of the cartilage.Despite the apparent cost of high cost with chondroprotectors, it is difficult to overestimate their convenience for patients and effectiveness.First, these substances, accepted inside, are perfectly absorbed from the stomach, and the drug losses "along the road" to cartilage are minimal.Secondly, they are able to suppress inflammation in the joint and, in addition, reliably slow the process of destroying joint cartilage!Most of the time, they are prescribed courses because they have a very long "ace" that lasts several months and sometimes up to six months.

Hyaluronic acid -based medications are sound hyaluronates.These funds are sold as syringes prepared for intra -articular administration.Hiralurones are an artificial synovial liquid.The effect of treatment with this method can last up to 12 months.

Surgical treatment of knee articulation arthrosis

As with hip joint arthrosis, in case of serious changes and loss of persistent function, it reaches the operation.With gonarthrosis, currently two types of interventions are performed: arthrodesis (real estate compound) and endoprothetic.The first operation is rarely performed, according to special nominations, when the installation of an endoprhesis is impossible for any reason.The result of this operation is that the knee becomes immovable.But it doesn't hurt.Endoprostrate operation is much more profitable in terms of function.Remember that with great body weight, this operation is not performed -the risk of complications in the post -operative period is very large.From the moment of removal of damaged sections from the joint and the installation of the prosthesis until the function is completely restored, no more than three weeks.

How can ridiculous osteoarthritis threaten?

Over time, osteoarthritis does not return, but only aggravates, especially maintaining provocative factors.Consider the main sources of danger for the health and life of a patient with osteoarthritis.

• Chronic pain of various intensity- A very important risk factor, especially in the elderly.Unpleasant sensations constantly experienced can lead to sleep disorders, a reduced background of humor and even depression.It is difficult to predict which chain of adverse events pull the phenomena listed.
• Veins Pathology.Constant inflammation in the knee area, the growth of bone-osteophyte peaks, which can mechanically impair popliteal vessels, can lead to the development or progression of leg veins varicose veins.Sometimes orthopedists refuse to operate their knees until varicose veins are removed, but vein phlebologists do not begin surgery on veins until there are pronounced knee joints.
• Reduced limb function.With a distant process, the board may completely lose the ability to move, and this, in most cases, is a sign of disability.
• involvement of other articulations.We have already discovered as a seemingly common phenomenon, as boring feet, can "pull" the knee articulation and lead to the development of osteoarthritis.In the same way - along the chain - there is an involvement in the painful process of the opposite side of the knee.If the patient neglects the recommendations, refusing to use a cane, preferring to “slim in his two”, arthrosis of hip joints develops a lot soon.The legs are twisted, the march becomes a "duck".
• immobility.This severe complication of the disease occurs in cases where joint bones are quite destroyed, there is no cartilage, joint movement is strongly painful or impossible due to fusion (this is called "ankylosis") bones between each other.In this situation, only surgery can help the patient, but only if it is technically viable.The surpassed is dangerous in the general sense: causes obesity, osteoporosis, muscle atrophy, the rapid development of internal organs diseases.In addition, a immobilized person, of course, must constantly take care of himself.
• Inoperability.Unfortunately, there are several states that make it impossible for the operation, and one of them is very voted, "neglected" osteoarthritis in patients over 80 with serious related diseases.

Prevention

• Exclude joint injuries.It seems: There is nothing easier.For a while, abandoning jumps, running, walking on the stairs, dancing, high heels is not difficult.In practice, it is this point that causes the largest number of protests by patients.A person, if he suffers recently, is usually not ready for the fact that some important point in his daily life will be lost.But if you do not follow these tips, there is a risk of a quick decrease in quality of life and disability.
• Reducing weight and keeping it within the ideal limits is an extremely important recommendation!No matter how miraculous this effect is or the tool, fat people will not be able to appreciate it.Because while the joints are overwhelmed overweight, the microtraums are repeated daily.This can reduce all efforts to "no".In addition, for some treatment methods, obesity is a direct against -Indication.
• Walking with support.The universal rule for unloading the joint using the support is as follows: a cane, crutch or railing must be in the opposite hand to the affected limb.That is, if the right knee hurts, the cane should be kept left and vice versa.
• Boring feet correction.It seems that like boring feet and knee joint arthrosis can be connected?It happens directly.If the foot is installed incorrectly (now we are talking about longitudinal or mixed flattened feet, not about transverse), the load is redistributed to the knee joint.In this case, the severity of the body with a step does not fall in the center of the joint, but on the right or left.Consequently, the right or left meniscus suffers more and, as it suffers more, we wear faster.Then comes the "line" of the joint cartilage, where the meniscus cannot deal with its function.This process ends with the formation of typical changes of "artractor" in the knee joint (the appearance of bone growth).