Osteoarthritis of the knee

15 September 2020

Osteoarthritis of the knee joint, also called knee osteoarthritis, can dramatically affect a person's quality of life. During the development of the disease, there is a gradual loss of hyaline cartilage in the joint. Gradually, the cartilage loses its density and height. Its razvlecheniya and thinning are noted, and over time it completely disappears. As a result, there is no soft protective pad in the bone, and this leads to an increased load on the end plate of the innervated articular surface of the bone. As a result of this load, pain develops. The code for osteoarthritis of the knee joint according to ICD-10 is M17.

The knee joint is quite often affected, since it is the knee that has a significant load during walking, physical exertion and running. In this case, awkward movements can lead to damage to the soft tissues of the knee and cause osteoarthritis. This is why knee osteoarthritis is one of the main causes of disability. According to statistics, this disease affects about 20% of the inhabitants of the planet to varying degrees.

Why osteoarthritis develops, how to prevent the development of this disease, which doctor treats osteoarthritis of the knee joint, and what kind of treatment methods the doctor can recommend after diagnosis will be discussed in this article.

Pathogenesis

The disease develops against the background of a mismatch between the load on the joint and its ability to resist it. In this case, the properties of cartilage can be determined by genetics or change due to the influence of acquired factors - both exogenous and endogenous. The development and progression of knee osteoarthritis can occur with age, against a background of obesity, due to dysplasia of the patellofemoral joint or changes in the axis of the lower limb, disorders of thebiomechanics of the joint, lesions of the menisci and ligaments.

The basis of pathogenesis is the predominance of catabolic over anabolic processes, which is noted in cartilaginous and subchondral bones, menisci and synovium. As a result, structural changes occur and the biological properties of the cartilage are lost. In addition, the pathological process spreads to muscles and ligaments.

The basis of articular cartilage is the matrix of connective tissue and chondrocytes. The connective tissue matrix contains type II collagen and agrecan molecules. The cushioning properties of cartilage are provided precisely by the connective tissue matrix.

The inflammatory process in osteoarthritis is not as intense as in arthritis. However, in osteoarthritis, pro-inflammatory mediators are also present.

Classification

Depending on the origin of knee osteoarthritis, the following types are distinguished:

Primary (idiopathic)- develops without the influence of any external cause.
Secondary- certain factors lead to the development of the disease. Most often they are associated with injuries, fractures, surgical interventions on the joint, as well as inflammatory factors - acute and chronic arthritis.

The following degrees of osteoarthritis of the knee are also determined:

Osteoarthritis of the 1st degree- is determined in the period from the onset of the first signs of the disease to the development of bone deformities, visible on x-rays or during examination. During this period, pain of varying intensity appears during movement.
At grade 2- unpleasant sensations are observed even at the slightest exertion. When walking and squatting, the knee cracks, the mobility of the joint decreases. The photo shows the growth of bone tissue along the edges of the joint, as well as the narrowing of the joint space. On external examination, it can be noted that the size of the knee is increased.
At grade 3there is virtually no cartilage tissue inside the joint. If the development of the disease progresses, the bones can grow together, causing the leg to become completely immobile. Sleep is disturbed, it becomes impossible to move without a stick or crutch.

The following types of this disease are also distinguished:

Patellofemoral osteoarthritis of the knee jointis a condition in which degenerative changes in the posterior part of the kneecap, that is, the patella, are noted. With this form of the disease, the pain is mainly disturbed when descending a ladder or a mountain. Patellofemoral osteoarthritis can develop in runners. The disease is often diagnosed in young people.
Post-traumatic osteoarthritis of the knee joint- a consequence of the injury. The type of post-traumatic illness may not appear initially. But later a person loses the full-fledged motor activity of the joint.

Causes of osteoarthritis of the knee joint

Currently, work is underway to study the reasons leading to the development of such a pathology.

