Treatment of osteoarthritis of the knee joint.

Arthrosis of the knee jointis a degenerative-dystrophic disease of cartilage tissue, which leads to the exposure of the bone heads and impaired mobility in the joint. The disease is non-inflammatory in nature and progresses slowly: the transition from the initial stage to disability takes from several years to several decades. Knee osteoarthritis is one of the 5 leading causes of invalidity and disability worldwide.

Osteoarthritis of the knee (gonarthrosis) affects more than 20% of people over the age of 55, but the disease is rapidly getting younger; more and more often its symptoms appear at the age of 25 years.

Timely treatment of arthrosis of the knee joint will help avoid complications and the destruction of cartilage tissue.

Signs of knee osteoarthritis.

The wear of the articular cartilage is accompanied by characteristic signs, the intensity of which depends on the stage of the disease.Very often, patients complain of:

• morning stiffness and decreased mobility in the joint (a warm-up is required upon waking);
• pain and discomfort in the knees, which increase after physical exertion (walking, running or standing) and disappear with rest;
• at the 2nd stage - the so-called. initial pain that occurs after a long stay in one position;
• increased fatigue, which is often attributed to age-related changes;
• dry and rough crackling, which is regularly repeated when bending and unbending the knees;
• edema and other symptoms of inflammation that appear in the second stage of the disease due to trauma to the periarticular tissues;
• meteosensitivity, increased symptoms in the cold season.

When trying to bend the knee affected by gonarthrosis to the stop, there is a sharp pain and a feeling of physical hindrance. In the later stages, even with the treatment of arthrosis of the knee joint, patients have impaired gait (becomes waddling, patients walk with stiff legs), deformity of the lower extremities appears in the form of the letters "O" or "X". ".

The insidiousness of the disease lies in the fact that it can continue in a latent form for years, and the first significant symptoms often appear only in the second stage, when complete restoration of synovial cartilage is no longer possible.
Therefore, it is important to see a doctor at the first sign of discomfort in the knees, for example weakness, such as pulling pains that occur when there is not enough synovial fluid production. Remember: knee pain is not normal, regardless of age. Timely examination and treatment of osteoarthritis of the knee joint of the first degree can fully protect you from excruciating joint pain in old age.

What happens if knee osteoarthritis is not treated?

With self-medication, non-compliance with the doctor's recommendations or lack of treatment, osteoarthritis of the knee joint progresses on average 3-8 times faster than with complex therapy. If gonarthrosis progresses aggressively, the patient may lose the ability to move normally even before the onset of retirement age.

Especially important is the effective treatment of arthrosis of the knees in the acute stage. It can be provoked by cold and damp weather, physical or emotional stress, allergies, poisoning, moving to a region with a different climate, in a word, any shock to the body. Exacerbation of arthrosis occurs with the destruction of a large number of chondrocytes. In response, the body produces enzymes that are designed to process and remove dead cells. However, if its concentration is too high, healthy areas of cartilage also suffer: cell membranes become thinner, and foci of erosion appear in the synovial lining of the joint. This process, if not stopped by drug treatment of osteoarthritis of the knee, can continue for several weeks, and with chronic stress, lack of sleep, or poor diet, it can be permanent.

Ultimately, without treatment, knee osteoarthritis leads to a complete reduction of the joint space lumen due to the growth of osteophytes. The space necessary for normal movement is closed, and the patient cannot bend the leg even 30-45 °. The difficulty is not only climbing stairs, but also trying to get up from the sofa or normal movement. This condition is accompanied by pain, from which conventional painkillers do not help. In such cases, there is only one option for the treatment of arthrosis of the knee joint - surgical, with a complete replacement of the joint architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients do not manage to return to a completely normal life.

Treatment of knee osteoarthritis

Depending on the stage of the disease and the condition of the joint, conservative or surgical treatment of arthrosis of the knee joint is used.

