Have you ever had pain in your knee? It is extremely annoying when you suddenly start to accelerate or when you can't get down without pain in your knee. Osteoarthritis of the knee joint is not life-threatening, but sharply worsens its quality.
What is knee osteoarthritis?
Knee arthrosis(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 needThen do not put yourself in this situation.
Causes of osteoarthritis of the knee joint.Distinguish between primary and secondary osteoarthritis of the knee joint. If the cause of the disease is not determined, such osteoarthritis is called primary, inherited from the mother. If the grandmother suffers from osteoarthritis of the knee joints, then her daughter and granddaughter may be younger with the disease.
Secondary osteoarthritis develops as a result of trauma, congenital anomalies of the knee joint, physical activity (sports, occupation), endocrine diseases.
Risk factors are overweight, female sex, old age. Cartilage is very sensitive to a decrease in female sex hormones, and with menopause all the joints begin to "break down". Therefore, overweight older women suffer more severely and more often from osteoarthritis of the knee joint.
Knee anatomy.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 cartilage space between the bones is called the meniscus and is cushioned. The knee joint has the largest synovium, forming large turns and burs.
The joint cavity is filled with synovial fluid that nourishes the articular cartilage. Synovial fluid contains hyaluronic acid, which is needed for smooth sliding of joint surfaces. The ligaments, muscles, and their tendons guide and restrict movement in the joint.
General description.Arthrosis of the knee joint causes destruction of articular cartilage. There are three stages of knee osteoarthritis. In the first stage, the nutrition of the articular cartilage and meniscus is impaired. Cartilage loses elasticity and cracks. Abnormal friction occurs between the bones. Joint overload is accompanied by inflammation and pain in the knee.
In the second stage, the destruction of articular cartilage and meniscus begins. Bone reacts to the load with marginal growths - osteophytes ("thorns"). The amount of intraarticular fluid decreases, the narrowing of the joint space increases. As a result, knee pain already occurs during normal exercise, walking.
In the third stage, obvious bone deformity of the knee joint is detected with severe restriction of natural movements.
Symptoms of osteoarthritis of the knee joint.The main symptoms of osteoarthritis are pain, limited mobility and deformity of the knee joints. Osteoarthritis of the knee joints is a long time, there is a slow, irreversible increase in symptoms. If the pain in the knee appears suddenly, suddenly, for the first time, it is most likely not osteoarthritis.
Osteoarthritis of the knee joint begins gradually with overload, long walks, discomfort when descending, squatting, or minor pain in the knee. At rest, the pain passes quickly.
In the second stage, the knee pain already appears with normal force. The volume of active movements in the knee joint decreases. The shape of the joint changes due to bone deformation and abnormal fluid accumulation in the joint.
In the third stage, the pain becomes chronic, not only during movement, but also at rest. Night pains disrupt sleep. It is difficult for the knee to fit into bed without pain. Swelling of the joint indicates the addition of inflammation. The mobility of the knee joint is minimized.
The joint is significantly deformed, the legs are O or X-shaped. In severe cases, with the development of ankylosis (inactivity), it is completely destroyed.
There are 4 types of pain with osteoarthritis of the knee joint:
- The type of mechanical pain occurs under the influence of physical activity during the day and decreases during the night rest period. These knee pains are associated with a decrease in the damping ability of cartilage and bone structures. Knee pain is usually localized in the anterior and inner region of the knee joint and in the upper part of the lower leg.
- Nocturnal pain is associated with venous blood stasis, excess pressure in the joint, and inflammation.
- "Initial" pain occurs after a period of rest, disappears 15-20 minutes after movement in the joint. This knee pain is caused by friction of the articular surfaces where the cartilage fragments are placed.
- Persistent knee pain is caused by muscle spasm as well as the development of synovitis.
Complications of osteoarthritis of the knee.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.
Normally there is 3-5 ml of synovial fluid in the knee joint. Increased production of inflammatory fluid occurs in diseases of the joints. The amount of eruption (pathological fluid) can be 30-70 and even more than 100 ml. The knee effusion first fills the space inside the patella (medial fossa). With an increase in volume, the upper volvulus is filled 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. It's not a tumor, it's not an oncology, and it doesn't need surgery. A baker's cyst can cause discomfort, pressure, and knee pain when moving. The cyst is between 2 and 6 cm in diameter, and larger cysts can compress the nearby peroneal nerve with the development of weakness and numbness in the leg.
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. With osteoarthritis, inflammatory changes, leukocytes, and blood count without ESR are normal. Rheumatic tests are negative. Uric acid levels are normal.
X-ray shows bone changes in the joint, excluding the traumatic causes of joint pain. In our country, X-ray classification is used according to the stages of osteoarthritis.
Stage 1 - the presence of marginal bone growths with a slight narrowing of the joint space;
Stage 2 - the joint space narrows more precisely, subchondral sclerosis occurs;
Stage 3 - a sharp narrowing of the joint space, smoothing of the joint surfaces, the development of cysts;
MRI of the knee is performed in the early stages 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 examination of the knee joint helps to visualize the soft tissues (meniscus, muscles, ligaments) and assess the volume of 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 assesses the degree of cartilage destruction under a microscope.
