How is knee osteoarthritis diagnosed and treated?

Arthrosis of the knee joint is also known as gonarthrosis or deforming osteoarthritis. The disease can have serious consequences, including disability. At the first signs of osteoarthritis of the knee, you should consult a doctor for diagnosis and treatment. Therapy must be carried out in strict compliance with the conditions and other regulations.

General characteristics of the disease

Gonarthrosis is a progressive lesion of the cartilage that lines the surface of the joint. As a result of such changes, the functionality of the joint is impaired and pain occurs.

Deforming osteoarthritis is chronic. In most cases, the disease progresses slowly, but certain factors can accelerate its progression. This mainly affects the individual characteristics of the body, the activity and physical activity of the patient, as well as accompanying pathologies.

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

With osteoarthritis of the knee, the mechanisms of cartilage nutrition are disturbed so that their function is gradually disturbed. With osteoarthritis of various localizations, pathology of the knee joint occurs in every third patient.

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 if they are overweight - obesity of 2 or 3 degrees.

There is an opinion that primary osteoarthritis of the knee is linked to average life expectancy. It has increased significantly compared to the past centuries and the joints simply wear out over time.

Gonarthrosis related to natural aging is considered normal. If the articular cartilage is destroyed earlier or this process is too intense, then this condition is considered pathological.

Causes of secondary osteoarthritis of the knee joint

Secondary gonarthrosis can be triggered by the following factors:

• genetic predisposition if it can be clearly traced back;
• broken leg;
• dislocation of the knee joint;
• meniscus injury;
• congenital dysplasia of the knee joint;
• extreme physical activity (typical of athletes);
• constant static loads;
• rheumatism;
• rheumatoid arthritis (not to be confused with rheumatism);
• ankylosing spondylitis;
• congenital deformity of the lower extremities - valgus or varus;
• congenital shortening of a limb;
• metabolic syndrome;
• gout;
• acromegaly;
• osteomyelitis;
• chondrocalcinosis;
• pathologies related to material exchange;
• Joint hypermobility - the ligaments are inherently weak;
• hemochromatosis;
• diabetes mellitus;
• pathology of the endocrine system.

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

Symptoms of gonarthrosis

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

• Grind and click.These symptoms usually appear while moving and are often ignored by patients. A crunch in the knee can cause grooves, osteophytes, and ulcers to appear on the joint surfaces.
• Restrained movements.This symptom is very important during diagnosis as it allows you to differentiate osteoarthritis of the knee from a number of other pathologies that affect the musculoskeletal system. The movement is usually stiff in the morning. When a person starts walking, this symptom will go away within half an hour. If the stiffness lasts for an hour or more, it may indicate an inflammatory process or other pathology.
• Reduced range of motion.This symptom implies that the patient cannot fully bend the knee. This is due to pain syndrome, which reduces the intensity with which a person tries to move their leg less. Over time, this leads to a shortening of the ligaments known as contractures.
• Stuck connection.Osteoarthritis of the knee can block the joint in a certain position and it is impossible to move it due to severe pain. This usually occurs due to changes in the articular surfaces when the knee's inner ligaments are pulled and protrude from the pineal glands. In this case, only the reverse shift of the tape can help. More rarely, the cause of joint obstruction is the penetration of a foreign body into the joint space. Problems can be caused by part of the meniscus or a fragment of an osteophyte.

Classification of the disease

Each of the levels has specific functions:

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

The exact stage of gonarthrosis is determined by a specialist. In this case, you do not need to focus on the symptoms of the disease, but on the X-rays received. Pathology does not always follow the standard pattern.

Diagnosis

Only instrumental diagnostics help determine deforming osteoarthritis:

• X-ray;
• ultrasound;
• Tomography - computed or magnetic resonance tomography;
• arthroscopy;
• thermography;
• scintigraphy.

An x-ray is often sufficient to detect osteoarthritis of the knee. It is carried out in two projections. If only one knee is affected, a picture of the healthy limb is still taken to compare the results.

Which doctors should I ask for help?

Various specialists can be involved in osteoarthritis deformans. In a conventional clinic, they usually consult a surgeon.

Arthrologist, rheumatologist and orthopedist usually deal with problems of osteoarthritis of the knee. In addition, the participation of a chiropractor or arthroscopist may be required. A physical therapist, a physical therapist, and a massage therapist qualified in the field are usually involved in the treatment process.

