knee osteoarthritis

The knee joint is constantly under stress. Running, jumping, walking, climbing stairs or just standing can affect the condition of the cartilage tissue in your knees. If the balance of cartilage is disturbed, knee joint arthrosis - knee joint disease - can begin to form.Styroarthrosis is a deforming arthropathy of the knee joint, with chronic damage to the hyaline cartilage surface and bones (femur and tibia). Symptoms of knee joint disease are pain that worsens with movement. Movement is restricted due to the accumulation of fluid in it. Later, knee movement is restricted due to disruption of leg support. Pathological diagnosis is based on the collection of the patient's history and chief complaints, visual examination of the knee joint, and the results of hardware examination. Nearly everyone develops this age-related disease of the musculoskeletal system in old age.

General information

Knee arthritis (from Latin articulatio genus - knee joint), the most common arthropathy, is a degenerative, dystrophic, progressive disease of the cartilage of the knee joint that is non-inflammatory. Women and older adults commonly suffer from knee joint disease. But joint disease can develop even in young people after an injury during strenuous exercise.Arthropathy is caused by changes in the cartilage structure within the joints rather than salt deposition. In knee arthrosis, salt deposits can occur in the tendons that attach to the ligamentous apparatus, but they are not the cause of painful symptoms. First, cracks develop in the cartilage, causing it to lose thickness in certain areas. Gradually, the load is redistributed and the joints come into contact with the bones, accelerating the painful process. As a result, the following changes occur in the knee joint:

• Knee cartilage thins until it disappears;
• changes in synovial fluid composition and quantity;
• Damage to the kneecap due to friction;
• the appearance of osteophytes;
• stiffness due to compression of the joint capsule;
• Muscle spasms.

As a result, the knee joint becomes deformed and mobility is restricted, leading to disability and loss of work ability.Knee osteoarthritis can be unilateral, affecting only one knee of the right or left leg, or if it is bilateral, both knee joints are affected.

Symptoms of knee arthritis

Symptoms of knee joint disease can be very different:

• Initially, you may experience mild discomfort when climbing stairs, and then the pain worsens and becomes painful even when resting;
• Stiffness occurs in the morning, lasts for a few minutes at first, then lasts for half an hour;
• A violent crunching sound occurs, which is already accompanied by the pain of a secondary injury;
• Restricted mobility, difficulty bending and straightening the knee due to pain, bone friction, and osteophyte growth; the joint may become blocked (ankylosis) in the final stages;
• Unsteady gait due to muscle atrophy (loss of muscle size);
• Deformation of the knee joint due to growth and changes in shape of the bones, inflammatory processes in the muscles and ligaments that increase swelling of the tissues surrounding the joint;
• Lameness occurs as the knee joint disease progresses; in the later stages, patients may even need a walker to walk.

Arthropathy gradually begins. In the first stage of knee joint disease, patients may experience mild stiffness and pain when going up and down stairs. The area below the knee may tighten. Characterized by an initial painful sensation from a sitting position at the onset of ascent. The pain subsides when the patient walks away, but returns with exertion.There are no external changes to the knee. Swelling and progression of synovitis may sometimes occur - a buildup of fluid causing the joint to become enlarged, swollen, feeling heavy and limited in movement.In the second stage, severe pain occurs with prolonged exercise and worsens with walking. Pain is usually localized on the front surface of the joint. The pain goes away after rest but returns with activity.As arthrosis progresses, the knee joint moves less; pain and a rough, sharp crunching sound occur when you try to bend the leg as far as possible. Structural changes occur and the joints enlarge. Synovitis is characterized by more fluid accumulation in the synovium. In stage three, the pain becomes constant, bothering you not only while walking but also while resting. Pain occurs even at night; in order to fall asleep, the patient takes a long time to find the position of his legs. Flexion and extension of the joint are restricted. Sometimes patients are unable to fully straighten their legs. The joints enlarge and deform. Sometimes patients will have a valgus deformity of the legs, which is X-shaped or O-shaped. The patient's gait becomes unstable and wobbly due to leg deformity and limited movement. In severe cases of knee arthritis, patients need crutches to move around.

Causes of knee arthritis

Most joint diseases are caused by a variety of causes. These factors include:

• Injuried.25% of knee arthrosis is caused by injuries: meniscus damage, ligament rupture. Knee joint disease usually occurs three to five years after the injury, and sometimes the disease may occur earlier - after two to three months.
• Physical exercise.Typically, knee joint disease occurs after the fourth decade of life due to occupational sports and excessive physical stress on the knee joint, leading to the development of degenerative dystrophic changes. Fast running and strenuous squats are especially dangerous for joints.
• excess weight.Excess weight can significantly increase the load on the knee joint, which can lead to injury. Knee arthropathy is particularly difficult if metabolic disorders and varicose veins are present.
• Sedentary lifestyle.

