How is osteoarthritis of the knee diagnosed and treated?

Osteoarthritis of the knee joint is also called gonarthrosis or deforming osteoarthritis. Illness can lead to serious consequences, including disability. At the first signs of knee osteoarthritis, you should see a doctor for diagnosis and treatment. Therapy should be carried out in strict compliance with the conditions and other prescriptions.

General characteristics of the disease

Knee osteoarthritis is a progressive lesion of the cartilage lining the joint surface. As a result of such changes, the functionality of the joint is impaired and pain appears.

Osteoarthritis deformans is chronic. In most cases, the disease progresses slowly, but certain factors can accelerate its progression. This mainly concerns the individual characteristics of the body, the activity and physical activity of the patient, concomitant pathologies.

Two concepts are often confused: arthritis and osteoarthritis. These pathologies are similar in some characteristics, but differ in the nature of the course. Only a specialist can make an accurate diagnosis and prescribe the appropriate treatment.

With knee osteoarthritis, the cartilage nutrition mechanisms are disrupted, its functioning is therefore gradually disrupted. Among osteoarthritis of various locations, pathology of the knee joint occurs in one in three patients.

Causes of primary osteoarthritis of the knee joint

This is the most common form of the disease. Women of advanced age are at risk of developing a primary pathology, especially in the presence of overweight - obesity of 2 or 3 degrees.

There is an opinion that primary knee osteoarthritis is associated with average life expectancy. Compared to past centuries, it has increased significantly, and the joints simply wear out over time.

Knee osteoarthritis associated with natural aging is considered normal. If the articular cartilage is destroyed earlier or this process is too intense, this condition is considered pathological.

Causes of secondary osteoarthritis of the knee joint

Secondary knee osteoarthritis can be triggered by the following factors:

• genetic predisposition, provided it can be clearly traced;
fractured leg
• ;
• dislocation of the knee joint;
• lesion of the meniscus;
• congenital dysplasia of the knee joint;
• extreme physical activity (typical of athletes);
• constant static charges;
rheumatism
• ;
• rheumatoid arthritis (not to be confused with rheumatism);
• ankylosing spondylitis;
• congenital deformity of the lower limbs - valgus or varus;
• congenital shortening of a limb;
metabolic syndrome
• ;
• drop;
• acromegaly;
osteomyelitis
• ;
• chondrocalcinosis;
• pathologies associated with the exchange of matter;
• joint hypermobility - the ligamentous apparatus is inherently weak;
hemochromatosis
• ;
• diabetes mellitus;
• pathology of the endocrine system.

There are many possible causes of deformation of osteoarthritis, which is why this pathology is called polyetiologic. Often it is not possible to identify the exact cause of the disease, therefore, a diagnosis of primary (idiopathic) knee osteoarthritis is made.

Symptoms of knee osteoarthritis

In addition to pain (the main symptom), the pathology may be accompanied by the following symptoms:

• Crunch and click.These symptoms usually appear during movement and are often ignored by patients. Tightening of the knee can mean the appearance of furrows, osteophytes, ulcerations on the joint surfaces.
• Movements retained.This symptom is very important during the diagnosis, because it allows to differentiate knee osteoarthritis from a number of other pathologies that affect the musculoskeletal system. Movements are generally stiff in the morning. When a person begins to walk, this symptom goes away within half an hour. If the stiffness persists for an hour or more, it may indicate an inflammatory process or other pathology.
• Reduced range of motion.This symptom implies that the patient is unable to fully bend the knee. This is due to pain syndrome, softening the intensity with which a person tries to move their leg less. Over time, this leads to a shortening of the ligaments, called contractures.
• Seal stuck.Knee osteoarthritis can cause the joint to get stuck in a certain position and it is impossible to move it due to severe pain. This usually happens due to changes in the joint surfaces, when the internal ligaments of the knee are pulled, protruding from the pineal glands. In this case, only the reverse displacement of the ligament can help. Less commonly, the cause of joint blockage is the entry of a foreign body into the joint space. The source of the problem may be part of the meniscus or a fragment of an osteophyte.

Classification of the disease

Each of the steps has specific characteristics:

1. The first stepis ​​initial, it is also called easy. The first signs of pathology are considered its onset, and the transition to the next stage is characterized by the appearance of bone deformities. They can be detected by visual inspection or X-rays. At the first stage of the disease, the accumulation of fluid in the joint begins already - this phenomenon is called synovitis. It is he who causes the pain, which so far only manifests itself when moving. Their intensity may vary.
2. In the second (moderate) stageof knee osteoarthritis, pathological changes are visible even visually. They are manifested by an increase in the size of the knee, its deformation. On the x-rays, you can see that the bone tissue around the edges of the joint has grown and the joint space has narrowed. It is at this stage that the pain syndrome manifests itself at the slightest load, and when walking or squatting, the knee begins to squeal.
3. Third-stage deforming osteoarthritis (severe)is ​​diagnosed when there is virtually no cartilage tissue in the joint. If the pathology is difficult, the bones can grow together, which will lead to complete immobility of the affected limb.