Treatment of gonarthrosis

Treatment of osteoarthritis of the knee joint takes a long time. In most cases, outpatient treatment is sufficient. It includes a whole range of measures. The treatment is based on medicinal, physiotherapeutic and physiotherapeutic exercises. In some cases, surgery is required. Folk recipes can also be used for osteoarthritis of the knee, but these must be combined with traditional medicine.

drug therapy

The use of various drugs is the main component of treating osteoarthritis of the knee. With such a disease, an integrated approach is required, which implies the possibility of using the following drugs:

• Preparations of a non-steroidal anti-inflammatory group.These drugs are produced in various forms, but for osteoarthritis, preference is given to tablets for oral administration, solutions for injections, means for external use in the form of creams, ointments and gels. Nonsteroidal anti-inflammatory drugs not only fight inflammation, but also relieve pain.
• corticosteroids.Such drugs are usually resorted to when the disease is severe or when drugs in the nonsteroidal anti-inflammatory group are ineffective. Usually they are used as injections, where the drug is injected into the joint capsule. Corticosteroids are used as symptomatic therapy to relieve 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, resort to strong opiates.
• chondroprotectors.Thanks to these drugs, the cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors is evident for a long time, so they are used for long therapeutic courses. Such drugs are suitable for 1 or 2 degree pathology.
• Anticonvulsants and muscle relaxants.Such drugs are necessary if the pathology is accompanied by muscle spasms.
• vasodilator drugs.Such drugs improve blood circulation and relieve cramps in small vessels. A combination of vasodilating drugs and chondroprotectors is effective, since in this case the cartilage tissue is better saturated with nutrients.
• Warming ointmentsto improve blood circulation. Such means are appropriate in the absence of synovitis.

Medicines are prescribed by a doctor. Only he can determine which drugs are needed in each individual case, according to which scheme they must be taken and how long the therapeutic course should last for each prescribed drug.

Physiotherapy

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

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

• Phonophoresis.This technique is ultrasound therapy combined with the effects of medication. High-frequency vibrations heat the tissue of the knee joint, which allows drugs to penetrate deeper into them.
• shock wave therapy.The procedure uses a special device that generates radial sound waves. Under their action, the blood supply in the periarticular area is activated, which stimulates the restoration of cartilage and bone structures.
• Ozone therapy.This process uses active oxygen. It has an analgesic and anti-inflammatory effect on the tissues.
• Electromyostimulation.This technique is often used during rehabilitation and when there are contraindications to physical activity. Under the influence of electrical impulses, muscle tone increases and blood circulation improves.
• Diathermy.This technique relates to electrotherapy and involves the use of high-frequency, high-intensity currents for deep heating.
• cryotherapy.This technique is also known as 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 and relieves muscle spasms.
• Hirudotherapy.This technique is seen as an alternative. Leeches are placed around the affected joint. The procedure relieves pain, relieves swelling and stimulates regeneration.
• Laser therapy.This technique is usually used in the early stages of the pathology. It offers anti-inflammatory, analgesic and stimulant effects.
• plasma therapy.This procedure is also known as joint plasmolifting. These are intra-articular injections. For them, the patient's own blood plasma, saturated with platelets, is used. This procedure relieves inflammation and promotes the regeneration of cartilage tissue.
• Spas- turpentine, radon, hydrogen sulfide.
• acupuncture.Such a procedure is usually used in the initial stages of pathology. This technique relieves swelling, eliminates pain, and allows joint mobility to be restored.

Movement therapy

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

In times of worsening disease, exercise therapy is not used. At this point the joint needs rest and maximum relief. Movement activity is allowed when inflammation and pain are relieved. From this moment on, 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 severity of the disease and the individual characteristics of the patient.

Gymnastics

At home, a patient with osteoarthritis of the knee can do some exercises on his own. You need to do it gradually - first you need to warm up, then do strength exercises and finish with stretching.

The warm-up takes place as follows:

• Put your feet shoulder width apart and lower your arms along your body or lean on the back of a chair. Slowly step on your toes, rest at the extreme point for 3 seconds, then gently transfer the weight to your heels, lifting your toes as high as possible. Do 10 repetitions without sudden movements.
• The start position remains the same. The leg bent at the knee must be raised to the waist and then lowered. Alternate doing 15 repetitions on each leg. Movements should be slow and fluid.
• Lie on your back, lift your bent knees and simulate the rotation of the bicycle pedals. You need to twist in one direction for half a minute, and then in the other. Move slowly.
• Place your feet shoulder-width apart, straighten your back, and bend your elbows. Simulate running in place by alternately shifting your weight from one leg to the other. Movements should be done on your toes, not your heels. Do the exercise for about 5 minutes.

surgery

Deformed osteoarthritis may require surgical treatment. You use the following options:

• puncture.This procedure is minimally invasive. It is used not only to examine the 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 an independent operation or it can be one of its stages. This technique is endoscopic and does not require dissection of the joint cavity. Special thin and flexible instruments are used for its operation, and all manipulations are 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 flexible. During the operation, the bone that is involved in the formation of the knee joint is sawed and then fixed in another position. Such a surgical procedure is suitable for deforming osteoarthritis of the 1st or 2nd degree.
• Endoprosthetics.Such an operation is resorted to if the third degree of osteoarthritis of the knee is diagnosed. During the operation, the knee joint is replaced by a biocompatible construction. It is necessary to restore the patient's previous range of motion and normal quality of life. Endoprosthetics is a rather 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 implies adherence to the diet. It must conform to the following principles:

• If necessary, normalize your body weight. The BMI should not be more than 20. Weight loss should be gradual - 2-3 kg per month.
• Reduce carbohydrates and animal fats.
• Most of the fat you eat should be of vegetable origin.
• You need to eat fish at least 1-2 times a week.
• You should eat fractionated. The portion should be small, but it should be 5-6 meals a day.
• End every meal with vegetables or fruits.
• For cooking, you should choose cooking, including steaming, braising, baking.
• Pay attention to the drinking regime. The average person needs 2 liters of fluids per day and should be mostly clean water with no gas.
• Drink water before you eat. A glass is enough half an hour before meals.
• Reduce your salt intake.
• Avoid alcohol, carbonated and sugary drinks.
• Beef, pork, semi-finished products, hot peppers, white cabbage and sour fruits should be excluded from the diet.
• It is useful to eat jellied meat, jelly on gelatin, cheese, cottage cheese, chicken, legumes.

