How is knee arthrosis diagnosed and treated?

Arthrosis of the knee joint is also called gonarthrosis or deforming osteoarthritis. The illness can lead to serious consequences, including disability. At the first signs of gonarthrosis, you should consult a doctor for diagnosis and treatment. Therapy must be completed in strict compliance with the terms and other prescriptions.

General characteristics of the disease

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

Deforming osteoarthritis 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 arthrosis. 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 gonarthrosis, the mechanisms of cartilage nutrition are disrupted, so its functioning is gradually disrupted. Among arthrosis of various localizations, pathology of the knee joint occurs in every third patient.

Causes of primary arthrosis of the knee joint

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

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

Gonarthrosis associated with 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 arthrosis of the knee joint

Secondary gonarthrosis can be triggered by the following factors:

• genetic predisposition, provided it can be clearly traced;
• leg fracture;
• dislocation of the knee joint;
• meniscus injury;
• congenital dysplasia of the knee joint;
• extreme physical activity (typical for 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 one limb;
• metabolic syndrome;
• gout;
• acromegaly;
• osteomyelitis;
• chondrocalcinosis;
• pathologies associated with material exchange;
• articular hypermobility - the ligamentous apparatus is inherently weak;
• hemochromatosis;
• diabetes mellitus;
• pathology of the endocrine system.

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

Symptoms of gonarthrosis

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

• Crunch and click.These symptoms usually appear during movement and are often ignored by patients. A crunch in the knee may mean that grooves, osteophytes, ulceration have appeared on the articular surfaces.
• Restrained movements.This symptom is very important during diagnosis, as it allows to differentiate gonarthrosis from a number of other pathologies that affect the musculoskeletal system. Movement is usually stiff in the morning. When a person begins to walk, this symptom disappears within half an hour. If the stiffness persists for an hour or longer, this 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 of which a person tries to move his leg less. Over time, this leads to a shortening of the ligaments, which are called contractures.
• Jammed joint.Gonarthrosis can lead to blockage of the joint in a certain position, and it is impossible to displace it due to severe pain. This usually occurs due to changes in the articular 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 jamming is the ingress of a foreign body into the joint space. The source of trouble can be a part of the meniscus or a fragment of an osteophyte.

Classification of the disease

Each of the stages has specific features:

1. The first stageis ​​initial, it is also called easy. The first signs of pathology are considered its beginning, 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. At the first stage of the disease, the accumulation of fluid in the joint already begins - this phenomenon is called synovitis. It is he who causes pain, which is manifested so far only when moving. Their intensity can vary.
2. At the second (moderate) stageof gonarthrosis, pathological changes are visible even visually. They are manifested by an increase in the size of the knee, its deformation. On x-rays, you can see that the bone tissue at the edges of the joint has grown, and the joint space has narrowed. It is at this stage that the pain syndrome manifests itself from the slightest load, and when walking or squatting, the knee begins to crunch.
3. The third (severe) stagedeforming osteoarthritis is diagnosed when there is practically no cartilage tissue in the joint. If the pathology is difficult, then the bones can grow together, which will cause complete immobility of the affected limb.

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

Diagnostics

Only instrumental diagnostics will help to determine deforming osteoarthritis:

• x-ray;
• ultrasound scanning;
• tomography - computed or magnetic resonance imaging;
• arthroscopy;
• thermography;
• scintigraphy.

Often one X-ray is enough to detect gonarthrosis. It is performed in two projections. If only one knee is affected, an image of the healthy limb is still taken to compare the results.

Which doctors should I seek help?

In the case of osteoarthritis deformans, different specialists can be involved. In a conventional clinic, they usually consult a surgeon.

Arthrologist, rheumatologist, orthopedist usually deal with the problems of gonarthrosis. Additionally, the participation of a chiropractor, arthroscopist may be required. A physiotherapist, a physical therapy instructor, a massage therapist qualified in the field is usually involved in the treatment process.

Treatment of gonarthrosis

Therapy for arthrosis of the knee joint takes quite a long time. In most cases, outpatient treatment is sufficient. It implies a whole range of measures. The treatment is based on drug therapy, physiotherapy and physiotherapy exercises. In some cases, surgery is required. With gonarthrosis, it is also allowed to use folk recipes, but they must be combined with traditional medicine.