At the moment, the causes of knee osteoarthritis are associated with the influence of the following factors:

Age - at a certain age, degenerative changes in the tissues begin in a person, and the ability of cartilage tissue to regenerate itself decreases.
Arthritis - Over time, arthritis can lead to the development of osteoarthritis.
Postponed Injury and Overload - In addition to injury, the development of the disease can often cause the urge to kneel, squat, lift weights.
Obesity and overweight - due to excessive body weight, there is an increased load on the joints of the legs. In addition, substances that cause damage to the joint enter the bloodstream from the pathological fatty tissue, and then into the joint.
Heredity - in some cases the development of the disease is determined by a defective gene responsible for the growth of cartilage tissue. As a result, this fabric may have poor resistance to damage. If close relatives have had osteoarthritis, this increases its likelihood.
Diseases leading to metabolic disorders - the risk of this pathology increases with atherosclerosis, diabetes mellitus.
Hormonal disorders - women get sick more often after age 55.
Sports - people who play certain sports are more likely to develop this disease. This is typical for runners, as well as football, tennis and basketball players.

Symptoms of osteoarthritis of the knee

As a rule, the symptoms of osteoarthritis of the knee joint increase slowly, as the process of its development lasts for years. If several joints are affected, symptoms of polyarthrosis develop.

The manifestations of the disease depend on its severity, age and a number of other factors.

However, the main symptoms of knee osteoarthritis are as follows:

Pain in the knee joint, worse with activity. At rest, the knee hurts less.
Swelling in the knee area.
A feeling of warmth in the joint.
Unpleasant sensations of stiffness in the joint, which appear after a person has been in a static position for a long time.
Decreased range of motion in the knee joint, preventing a person from getting up from a chair, going down stairs, or getting out of a car.
Crunching and crackling of the knee, most often seen with sudden joint movements
Climate change is believed to affect the degree of pain and discomfort.

Analyzes and diagnostics

To determine if such a disease can be cured, the diagnosis must be confirmed initially. In the process of diagnosis, the doctor examines and questions the patient. But the most informative study in this case is an x-ray of the knee.

Also, to clarify the diagnosis, it is advisable to undergo an ultrasound, during which arthritis can be ruled out and the height of the articular cartilage can be measured.

If necessary, schedule additional exams.

Treatment of osteoarthritis of the knee

In order for the treatment of this disease to be as effective as possible, it is first necessary to confirm the diagnosis and select the correct scheme of complex therapy. Treatment of osteoarthritis of the knee joint at home is possible if the patient carefully adheres to all the recommendations of a specialist, practicing both drugs and additional methods of treatment. Only then can home therapy be effective.

Drug therapy and other methods of treating this disease are used depending on the degree of damage. The simplest is the treatment of osteoarthritis of the knee joint of the 1st degree. In case of a disease of the first degree, a complex treatment regimen is used, which allows you to achieve an effect in the shortest possible time. Therefore, if a person is diagnosed with 1st degree OA, the condition should be treated immediately.

Regarding the treatment of osteoarthritis of the knee joint of the 2nd degree, the doctor makes a decision based on the patient's condition. Since at this stage changes in cartilage tissue begin, treatment should be carried out immediately.

The cure for grade 3 osteoarthritis of the knee depends on many factors. At grade 3, the cartilage thins, so treatment at this stage is long and the least effective.

Drugs

The medical treatment of osteoarthritis of the knee is aimed at providing analgesic and anti-inflammatory effect. It is also important to reduce the severity of cartilage destruction.

The following drugs are used for this purpose:

