How is knee osteoarthritis diagnosed and treated?

5 December 2020

Osteoarthritis of the knee joint is also called gonarthrosis or deforming osteoarthritis. The disease can have serious consequences, including disability. At the first signs of gonarthrosis, you should consult a doctor for diagnosis and treatment. Therapy should be completed in full compliance with the conditions and other prescriptions.

General features of the disease

Gonarthrosis is a progressive lesion of the cartilage that covers the joint surface. As a result of such changes, the function of the joint is impaired and pain appears.

Deformative osteoarthritis is a chronic disease. In most cases, the disease progresses slowly, but certain factors can accelerate its development. This mainly applies to the individual characteristics of the body, the patient's activity and physical activity, and the accompanying pathologies.

The 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 appropriate treatment.

With gonarthrosis, the cartilage nutrition mechanisms are disrupted, so its activity is gradually disrupted. Among the arthrosis of different 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, especially those who are overweight - 2 or 3 degrees of obesity, are at risk of developing primary pathology.

There is an opinion that primary gonarthrosis is associated with middle life. Significantly increased compared to previous centuries, and the joints simply wear out over time.

Gonarthrosis associated with natural aging is considered normal. This condition is considered pathological if the joint cartilage has been destroyed before or if this process is too intense.

Causes of secondary osteoarthritis of the knee

Secondary gonarthrosis can be triggered by the following factors:

genetic predisposition, provided that it is clearly traced;
leg fracture;
protrusion of the knee joint;
meniscus damage;
congenital dysplasia of the knee joint;
excessive 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 a limb;
metabolic syndrome;
gut;
acromegaly;
osteomyelitis;
chondrocalcinosis;
pathologies related to material exchange;
articular hypermobility - the garden apparatus is essentially weak;
hemochromatosis;
diabetes;
pathology of the endocrine system.

There are many causes of deformable osteoarthritis, so this pathology is called polyetiological. It is often impossible to determine the exact cause of the disease, so the diagnosis of primary (idiopathic) gonarthrosis is made.

Symptoms of Gonarthrosis

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

Break and tap.These symptoms usually appear during movement and are often overlooked by patients. A crisis in the knee may indicate the formation of grooves, osteophytes and ulcers on the joint surfaces.
restrained actions.This symptom is very important in the diagnosis, because it allows to distinguish gonarthrosis 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 disappears within half an hour. If the stiffness lasts for an hour or more, it may indicate an inflammatory process or other pathology.
For reduced movement.This symptom indicates that the patient is unable to fully bend the knee. This is caused by the pain syndrome, which softens the intensity at which a person tries to move their legs less. Over time, this leads to a shortening of the bonds called contractures.
mixed combination.Gonarthrosis can cause blockage of the joint in a certain situation, and it is impossible to remove it due to severe pain. This usually occurs due to changes in the joint surfaces when the internal ligaments of the knee are pulled out of the pineal glands. In this case, only the reverse displacement of the garden can help. Less commonly, the cause of joint obstruction is the entry of a foreign body into the joint cavity. The source of concern may be part of the meniscus or a piece of osteophyte.

Classification of the disease

Each of the stages has specific features:

Signs and symptoms of knee osteoarthritis

The first stageis the first, which 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. It can be detected by visual examination or X-rays. In the first stage of the disease, the accumulation of fluid in the joint begins - this phenomenon is called synovitis. So far, this is the only cause of pain that manifests itself when moving. Their intensity may vary.
pathological changes are visible. They manifest themselves with an increase in knee size, deformity. On X-rays, you can see that the bone tissue at the edge of the joint has grown and the joint space has narrowed. At this stage, the pain syndrome manifests itself from the slightest load, and the knee begins to crush when walking or squatting.

Third (severe) stageThe diagnosis of deforming osteoarthritis is made when there is virtually no cartilage tissue in the joint. If it is pathologically difficult, the bones can grow together, which will lead to complete immobilization of the affected joint.

The exact stage of gonarthrosis is determined by a specialist. In this case, you should pay attention to the X-rays, not the symptoms of the disease. Pathology does not always follow the standard regularity.

Diagnostics

Only instrumental diagnosis will help to diagnose deformed osteoarthritis:

x-ray;

ultrasound scan;

tomography - computer or magnetic resonance imaging;

arthroscopy;

thermography;

scintigraphy.

Often one x-ray is enough to detect gonarthrosis. Implemented in two projections. If only one knee is affected, a description of the healthy joint is still taken to compare the results.

Which doctors should I ask for help?

In the case of osteoarthritis deformities, different specialists may be involved. In a typical clinic, they usually consult a surgeon.

Arthrologist, rheumatologist, orthopedist generally deal with gonarthrosis problems. In addition, the presence of a therapist, arthroscopist may be required. The treatment process usually involves a physiotherapist, physical therapy instructor, and a massage therapist qualified in the field.

Treatment of gonarthrosis

Treatment of osteoarthritis of the knee joint takes a very long time. In most cases, outpatient treatment is sufficient. This includes all measures. Treatment is based on drug therapy, physiotherapy and physiotherapy exercises. In some cases, surgery is required. The use of folk recipes with gonarthrosis is also allowed, but they must be combined with traditional medicine.