The progression of knee joint disease, due to gout or ankylosing spondylitis, worsens as arthritis progresses. Risks for knee arthropathy are genetic weakness of the ligaments and impaired innervation of neurological disorders.

onset

The knee joint is formed by the surfaces of the femur and tibia. On the front of the knee joint surface is the patella. It slides as it moves between the grooves in the femur. The articular surfaces of the tibia and femur are covered with very strong, smooth and elastic hyaline cartilage, which can be up to six millimeters thick. When you move, cartilage reduces friction and acts as a shock absorber.Arthropathy has 4 stages:

• The first stage.There is a disturbance in blood circulation in the blood vessels that supply hyaline cartilage. Its surface becomes dry, small cracks appear, the cartilage gradually loses its smoothness, the cartilage tissue becomes thinner, and it no longer slides softly, but clings tightly, losing its shock-absorbing properties. There are no visual symptoms of arthrosis; X-rays show slight deviations.
• second stage.The bone structure changes and joint areas flatten to accommodate greater loads. The part of the bone that lies beneath the cartilage becomes denser. Along the edges of the joints, signs of initial calcification of the ligaments appear - spike-like osteophytes on X-ray; a narrowing of the joint space can also be seen. The synovial bursa of the joint degenerates and wrinkles appear. The fluid in the joint thickens, increases in viscosity, and deteriorates lubrication properties. The degeneration process of cartilage accelerates, becoming thinner and, in some places, disappearing completely. After disappearing, the friction of the joints increases and degeneration progresses rapidly. Patients experience pain during exercise, climbing stairs, squatting, and standing for long periods of time.
• The third phase.X-rays show marked and sometimes asymmetric narrowing of the joint space. As the meniscus deforms, the bones deform and press against each other. Movement of the joint is restricted due to the presence of numerous large osteophytes. There is no cartilage tissue. At rest, persistent pain troubles the patient; walking without support is impossible.
• The fourth stage.The knee joint cannot move; X-rays show that the cartilage is completely deformed, the joint bones are destroyed, there are many osteophytes, and the bones can fuse with each other.

Classification

Taking into account the pathogenesis of the disease, it can be divided into two types: primary idiopathic and secondary knee arthropathy. Primary lesions are absent, usually occur in older patients, and are bilateral. Secondary occurs due to disease and developmental disorders or in the context of knee injuries. It can occur at any age and is usually unilateral.

diagnosis

The diagnosis of joint arthritis is made by an orthopedic or traumatologist in a medical clinic.

• The appointment begins with the collection of a medical history—the patient’s main complaints and symptoms of concern. The doctor finds out the chief complaint, the presence of chronic illnesses, past injuries, fractures and injuries, and asks other questions.
• Examination can reveal joint mobility, deformation, and pain characteristics. In the first stage of knee arthrosis, the patient has no external changes. In the second and third stages, deformation and coarsening of joint contours, restricted movement, and leg bending are detected. When the patella moves, a sharp crunching sound can be heard. After palpation, the doctor will notice pain inside the joint space. The joints may increase in size. Joint swelling is detected. When palpating the joint, there is a feeling of fluctuation.
• The patient was referred for laboratory testing. Inflammation can be detected when doing general blood tests, while biochemical tests can reveal possible causes of the problem.
• Next, the patient needs to be instrumented for diagnosis. X-rays are used for this purpose. X-rays are a diagnostic method that allow you to detect signs of knee arthropathy: joint space narrowing, osteophytes, and bone deformities. Joint X-ray examination is a technique for clearly diagnosing pathological changes and dynamics of joints. When knee joint disease attacks, no changes will be visible on X-rays. Subsequently, narrowing of the joint space and compression of the subchondral area are identified. Knee joint disease can only be diagnosed through X-rays and clinical tests.
• Today, in addition to radiography, computed tomography (CT), which allows detailed study of bone changes, and magnetic resonance imaging (MRI), which allow a visual assessment of the condition of the joints, are used to diagnose arthropathy. Joints, to identify changes in muscle tissue and ligaments.
• During an ultrasound exam (ultrasound), the condition of the tendons, muscles, and joint capsules is evaluated.
• Fluid is drained from the affected joint so that a camera can be inserted to see inside the joint (arthroscopy).