Drug therapy

The use of various drugs is the main component of treatment for gonarthrosis. With such a disease, an integrated approach is required, implying the possibility of using the following medications:

• Preparations of non-steroidal anti-inflammatory group.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. Non-steroidal anti-inflammatory drugs not only fight inflammation, but also reduce pain.
• Corticosteroids.Such drugs are usually resorted to when the disease is severe, or drugs of the non-steroidal anti-inflammatory group are ineffective. Usually they are used as injections, injecting the medicine into the joint capsule. Corticosteroids are used as symptomatic therapy 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, then they resort to strong opiates.
• Chondroprotectors.Thanks to these medications, the cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors manifests itself for a long time, therefore they are used for long therapeutic courses. Such medications are appropriate for pathology of 1 or 2 degrees.
• Antispasmodics and muscle relaxants.Such drugs are necessary when the pathology is accompanied by muscle spasms.
• Vasodilator medicines.Such drugs improve blood flow, relieve spasm of small vessels. A combination of vasodilating drugs and chondroprotectors is effective, since the cartilage tissue in this case is better saturated with nutrients.
• Warming ointmentsto improve blood circulation. Such funds are appropriate in the absence of synovitis.

Medication is prescribed by a doctor. Only he can determine what drugs are needed in each specific case, according to what scheme they need to be taken and what should be the duration of the therapeutic course for each prescribed medication.

Physiotherapy

With deforming osteoarthritis, various physiotherapeutic methods are actively used. They are used for various purposes: to reduce pain, relieve inflammation, activate blood supply, and accelerate recovery.

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

• Phonophoresis.This technique is an ultrasound therapy combined with the effects of medication. Due to high-frequency vibrations, the tissues of the knee joint are heated, which ensures deeper penetration of medicinal substances into them.
• Shockwave therapy.The procedure uses a special apparatus that generates radial acoustic waves. Under their action, the blood supply in the periarticular region is activated, which stimulates the restoration of cartilaginous and bone structures.
• Ozone therapy.This procedure involves the use of active oxygen. It provides analgesic and anti-inflammatory effects on tissues.
• Electromyostimulation.This technique is often used during rehabilitation, as well as in the presence of contraindications to physical 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-frequency currents of high strength for deep heating.
• Cryotherapy.This technique is also called cold treatment. The affected skin area is exposed to a low temperature for a short period of time. This method restores metabolic processes, increases blood circulation, reduces the severity of inflammation, eliminates pain, relieves muscle spasm.
• Hirudotherapy.This technique is considered 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 at an early stage of pathology. It provides anti-inflammatory, analgesic and stimulating effects.
• Plasma therapy.This procedure is also called joint plasmolifting. It involves intra-articular injections. For them, the patient's own 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 resorted to at the initial stages of pathology. This technique relieves swelling, eliminates pain, and allows you to restore joint mobility.

exercise therapy

Physiotherapy is necessary for gonarthrosis. 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 strength and muscle endurance.

Exercise therapy is not used during periods of exacerbation of the disease. At this time, the joint needs rest and maximum unloading. Locomotor activity is allowed when inflammation and pain are relieved, from this moment 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 gonarthrosis can independently do some exercises. You need to do it in stages - first you need to warm up, then do strength exercises and finish with stretching.

Warming up is carried out as follows:

• Put your feet shoulder-width apart, and lower your arms along the body or lean on the back of a chair. Slowly rise on your toes, lingering at the extreme point for 3 seconds, then smoothly 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. It is necessary to raise the leg bent at the knee to the level of the waist, then lower it. Do 15 repetitions alternately on each leg. Movements should be slow and fluid.
• Lie on your back, raise your bent knees and simulate the rotation of the bicycle pedals. It takes half a minute to make rotational movements in one direction, then in the other. Move slowly.
• Place your feet shoulder-width apart, straighten your back and bend your elbows. Simulate running in place, alternately shifting weight from one leg to the other. Movements should be performed on toes, not leaning on the heels. Perform the exercise for about 5 minutes.

Surgery

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

• Puncture.This intervention is minimally invasive. It is used not only to study 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 be one of its stages. This technique is endoscopic and does not require dissection of the articular 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, then during it the articular surfaces are cleaned of fragments of the affected cartilage tissue.
• Periarticular osteotomy.This kind 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 sawn and then fixed in a different position. Such a surgical intervention is appropriate for grade 1 or 2 deforming osteoarthritis.
• Endoprosthetics.Such an operation is used when the third degree of gonarthrosis 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. Endoprosthetics is a rather complicated operation and therefore requires a long rehabilitation period.