Traditional medicine

Unconventional methods are also suitable for the treatment of osteoarthritis deformans. In this case, you should consult a specialist, since even the use of natural remedies has contraindications.

Use the following folk recipes effectively:

• Lubricate the back of the burdock leaf with honey, apply to the affected area, fix with cellophane and isolate. Hold the compress for up to 4 hours.
• You can use a cabbage leaf instead of the 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 need to 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. Leave in the dark for 3 weeks, strain and rub into the affected areas three times a day.
• Heat honey to a liquid state in a water bath and rub it into the affected knee, massaging it. Cover and insulate the treated area with gauze or bandage. The process is repeated every day for a week and a half.
• steam 5 tbsp. l. Oatmeal and cook over low heat for 5-8 minutes. Wrap the cooled mixture in a natural cloth, apply it to the affected area and fix it with polyethylene. Prepare a fresh mixture each time.
• Mix iodine evenly with honey and glycerin and leave it for 3 hours. Dip a cotton pad in the resulting composition and work the knee and the adjacent area with movements from the bottom up.
• Chop a clove of garlic and add a glass of vegetable oil. Insist in the dark for a week, strain and apply to the affected areas before bed.
• Grind white school chalk and mix it with yogurt or sour cream to make a thick slurry. Wrap it in natural tissue and make a compress for 2. 5 hours by insulating it with polyethylene. Repeat the process every day.
• Boil two large onions with skins in one liter of distilled water and drain. Drink the resulting infusion before meals three times a day.

Treatment of osteoarthritis of the knee should not be limited to traditional medicine. This disease requires an integrated approach that requires drug therapy and exercise.

prognosis, possible complications

The general prognosis for deforming osteoarthritis is poor due to the progression of the disease. The process of tissue breakdown and joint deformation cannot be reversed, but can be stopped or slowed down significantly.

The following factors influence the prognosis of gonarthrosis:

• Age of the patient.The younger he is, the less favorable the prognosis. The pathological process develops gradually, so in young people in old age the disease with joint damage can reach the final stage and cause various complications.
• Type of osteoarthritis.In the primary pathology, only the joint is affected and the disease usually progresses slowly. If there is a secondary illness, there are other disorders that can accelerate this process or cause complications.
• Compliance with the doctor's instructions.This applies to taking the necessary medication, performing physiotherapy, exercise therapy and relieving the pressure on the joint. It is also important to note the duration of drug therapy, since most drugs in certain courses must be taken regularly.
• body mass.If the patient has a lot of weight, the joints are exposed to increased stress, which has a negative effect on 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. Lack of exercise can also have a negative impact on the course of the disease if the joint is in one position for a long time.

The deformity of osteoarthritis progresses slowly, but without proper treatment it can cause a number of complications:

• Joint deformity.This occurs in the last stage of the disease. The leg can bend at an unnatural angle, which is not only aesthetically uncomfortable, but can also lead to a complete loss of joint function.
• infection.Microtrauma, for example a tear in the cartilage tissue, can cause such a complication. The pathogen can get from the infection source into the joint together with the current or the lymph. Surgical interventions - arthroscopy, diagnostic puncture can also be the cause of infection. The introduction of infections into the joint can provoke aseptic necrosis.
• Dislocation, fracture.Such complications arise against the background of a dysfunction of the knee joint, in which the load is not properly distributed, and excess can lead to injury.
• ankylosis.In this case, the bones grow together at the site of the missing joint. This is one of the most serious disorders because the fixation of the lower leg in one position means that motor function is lost.

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

Prevention

To avoid osteoarthritis of the knee, some preventive measures should be taken:

• maintains a normal body weight;
• Avoid heavy loads and strong pressure on the knees.
• ensure regular and sufficient physical activity;
• Avoid joint injuries;
• When an injury occurs, timely, competent and complete treatment is required.
• Strengthen the periarticular muscles.

Secondary prevention measures should also be highlighted. They are necessary if osteoarthritis of the knee has already been diagnosed and the rate of development needs to be reduced. In this case you need to take the following measures:

• resort to a course of chondroprotectors every six months or a year;
• timely, quick and efficient treatment of arthritis.

Osteoarthritis of the knee joint is a serious pathology that has a poor prognosis and can cause a number of complications. It is necessary to start treatment as early as possible in order to slow down the pathological process. Therapy should be comprehensive, some techniques should become part of lifestyle: diet, exercise, use of certain medications.