Nonsteroidal anti-inflammatory drugs - tablets and local remedies are used - ointments, gels. The most effective local and systemic application of these funds.
Chondroprotectors for osteoarthritis of the knee joint - chondroprotectors from the group of glucosaminoglycans (hyaluronic acid), chondroitin sulfates and others are used. These drugs for osteoarthritis of the knee joint are prescribed as part of a complex treatment. The price of chondroprotectors depends on the drug and varies widely.
For serious illnesses, drugs include steroids. Both injections for osteoarthritis of the knee joint can be given intramuscularly and external agents containing steroids can be used.
External agents with skin irritants. In the description of folk remedies, you can also find annoying compresses.
During treatment, your doctor may prescribe injections into the knee. Different drugs can be used for injections into the knee joint for osteoarthritis. In particular, corticosteroids are injected to relieve severe inflammation. Reviews of injections indicate that it is in this form that steroids work the fastest and most effectively. Blocking the knee can be done not only with glucocorticosteroids, but also with anesthetics. Reviews of the blockade indicate that this method effectively relieves even severe pain. Also, an injection into the knee can be performed during treatment with chondroprotectors. It improves metabolic processes, activates the production of collagen. But to achieve the effect, it is necessary to perform at least five injections. In addition, hyaluronic acid is injected intra-articularly, which improves the quality of intra-articular fluid and ensures effective protection of cartilage tissue. Vitamins can also be administered intra-articularly.
Method of Plasmolifting - its essence is the introduction of blood plasma rich in platelets into the affected knee.
Medical bile for osteoarthritis of the knee joint - used for compresses. It should be noted that medical bile can be an effective remedy only if its use is prescribed by a doctor according to a certain scheme. Therefore, the option “we treat at home” without consulting a doctor is unacceptable in this case.

Procedures and operations

For osteoarthritis and polyarthrosis, non-drug treatment methods are also used, the use of which is no less effective.

Physiotherapy. Various techniques are used, including the method of shock wave therapy, myostimulation, phonophoresis, ozone therapy, physiotherapy and others. Physiotherapy can reduce pain, relieve inflammation. Any physiotherapy prescribed by a doctor should be carried out exactly in the complex indicated by the doctor.

Laser therapy- produces decongestant, analgesic and anti-inflammatory effects.

Ozone therapy- it relieves pain, produces an anti-inflammatory effect, which helps to reduce the amount of hormonal agents used.

Knee pads for osteoarthritis of the knee- wearing such devices reduces the severity of pain. In addition, the knee pad protects it from instability. But in order to achieve the desired effect, it is necessary to choose the right knee pads or a knee pad. There are many general tips on how to choose knee pads for osteoarthritis of the knee. In addition, many different models of such knee pads are offered - with movement restrictions, amplifiers, etc. But still, those who want to buy knee pads for osteoarthritis, it is advisable not to rely on the reviews of users, but on the recommendations of the doctor. The price of an orthopedic knee brace depends on different characteristics - material, quality. Knee pads are particularly useful if the patient develops post-traumatic arthritis. But patellofemoral osteoarthritis, as well as other types of disease, can be treated with this method.

Therapeutic exercises for osteoarthritis of the kneeis an effective method that allows you to improve the condition and prevent surgery, provided that a person performs regularly and persistentlyexercise therapy for osteoarthritis of the knee. Physiotherapy exercises help strengthen the muscles of the legs and stop the development of the pathological process. However, a series of exercises for osteoarthritis of the knee joint should be performed in a certain order, and such gymnastics is selected individually. Therefore, it is better if the basis of the classes is not a gymnastics video, but a set of exercises developed by a doctor. In this case, it is not only the load that is important, but a full-fledged exercise therapy.

With similar pathology, different types of exercise therapy can be done.

Special gymnastics.Such exercises are recommended both during treatment and for people over 40 as a preventive measure. Knee exercises should be done every day. These exercises are also suitable for older people, as they can be performed at a calm pace.

Massage and manual therapy- suitable for patients with reduced mobility, can be combined with exercise therapy. In the absence of the possibility of consulting a massage therapist, self-massage can be carried out according to the scheme that the specialist will demonstrate.

As additional methods to improve the patient's condition and active rehabilitation, yoga, acupuncture, joint stretching, special exercises on simulators (exercise bike and others) can be practiced.

If conservative methods prove ineffective, surgical treatment is performed.

The following techniques can be used:

Puncture- getting rid of excess fluid in the joint can reduce symptoms of inflammation and restore mobility.
Arthroscopy- can be performed endoscopically. Using this technique, the joint surfaces are cleaned of fragments of destroyed cartilage tissue.
Periarticular osteotomy- in such an operation, one of the bones that form the knee joint is sawed off and reattached at a different angle. As a result, the severity of the pain decreases and the mobility of the knee increases. The intervention is effective in the first and second degree of the disease.
Endoprostheses- replacement of the knee joint with a special biocompatible construction. This is a very complex intervention, which is carried out with the third degree of the disease.