The exact stage of knee osteoarthritis is determined by a specialist. In this case, you should focus not on the symptoms of the disease, but on the x-rays received. Pathology does not always follow the standard pattern.

Diagnostics

Only instrumental diagnostics will help determine deforming osteoarthritis:

• radiography;
ultrasound
• ;
tomography
• - magnetic or computed resonance imaging;
arthroscopy
• ;
thermography
• ;
• scintigraphy.

Often, an x-ray is sufficient to detect knee osteoarthritis. It is made in two projections. If only one knee is affected, an image of the healthy limb is always taken to compare the results.

Which doctors should I seek help from?

In the case of deforming osteoarthritis, different specialists may be involved. In a conventional clinic, they usually see a surgeon.

The arthrologist, rheumatologist, orthopedist usually deal with knee osteoarthritis problems. In addition, the participation of a chiropractor, arthroscopist may be necessary. A physiotherapist, physiotherapy instructor, massage therapist qualified in the field is usually involved in the treatment process.

Treatment of knee osteoarthritis

The treatment of osteoarthritis of the knee joint takes a fairly long time. In most cases, outpatient treatment is sufficient. This involves a whole range of measures. Treatment is based on pharmacotherapy, physiotherapy and physiotherapy exercises. In some cases, surgery is necessary. With knee osteoarthritis, it is also allowed to use folk recipes, but they should be combined with traditional medicine.

Drug treatment

The main component in the treatment of knee osteoarthritis is the use of various drugs. With such a disease, an integrated approach is necessary, involving the possibility of using the following drugs:

• Nonsteroidal anti-inflammatory drugs.These drugs are produced in various forms, but for osteoarthritis, tablets for oral administration, solutions for injections, agents for external use in the form of creams, ointments, gels are preferred. Nonsteroidal anti-inflammatory drugs not only fight inflammation, but also reduce pain.
• Corticosteroids.These drugs are usually used when the disease is severe or when drugs from the nonsteroidal anti-inflammatory group are ineffective. Usually they are used in the form of injections, injecting the drug into the joint capsule. Corticosteroids are used as a symptomatic treatment to eliminate inflammation and severe pain.
• Analgesics.When prescribing such drugs, the severity of the pain syndrome is taken into account. If the pain syndrome is of high intensity, they resort to strong opiates.
• Chondroprotectors.Thanks to these drugs, the cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors has been manifested for a long time, so they are used for long therapeutic treatments. These drugs are suitable for pathology of 1 or 2 degrees.
• Antispasmodics and muscle relaxants.Such drugs are necessary when the pathology is accompanied by muscle spasms.
• vasodilator drugs.These drugs improve blood circulation, relieve spasms of small vessels. A combination of vasodilator drugs and chondroprotectors is effective, since the cartilage tissue in this case is better saturated with nutrients.
• Warming ointmentsto improve blood circulation. These funds are appropriate in the absence of synovitis.

Medicines are prescribed by a doctor. Only he can determine which drugs are needed in each specific case, depending on the scheme to be taken and the duration of therapeutic treatment for each prescribed drug.

Physiotherapy

In deforming osteoarthritis, various physiotherapeutic methods are actively used. They are used for a variety of purposes: to reduce pain, relieve inflammation, activate blood supply, and speed recovery.

The following physiotherapy methods are effective for osteoarthritis of the knee:

• Phonophoresis.This technique is an ultrasound therapy associated with the effects of drugs. Due to the high-frequency vibrations, the tissues of the knee joint are warmed up, which ensures deeper penetration of medicinal substances.
• Shock wave therapy.The procedure uses a special device that generates radial acoustic waves. Under their action, the blood supply to the periarticular region is activated, which stimulates the restoration of cartilage and bone structures.
• Ozone treatment.This procedure involves the use of active oxygen. It has analgesic and anti-inflammatory effects on the tissues.
• Electromyostimulation.This technique is often used during rehabilitation, as well as in the presence of contraindications to exercise. Under the influence of electrical impulses, muscle tone increases and blood circulation improves.
• Diathermy.This technique refers to electrotherapy and involves the use of high intensity high frequency currents for deep heating.
• Cryotherapy.This technique is also called cold treatment. The affected skin area is exposed to a low temperature for a short time. This method restores metabolic processes, increases blood circulation, reduces the severity of inflammation, eliminates pain, relieves muscle spasms.
• Hirudotherapy.This technique is considered as an alternative. Leeches are placed around the affected joint. The procedure relieves pain, relieves swelling, and stimulates regeneration.
• Laser therapy.This technique is generally used at an early stage of the pathology. It provides anti-inflammatory, analgesic and stimulant effects.
• Plasma therapy. This procedure is also called joint plasmolifting. These are intra-articular injections. For them, the patient's blood plasma is used, which is saturated with platelets. This procedure relieves inflammation, promotes the regeneration of cartilage tissue.
• Healing baths- turpentine, radon, hydrogen sulfide.
• Acupuncture.Such a procedure is usually used in the early stages of pathology. This technique relieves swelling, eliminates pain and allows you to restore joint mobility.