Drug treatment

The use of various drugs is a key part of the treatment of gonarthrosis. With such a disease, an integrated approach is required that takes into account the possibility of using the following drugs:

Nonsteroidal anti-inflammatory drugs.These drugs are produced in different forms, but for arthrosis, substances for external use in the form of tablets for oral administration, solutions for injection, creams, ointments, gels are preferred. Nonsteroidal anti-inflammatory drugs not only fight inflammation but also reduce pain.

Corticosteroids.Such drugs are usually used when the disease is severe or when non-steroidal anti-inflammatory drugs are ineffective. They usually use the drug as an injection by injecting it into the joint capsule. Corticosteroids are used as a symptomatic therapy to relieve inflammation and severe pain.

Analgesics.The severity of the pain syndrome is taken into account when prescribing such drugs. If the pain syndrome is high, they resort to strong opium.

Chondroprotectors.Thanks to these drugs, cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors is long-lasting, so they are used in long therapeutic courses. Such drugs are suitable for grade 1 or 2 pathology.

Antispasmodics and muscle relaxants.Such drugs are needed when accompanied by pathological muscle spasms.

vasodilator drugs.These drugs improve blood flow and relieve spasm of small blood vessels. In this case, the combination of vasodilating drugs and chondroprotectors is effective because the cartilage tissue is better saturated with nutrients.

warming ointmentsto improve blood circulation. Such tools are suitable in the absence of synovitis.

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

Physiotherapy

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

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

phonophoresis.This technique is ultrasound therapy combined with medication. Thanks to high-frequency vibrations, the tissues of the knee joint are heated, which allows the drug to penetrate deeper.

Shock wave therapy. The procedure uses a special device that generates radial acoustic waves. By their actions, the blood supply to the periarticular region is activated, which stimulates the regeneration of cartilage and bone structures.

Ozone therapy.This procedure involves the use of active oxygen. Has analgesic and anti-inflammatory effect on tissues.

Electromyostimulation.This technique is often used during rehabilitation, as well as when there are 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 with high power for deep heating.

Cryotherapy.This method 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, relieves pain, eliminates muscle spasms.

Hirudotherapy.This technique is considered an alternative. Leeches are placed around the affected joint. The procedure relieves pain, eliminates swelling and stimulates regeneration.

Laser therapy.This technique is generally used in the early stages of pathology. Has anti-inflammatory, analgesic and stimulating effect.

Plasma treatment.This procedure is also called joint plasmolifting. This includes intra-articular injections. For them, the patient's own blood plasma, saturated with platelets, is used. This procedure eliminates inflammation and promotes the regeneration of cartilage tissue.

Healing baths- turpentine, radon, hydrogen sulfide.

Acupuncture.Such a procedure is generally used in the early stages of pathology. This technique eliminates swelling, relieves pain and restores joint mobility.

exercise therapy

Gonarthrosis needs physiotherapy. Various exercises should 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.

Sports therapy is not used during periods of disease exacerbation. At this point, the joint needs rest and maximum comfort. Locomotor activity is allowed when inflammation and pain are relieved, at least 5 days from now.

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

Gymnastics

A gonarthrosis patient can do some exercises independently at home. You need to do this in stages - first warm up, then do strength exercises and finish by stretching.

Warming up is as follows:

Spread your legs shoulder-width apart and lower your arms across your body or lean back in a chair. Slowly get on your feet, stay at the extreme point for 3 seconds, then transfer the weight to your heels smoothly, lifting your legs as high as possible. Repeat 10 without making sudden movements.

The starting position remains the same. The bent leg at the knee should be raised to waist level, then lowered. Repeat 15 times in turn on each leg. The movements should be slow and fluid.

Lie on your back, lift your bent knees and simulate the rotation of the bicycle pedals. It takes half a minute to make rotational movements in one direction 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 changing the weight from one foot to the other. The movements should be done with your toes, without leaning on the heels. Exercise for about 5 minutes.

Surgery

Deformative osteoarthritis may require surgical treatment. Use the following options:

piercing.This intervention is minimally invasive. It is used not only to study intra-articular fluid, but also to eliminate 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 as one of its stages. This technique is endoscopic and does not require dissection of the joint space. Special delicate and flexible tools are used for the operation, and all manipulations are controlled via a micro-video camera. If arthroscopy is used as an independent operation, then the joint surfaces are cleaned of fragments of affected cartilage tissue.

Periarticular osteotomy.This type of operation is quite traumatic. It is used to redistribute the load on the knee to reduce pain syndrome and make the joint more mobile. During the operation, the bone involved in the formation of the knee joint is sawn and then fixed in a different position. Such a surgical intervention is suitable for osteoarthritis with grade 1 or 2 deformity.

Endoprosthetic.Such an operation is performed when a diagnosis of third-degree gonarthrosis is made. During the operation, the knee joint is replaced with a biocompatible structure. It is necessary to restore the previous level of movement and the patient's normal quality of life. Endoprosthesis is a very complex operation and therefore requires a long rehabilitation period.