Treatment of osteoarthritis of the kneepresents a difficult task. In each case, you must choose an individual treatment program.
When you start talking nonsense during a consultation, patients are surprised at first. Why are we here? Inject a miraculous needle so that my knee does not hurt again. We must explain that there is no such method to eliminate osteoarthritis. To get rid of it, you have to move, lose weight, sign up for the pool. And a person wants to lie on the couch, enlarge the "beer belly", take the problem with a bunch of drugs and stay healthy. But hey !!! In this situation, medicine is powerless.
Painkillers do not cure, they just relieve pain. Anti-inflammatory drugs are prescribed only during the exacerbation of pain in the knee joints. Some non-steroidal anti-inflammatory drugs reduce the pain and help destroy cartilage. Healing ointments do not improve knee arthrosis, but help reduce knee pain a bit. With edema, redness of the joint, warming ointments and compresses are contraindicated; it is better to use topical medications with non-steroidal anti-inflammatory drugs.
Chondroprotectors do not relieve pain, are expensive and should be taken for a long time. I consider them "dummy" and practically do not define them. Avocado and soy extracts are currently available in pharmacies, but I have not yet used this drug in my clinical practice and have no idea about its effectiveness.
Appropriate physiotherapy exercises should be performed in a sitting or lying position to treat and prevent osteoarthritis of the knee joint. It is strictly forbidden to sit or jump. It is useful to do cycling, swimming or water sports, skiing. Labor exploitation in the country often causes increased knee pain. Running with arthrosis of the knee joints, walking uphill, lifting weights is not recommended.
Diet for osteoarthritis of the knee joint.The knee joints carry a load in the form of their own weight. For this reason, overweight people need to lose at least 3-5 kg. Some patients need to lose more than ten kilograms. Otherwise, no treatment will be effective. It is not necessary to "sit" on a 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 the harmful products (sweet, starchy foods, beer, etc. ). Proper eating should become a habit. You need to eat the right foods every 3 hours to lose weight.
To reduce inflammation in the joints, homeopaths recommend foods that alkalize 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.
Sausage, sausage, smoked meat, fast food is believed to increase inflammatory processes in the joints. Instead of pharmaceutical chondroprotectors, I recommend a properly prepared mixed meat dish.
Orthopedic correction reduces stress in the knee joints. If you have pain in your knee joints, you should remove the patella. In advanced cases, walking with a stick is indicated. A heel sole is recommended when shortening the leg. Recently, it is fashionable to use kinesio tapes. These are adhesive tapes made of natural cotton around the affected knee, which do not restrict mobility, help relax the joint and reduce muscle spasms.
I think interstitial electrical stimulation is the most effective way to treat pain in osteoarthritis. VTES gives very good results in combination with hirudotherapy (aqueous therapy) and pharmacopuncture. I will give a situation from experience.
A 54-year-old man with osteoarthritis of the right knee in stage II approached me for help. Knee pain has been bothering him for 6 years. Over the years, she has undergone numerous drug treatments, physiotherapy courses, corticosteroid blockade, and repeat courses at a rehabilitation center. However, the patient's condition only worsened. He approached me for advice on whether to agree to a joint replacement operation or to try something else conservatively. I did not have to convince him for a long time, he immediately agreed to the treatment I offered.
In the first session, I gave him 6 leeks, which helped him to cope with the swelling of the joints and relieve night pain. Knee movement has become easier and freer. The man relaxed a little. Then we performed 3 interstitial electrical stimulation procedures and almost completely stopped the pain syndrome.
After that, success was reinforced by the application of homeopathic remedies that have anti-inflammatory and chondroprotective effects on acupuncture points. Three weeks after the start of therapy, the patient threw the cane and began to move freely without interruption. 3 years have passed since then. Knee pain did not return. Once a year we hold a session of VTES for prophylactic purposes.
In an emergency, hormones in the joints are very effective in relieving severe pain, swelling and inflammation. The indication is an effusion, blockade with corticosteroids in the "dry joint" is prohibited! The pain is temporarily relieved, but such an injection does not cure the arthrosis itself, and the cartilage that follows is further destroyed. It should be done by a specially trained doctor who is well aware of the indications, contraindications, medications, points of application. In general, no more than 3 blocks are required for a connection.
After the swelling and inflammation have subsided, hyaluronic acid preparations, called liquid prostheses, are injected into the joint. It acts on the joint like a natural lubricant, improves the sliding of bone surfaces and restores the shock-absorbing functions of cartilage. However, hyaluronic acid preparations are expensive and last only 6-8 months. There is no point in giving hyaluronic acid drugs 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 cinquefoil, compresses with radish, horseradish or ginger, turpentine baths.
Endoprosthetics of joints should be performed only in case of severe dysfunction of the knee joint, because after 10-15 years this joint must be replaced again. Will there be enough strength and health every 10-15 years for general anesthesia surgery and subsequent rehabilitation??? Therefore, do not rush to agree to an operation! Take care of your joints!