exercise therapy

Physiotherapy is necessary for knee osteoarthritis. The various exercises must be supervised by a qualified professional. The main goal of exercise therapy is to restore joint mobility and achieve a certain range of motion. It is also necessary to increase muscle strength and endurance.

Exercise therapy is not used during times of exacerbation of the disease. At this time, the joint needs maximum rest and relief. Locomotor activity is allowed when the inflammation and pain have been relieved, from this time at least 5 days should pass.

The exercise therapy program should be developed individually for each patient. It is necessary to take into account the peculiarities of the course of the disease, the degree of its severity, the individual characteristics of the patient.

Gymnastics

At home, a patient with knee osteoarthritis can do some exercises independently. You need to do it in stages - first you need to warm up, then do strength training exercises and finish with stretching.

Preheating is performed as follows:

• Spread your feet shoulder-width apart and lower your arms to your sides or lean over the back of a chair. Slowly step up onto your toes, lingering at the extreme point for 3 seconds, then gently transfer the weight to your heels, lifting the toes as high as possible. Do 10 reps without making any sudden movements.
• The starting position remains the same. You have to raise the leg bent at the knee at waist level, then lower it. Do 15 repetitions alternately on each leg. Movements should be slow and fluid.
• Lie on your back, raise your knees bent at the knees and simulate the rotation of the pedals of the bike. You need to turn for half a minute in one direction, then in the other. Move slowly.
• Spread your feet shoulder-width apart, straighten your back, and bend your elbows. Simulate running in place, alternately shifting the weight from one leg to the other. Movements should be done on the toes, not leaning on the heels. Perform the exercise for about 5 minutes.

Surgery

Deforming osteoarthritis may require surgical treatment. They use the following options:

• Puncture.This intervention is minimally invasive. It is used not only to study intra-articular fluid, but also to remove its excess. As a result of such manipulations, inflammation is reduced and joint mobility is restored, but sometimes only partially.
• Arthroscopy.This procedure can be performed as a stand-alone operation or be one of its steps. This technique is endoscopic and does not require dissection of the joint cavity. For the operation, special thin and flexible instruments are used, and all manipulation is controlled by means of a micro video camera. If arthroscopy is used as an independent operation, the joint surfaces are cleaned of fragments of the affected cartilage tissue.
• Periarticular osteotomy.This type of surgery is quite traumatic. It is used to redistribute the load on the knee, so that the pain syndrome decreases and the joint becomes more mobile. During the operation, the bone, which is involved in the formation of the knee joint, is sawed off and then fixed in a different position. Such surgery is suitable for grade 1 or 2 deforming osteoarthritis.
• Endoprostheses.Such an operation is used when the third degree of knee osteoarthritis is diagnosed. During surgery, the knee joint is replaced with a biocompatible construction. It is necessary to restore the previous range of motion and the patient's normal quality of life. The endoprosthesis is quite a complicated operation and therefore requires a long period of rehabilitation.

Diet and general recommendations

Despite the fact that the pathology affects the knee joint, its treatment involves compliance with the diet. It must respect the following principles:

• If necessary, normalize the body weight. BMI should not exceed 20. Weight loss should be gradual - 2-3 kg per month.
• Reduce your intake of carbohydrates and animal fats.
• Most of the fat you eat should be from plant sources.
• You should eat fish at least 1-2 times a week.
• You should eat in portions. The portion should be small, but there should be 5-6 meals per day.
• Finish each meal with a vegetable or fruit.
• For baking, you need to choose baking, including steaming, stewing, baking.
• Observe the drinking regime. On average, a person needs 2 liters of fluid per day, and most of it should be clean water without gas.
• Drink water before you eat. A glass is enough half an hour before meals.
• Cut down on your salt intake.
• Avoid alcohol, carbonated drinks and sugary drinks.
• Beef, pork, semi-finished products, hot peppers, white cabbage, sour fruits should be excluded from the diet.
• It is useful to eat jelly meat, jelly on gelatin, cheese, cottage cheese, chicken, legumes.

Traditional medicine

In the treatment of deforming osteoarthritis, unconventional methods are also suitable. In this case, you should consult a specialist, because even the use of natural remedies has contraindications.