Treatment of osteoarthritis of the knee joint with folk remedies

Many reviews of the treatment of folk remedies for this disease confirm that these methods can be used as an auxiliary, thereby facilitating the patient's condition. However, these methods should not replace the main treatment. Folk remedies are used for rubbing, compresses, bathing, ingestion. Any topic forum contains a lot of advice on this subject.

Rub with garlic. Several cloves of garlic should be peeled and chopped. Mix the resulting oatmeal with 200 ml of vegetable oil and insist in a dark place for a week. Apply to knee overnight with film and warm cloth on top.
ground mustard. To prepare the remedy, take 50 g of camphor and mustard powder, 500 ml of vodka, the protein from one egg. All of them are mixed and stored in a jar in a dark place for a week. Then the product should be rubbed on the knee three times a day.
Elecampane Grind. Pour 50 g of elecampan root with 125 ml of vodka and let stand for two weeks. Rub twice a day.
Burdock compresses. Burdock is a popular folk remedy for the treatment of osteoarthritis. Several burdock leaves should be folded over with the woolly side and greased with vegetable oil. Tie them at the knee and cover them with cellophane and a warm cloth on top. Also, burdock leaves can be greased with vodka. The compress is applied at night. Likewise, treatment with horseradish leaves is carried out.
Cabbage leaf. It is also applied to the sore spot at night. It is pre-lubricated with honey, cologne or vodka.
Compress of honey. It is necessary to mix in equal parts honey, ammonia (10%), glycerin and medical bile, add a few drops of iodine. Store the premixed product in a dark place for 10 days. Warm up before applying the compress.
Onion decoction. It is taken internally. To prepare the broth, you need to take two large onions, cut them and pour 1 liter of water. Cook until the onions are tender. Take a decoction of 100 ml three times a day.
Celery juice. Grind the celery stalks in a blender, squeeze the juice. Drink 100 ml of juice three times a day.
Gelatin. With osteoarthritis, it is recommended to consume foods containing gelatin. It is recommended to include jelly, jelly and other dishes with gelatin in the menu.
Pine needle bath. Pour boiling water over 1 kg of pine needles and let stand for several hours. Add to a hot bath, in which you can also dissolve 0, 5 kg of salt. Take a bath for 20 to 30 minutes.

Prevention

In order to prevent the development of osteoarthritis of the knee joint, the following preventive measures should be observed:

Eat well and include a variety of foods containing vitamins and minerals in your diet.
Avoid excessive loads on the knee joint, protect it from injury.
Quit bad habits.
Keep track of weight, prevent obesity.
Timely treat all diseases, undergo preventive examinations.
Play sports, preferring gentle physical activity.
Wear high quality shoes that are as comfortable as possible.
Ensure correct posture.

Diet for osteoarthritis of the knee joints

Effectiveness: curative effect
Conditions: definitely

Diet is very important during treatment and rehabilitation. First of all, food should be healthy and light - it is important to avoid excessive weight gain, which can worsen the disease and cause acute osteoarthritis. But the acute course of the disease requires not only treatment, but also weight loss.

It is also important to include in the diet foods that contain components important for cartilage tissue:

Poultry, rabbit.
Sea fish.
Soy products.
Eggs.
Greens, zucchini, carrots, pumpkin.
Nuts.
Fruits, berries.
Vegetable oils.
Gelatin dishes.

At the same time, you should limit the consumption of these products:

Beans, sorrel, spinach, tomatoes.
Flour dishes.
Animal fat.
Spices, vinegar.
Alcohol.
Red meat

You should eat often, in small portions. You should also drink about 2 liters of fluid per day.

Consequences and complications

If the treatment is not carried out in time, osteoarthritis can lead to the development of such complications:

Inflammatory process of periarticular tissues.
Limitation of joint mobility.
Modification of the shape of the joints.
Degeneration of the hip joint.

Such complications can lead to the development of disability and irreversible changes.

Forecast

It is important to treat the disease in a timely manner. The best prognosis will be if you start treatment at 1 or 2 stages of the disease.