If necessary, the doctor will request research and additional consultations from more specialized experts.

Treatment of knee arthritis

Treatment of arthropathy can be divided into three groups:

• medicinal;
• physiotherapy;
• surgical.

Arthropathy is treated by traumatologists, rheumatologists, and orthopedists. Conservative treatment begins early. When joints deteriorate, doctors recommend giving them as much rest as possible. Prescribe the necessary procedures for the patient: exercise therapy, massage, mud therapy.Medication and physical therapy are used when patients are diagnosed with stage 1 and 2 disease; surgery and surgical intervention are used if the disease is extensive.

medical treatement

Taken correctly, medications can relieve pain and inflammation and slow the process of cartilage tissue destruction. Therefore, it is important to consult a doctor promptly.Important - Do not self-medicate. Choosing the wrong medication independently without consulting your doctor will only aggravate the condition and lead to serious complications.Medical treatment of joints includes taking the following medications:

• Anti-inflammatory (drug:Reduces inflammation and relieves joint pain;
• Hormones:Prescribed when anti-inflammatory drugs are ineffective;
• Antispasmodics:Help get rid of muscle spasms and relieve patients' conditions;
• Chondroprotectant:Drugs that improve joint metabolic processes and help restore joint function, as well as replace synovial fluid;
• Drugs to improve microcirculation:Improves nutrient and oxygen supply.

Tablets, intra-articular injections of steroid hormones, and topical medications are used depending on the case. The choice of medication is made by the attending physician. Sometimes patients with joint disease are admitted to a nursing home for treatment and are advised to walk with a cane or cane. To reduce the load on the knee joint, separate orthotics or special insoles are used. In addition, complex non-pharmacological methods are used to treat arthropathy:

• Physical therapy (physical therapy)Conducted under expert supervision;
• Massage courseIn the absence of inflammatory processes;
• osteopathyIn the treatment of arthrosis, not only the affected area is targeted, but also the resources of the entire organism are restored, since pathological processes that occur locally in the joint area are the result of many processes occurring throughout the body. During osteopathic treatment, the entire musculoskeletal system is treated to maximize the restoration of innervation and mobility to the spine, pelvic bones, sacrum, and eliminate compression of nerves and blood vessels throughout the body!

physiotherapy

Physical therapy methods are used to improve blood circulation in the joints, increase their mobility, and enhance the effectiveness of medications. Your doctor may prescribe the following procedures:

• Shock wave therapy:Ultrasound removes osteophytes;
• Magnetic therapy:Magnetic fields influence metabolic processes and stimulate regeneration;
• Laser Treatment:Lasers heat deep tissue;
• Electrotherapy (muscle stimulation):muscle shock;
• Electrophoresis or electrophoresis:Administration of chondroprotectants and analgesics using ultrasound and electrical current;
• Ozone therapy:Inject gas into the joint space.

Surgery

Even if the correct treatment is chosen, in some cases the treatment is ineffective. Surgical treatment and knee surgery are then performed on patients with severe pain syndromes:

• Endoprosthesis:Replacing an entire joint with a prosthesis;
• Arthrodesis:Affixed between bones to immobilize the bones to relieve pain and give the person a chance to lean on the leg;
• Osteotomy:Cut a piece of bone and place it at an angle in the joint to reduce stress.

If the endoprosthesis cannot be replaced, arthrodesis and osteotomy are performed.

prevention

Preventive measures and compliance with the recommendations of your doctor play an important role in the development of knee joint disease. In order to slow down the process of joint degeneration, it is important to follow these rules:

• Perform special physical activities: physiotherapy and gymnastics without unnecessary load on the joints;
• Avoid strenuous physical activity;
• Choose comfortable orthopedic shoes;
• Monitor your weight and daily routine - alternate special exercises with rest periods.

diet

The condition of the affected cartilage depends largely on nutrition. If arthropathy is present, it must be ruled out:

• Carbonated drinks;
• alcoholic beverages;
• greasy and overly spicy food;
• Canned food and semi-finished products;
• Products containing dyes, preservatives, and artificial flavors.

The diet should contain: protein, fatty acids such as omega-3, collagen contained in gelatin. It is necessary to eat without gaining weight.

consequences and complications

Knee osteoarthritis develops slowly, but if left untreated, serious complications can occur:

• Joint deformation and changes in the overall shape of the knee joint due to muscle reorganization and skeletal bending;
• shortening of lower limbs;
• Ankylosis – the knee joint is completely fixed;
• Damage to the musculoskeletal system.