Effectively use the following folk recipes:

• Lubricate the back of the burdock leaf with honey, apply to the affected area, secure with cellophane wrap and isolate. Keep the compress for up to 4 hours.
• You can use cabbage leaf instead of burdock. You can knead it with your hands or prick it in several places. Honey is optional.
• For internal use, you can use a tincture of burdock root. Raw materials should be finely chopped, steamed with boiling water and insisted. Drink a tablespoon 5 times a day.
• Rinse the potato sprouts, place them in a glass container and cover them with alcohol. Stay in the dark for 3 weeks, filter and use three times a day to scrub the affected areas.
• Heat the honey in a liquid water bath and rub the affected knee while massaging it. Cover the treated area with gauze or bandage and isolate. The procedure is repeated every day for a week and a half.
• Steam 5 tbsp. l. oatmeal and cook for 5 to 8 minutes over low heat. Wrap the cooled mixture in a natural cloth, apply to the affected area and secure with polyethylene. Whenever you need to prepare a fresh mixture.
• Also mix iodine with honey and glycerin, let stand 3 hours. Dip a cotton ball in the resulting composition and treat the knee and the adjacent area with up and down movements.
• Chop a head of garlic and add a glass of vegetable oil. Insist a week in the dark, filter and apply to the affected areas before bedtime.
• Grind white school chalk and mix with yogurt or sour cream to make a thick porridge. Wrap it in a natural cloth and make a compress for 2. 5 hours, insulating it with polyethylene. Repeat the procedure every day.
• Boil two large onions with husks in a liter of distilled water, strain. Drink the resulting infusion three times a day before meals.

Treatment of knee osteoarthritis should not be limited to traditional medicine. This disease requires an integrated approach, which necessarily includes drug therapy and exercise.

Prognosis, possible complications

The general prognosis of deformative osteoarthritis is poor due to the progressive nature of the disease. The process of tissue degradation and joint deformation cannot be reversed, but can be stopped or significantly slowed down.

The following factors influence the prognosis of knee osteoarthritis:

• Age of the patient.The younger it is, the less favorable the prognosis. The pathological process develops gradually. Therefore, with joint damage in young people, the disease can reach the last stage with old age and lead to various complications.
• Type of osteoarthritis.In primary pathology, only the joint is affected and the disease usually progresses slowly. Along with secondary disease, there are other disorders that can speed up this process or cause complications.
• Compliance with doctor's orders.This concerns the taking of the necessary drugs, physiotherapy procedures, exercise therapy and unloading of the joint. It is also important to observe the duration of drug treatment, since most drugs need to be taken regularly in some courses.
• Body mass.If the patient is overweight, the joints experience increased stress, which negatively affects the course of the disease.
• Profession.This factor is very important for the prognosis of the disease. Professional athletes, people under regular stress or constantly on their feet, suffer more and more. Sedentary work, when the joint is in the same position for a long time, can also negatively affect the course of the disease.

Osteoarthritis deformans progresses slowly, but without proper treatment it can lead to a number of complications:

• Joint deformity.This happens at the last stage of the disease. The leg can bend at an unnatural angle, which is not only aesthetically unpleasant, but can also lead to complete loss of joint functionality.
• Infection.A microtrauma, for example a crack in the cartilage tissue, can cause such a complication. The pathogen can enter the joint with current or lymph from the focus of infection. Surgery - arthroscopy, diagnostic puncture can also be the cause of infection. Introducing infections into the joint can cause aseptic necrosis.
• Dislocation, fracture.Such complications arise against the background of impaired function of the knee joint, in which the load is not properly distributed and excess can lead to injury.
• Ankylosis.In this case, the bones at the site of the missing joint grow together. It is one of the most serious disorders, because due to the fixation of the lower leg in one position, motor function is lost.

In most cases, complications arise through the fault of the patient, who has neglected his illness or ignored the doctor's orders.

Prevention

To avoid osteoarthritis of the knee, certain preventive measures must be taken:

• maintain a normal body weight;
• avoid heavy loads and strong pressure on the knees;
• ensure regular and sufficient physical activity;
• avoid joint injuries;
• if an injury is received, prompt, competent and comprehensive treatment is required;
• Strengthens the periarticular muscles.

Secondary prevention measures should also be highlighted. They are needed when knee osteoarthritis has already been diagnosed and it is necessary to reduce the rate of its development. In this case, you should take the following actions:

• to resort to a course of chondroprotectors every six months or one year;
• treat arthritis in a timely, fast, and effective manner.

Osteoarthritis of the knee joint is a serious condition with a poor prognosis and can lead to a number of complications. It is necessary to start treatment as soon as possible in order to slow down the pathological process. The therapy must be complete, certain techniques must be part of the lifestyle: diet, exercise, taking certain medications.