Diet and General Recommendations

Although the pathology affects the knee joint, treatment involves following a diet. Must comply with the following principles:

If necessary, normalize body weight. BMI should not exceed 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 should eat fish at least 1-2 times a week.

You have to eat partly. Portions should be small, but 5-6 meals a day.

Finish each dish with vegetables or fruit.

To cook, you must choose to cook, including steaming, cooking, and baking.

Follow a drinking regimen. On average, a person needs 2 liters of fluid a day, and most of it should be clean water without gas.

Drink water before meals. A glass is enough half an hour before a meal.

Reduce salt intake.

Avoid alcohol, fizzy 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 mixed meat, jelly on gelatin, cheese, cottage cheese, chicken, legumes.

Traditional medicine

Non-traditional methods are also suitable for the treatment of osteoarthritis deformities. In this case, you should consult a specialist, because there are contraindications to the use of natural remedies.

Make good use of the following folk recipes:

Lubricate the back of the burdock leaf with honey, apply to the affected area, cover with cellophane film and insulate. Keep the compress for up to 4 hours.

You can use a cabbage leaf instead of burdock. You can knead with your hands or stab in several places. Honey is optional.

You can use a tincture of burdock root for internal use. Raw materials should be finely chopped, steamed with hot water and insist. Drink a tablespoon 5 times a day.

Rinse the potato seedlings, put them in a glass jar and put alcohol on them. Leave in the dark for 3 weeks, filter and rub the affected areas three times a day.

Heat the honey in a liquid water bath and rub it on the affected knee, massage. Cover and insulate the treated area with gauze or bandage. The procedure is repeated every day for a week and a half.

Steam 5 tablespoons. l. spread oats and cook for 5-8 minutes on low heat. Wrap the cooled mixture in a natural cloth, apply to the affected area and cover with polyethylene. Prepare a fresh mixture each time.

Mix iodine with honey and glycerin, leave for 3 hours. Immerse a cotton pad in the resulting composition and process the knee and adjacent area with bottom-up movements.

Chop the garlic and add a glass of vegetable oil. Insist for a week in the dark, filter and apply to affected areas before bedtime.

Grind white school chalk and mix it with yogurt or sour cream to make a thick slurry. Wrap in a natural cloth and insulate with polyethylene and apply a compress for 2, 5 hours. Repeat the procedure every day.

Boil two large peeled onions in a liter of distilled water and strain. The resulting infusion is taken three times daily before meals.

Treatment of gonarthrosis should not be limited to traditional medicine. This disease definitely requires an integrated approach that includes medication and sports.

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 deformity cannot be reversed, but can be stopped or significantly delayed.

The following factors affect the prognosis of gonarthrosis:

Age of the patient.When you are young, the prognosis is just as unfavorable. The pathological process develops gradually, so in young people with joint damage, the disease can reach its final stage in old age and lead to various complications.

Type of osteoarthritis.In the primary pathology, only the joint is affected, and the disease usually progresses slowly. With a secondary disease, there are other diseases that can speed up this process or cause complications.

Compliance with doctor's orders.It is used to provide the necessary medication, physiotherapy, exercise therapy and joint relaxation. It is also important to monitor the duration of medication, as most medications need to be taken regularly in certain courses.

Body weight.If the patient is overweight, there is increased stress on the joints, which negatively affects the course of the disease.

Profession.This factor is very important for the prognosis of the disease. Professional athletes, people who are under constant stress or who are constantly on their feet, always suffer more. When the joint is in a state for a long time, immobile work can also adversely affect the course of the disease.

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

Joint deformation.This happens in the final stages of the disease. The leg can bend at an unnatural angle, which is not only aesthetically unpleasant, but can also lead to a complete loss of joint functionality.

infection.Microtrauma, such as a crack in cartilage tissue, can cause such a complication. The pathogen can enter the joint with current or lymph from the center of infection. Surgery - arthroscopy, diagnostic piercing can also be the cause of infection. Intrusion of infections into the joint may induce aseptic necrosis.

dislocation, fracture.Such complications occur against the background of improper load distribution and dysfunction of the knee joint, which can lead to excess damage.

ankylosis.In this case, the bones in the lost joint grow together. This is one of the most serious disorders, as motor function is lost due to the fixation of the lower leg in one position.

Complications are often the fault of the patient who neglects the disease or ignores the doctor's instructions.

Prevention

Some preventive measures should be taken to prevent osteoarthritis of the knee:

maintain a normal body weight;

Avoid heavy loads and strong pressure on the knees;

to provide regular and adequate physical activity;

no damage to the joints;

Injury requires timely, competent and complete treatment;

Strengthen the periarticular muscles.

Secondary preventive measures should also be emphasized. It is necessary when gonarthrosis is already diagnosed and the rate of development needs to be reduced. In this case, you need to take the following measures:

apply to a course of chondroprotectors once every six months or a year;

Treat arthritis in a timely, quick and effective way.

Osteoarthritis of the knee joint is a serious pathology with a poor prognosis and can lead to a number of complications. Treatment should be started as soon as possible to slow down the pathological process. Therapy should be comprehensive, some methods should become part of the lifestyle: diet, exercise, taking certain medications.