Diet and General Recommendations

Despite the fact that the pathology affects the knee joint, its treatment implies adherence to diet. It must comply with the following principles:

• If necessary, normalize body weight. BMI should be no more than 20. Weight loss should be gradual - 2-3 kg per month.
• Cut back on carbohydrates and animal fats.
• Most of the fat you eat should be of plant origin.
• You need to eat fish at least 1-2 times a week.
• You should eat fractionally. The portion should be small, but there should be 5-6 meals a day.
• Round off each meal with a vegetable or fruit.
• For cooking, you should choose cooking, including steaming, stewing, baking.
• Observe the drinking regime. On average, a person needs 2 liters of liquid a day, and for the most part it should be clean water without gas.
• Drink water before eating. One glass is enough half an hour before meals.
• Reduce salt intake.
• Avoid alcohol, carbonated 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 jellied meat, jelly on gelatin, cheese, cottage cheese, chicken, legumes.

Traditional medicine

In the treatment of osteoarthritis deformans, unconventional methods are also appropriate. In this case, you should consult with 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 film and insulate. Keep the compress up to 4 hours.
• You can use a 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 must be finely chopped, steamed with boiling water and insisted. Drink a tablespoon 5 times a day.
• Rinse the potato sprouts, place in a glass container and cover with alcohol. Stand in the dark for 3 weeks, strain and use three times a day to rub the affected areas.
• Heat honey in a water bath to a liquid state and rub into the affected knee, massaging it. Cover the treated area with gauze or bandage and insulate. The procedure is repeated every day for one and a half weeks.
• Steam 5 tbsp. l. rolled oats and cook for 5-8 minutes over low heat. Wrap the cooled mixture in a natural cloth, apply to the affected area and fix with polyethylene. Every time you need to prepare a fresh mixture.
• Mix equally iodine with honey and glycerin, leave for 3 hours. Dip a cotton pad into the resulting composition and process the knee and the adjacent area with movements from the bottom up.
• Chop a head of garlic and add a glass of vegetable oil. Insist a week in the dark, strain and apply to affected areas before bedtime.
• Grind white school chalk and mix with yogurt or sour cream to make a thick slurry. Wrap it in natural fabric 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 gonarthrosis should not be limited to traditional medicine. This disease requires an integrated approach, which mandatorily provides for drug therapy and exercise.

Prognosis, possible complications

The general prognosis of deforming osteoarthritis is unfavorable 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 gonarthrosis:

• Patient's age.The younger he is, the less favorable the prognosis. The pathological process develops gradually, therefore, with joint damage in young people, by old age, the disease can reach the last stage and cause various complications.
• Type of arthrosis.In primary pathology, only the joint is affected, and the disease usually progresses slowly. With a secondary disease, there are other disorders that can speed up this process or provoke complications.
• Compliance with doctor's orders.This applies to taking the necessary medications, undergoing physiotherapy, exercise therapy, and providing unloading of the joint. It is also important to observe the duration of drug therapy, since most drugs need to be taken regularly in certain courses.
• Body mass.If the patient has a lot of weight, then the joints experience increased stress, which negatively affects the course of the disease.
• Profession.This factor is very significant for the prognosis of the disease. Professional athletes, people who are under regular stress or constantly on their feet, always suffer more. Sedentary work, when the joint is in one position for a long time, can also negatively affect the course of the disease.

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

• Joint deformity.This occurs at the last stage of the disease. The leg can bend at an unnatural angle, which is not only aesthetically unpleasant, but can also cause a complete loss of joint functionality.
• Infection.A microtrauma, for example, a crack in the cartilage tissue, can provoke such a complication. The pathogen can enter the joint along with the current or lymph from the focus of infection. Surgical intervention - 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 occur against the background of a violation of the functionality of the knee joint, in which the load is not distributed correctly, and excess can lead to injury.
• Ankylosis.In this case, the bones at the site of the disappeared joint grow together. This is one of the most serious disorders, since due to the fixation of the lower leg in one position, the motor function is lost.

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

Prevention

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

• maintain a normal body weight;
• avoid heavy loads and strong pressure on the knees;
• ensure regular and sufficient physical activity;
• avoid injury to joints;
• if an injury is received, then timely, competent and complete treatment is necessary;
• Strengthen the periarticular muscles.

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

• to resort to a course of chondroprotectors every six months or a year;
• timely, quickly and efficiently treat arthritis.

Arthrosis 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 the lifestyle: diet, exercise, taking certain medications.