Treatment of arthrosis of the knee joint of the first degree is always carried out by conservative methods: with a successful combination of circumstances and good self-discipline of the patient, it is possible to achieve a cure for the disease or a stable remission.

Treatment of osteoarthritis of the knee joint of the second degree, as a rule, is based on the use of all methods of conservative treatment, however, the doctor may opt for minor surgical interventions on the joint if the disease is develops aggressively or with complications.

Treatment for grade 3 knee osteoarthritis almost always involves surgery.

Comprehensive conservative treatment of osteoarthritis of the knee joint involves the elimination of pain and inflammation, the restoration of cartilage tissue, and an increase in the range of motion of the joint. For this, the patient is prescribed an orthopedic regimen of loads and rest, drugs with systemic and local action (hormonal and non-hormonal anti-inflammatories, analgesics, chondroprotectors and others). Innovative biological methods are also gaining popularity - injections of drugs for the treatment of arthrosis of the knee joint directly into the articular bag. In this case, injections of PRP (platelet-rich plasma) are used, as well as injections of stem cells obtained from the patient's own adipose tissue. In parallel, auxiliary and rehabilitative methods are connected: physiotherapy, massage, manual therapy, therapeutic exercises.

Surgical treatment of osteoarthritis of the knee joint is carried out in cases where drugs are powerless.With this pathology, the doctor may prescribe the following interventions:

• knee arthroscopy. The collective name for a group of minimally invasive operations aimed at removing a fragment of joint tissue or osteophyte, or partial excision of the joint membrane. It allows you to delay or exclude prosthetics, as well as eliminate discomfort in the early stages of the disease. It is mainly used for the treatment of knee osteoarthritis in patients under 60 years of age.
• osteotomyAn operation to cut part of the bone and correct the load axis on the affected knee, which allows degenerative changes to be stopped. It is usually performed in the treatment of 2nd degree osteoarthritis of the knee joint.
• endoprosthesisPartial or total replacement of the knee joint with a titanium implant, which lasts 15 to 20 years. This technique is a last resort because it carries certain risks. Recommended for patients over 55 years of age.

All these operations require a recovery period and have a number of contraindications, so the best option is prevention (exercise therapy, chondroprotectors) and treatment of knee osteoarthritis in early stages.

In addition to the main methods of treatment, diet therapy and other methods are used to reduce body weight. To unload the diseased joint, bandages and other orthoses (canes, orthopedic insoles, etc. ) are used.

Treatment of knee osteoarthritis is prescribed by a rheumatologist or orthopedist. At the first appointment, he palpates the joint, performs motor tests, and then directs the patient for a CT scan or X-ray.

Therapeutic exercises for knee osteoarthritis.

Therapeutic exercise for the limbs of the lower waist is considered the most effective method of reducing pain and treating arthrosis of the knee joint of the first degree. The first results of therapeutic exercises come after 2-4 weeks of continuous training. Continuity in the treatment of osteoarthritis of the knee joint is one of the main factors affecting the effectiveness of exercise therapy. A full lesson is held 1 time a day every day, it is also recommended to do at least 3-4 trainings during the day.

Therapeutic exercises for osteoarthritis of the knee during periods of remission will help relieve pain.

The main task of physical exercises in the treatment of osteoarthritis of the knee joint is to strengthen the muscles of the thigh and lower leg, maintain the elasticity of the ligaments and tendons, as well as combat muscle atrophy, which It is characteristic of osteoarthritis. This allows you to transfer the load from the joint to the periarticular structures and thus slow down the mechanical abrasion of the cartilage and reduce inflammation.

Exercises for the treatment of osteoarthritis of the knee are performed for both legs! If there is a sharp pain, the session should be stopped or continued at a more gentle pace.

1. Starting position: lying on your back. One leg is extended on the ground, the other is raised bent at 90° (lower leg parallel to the ground). We make movements with the lower part of the leg up and down, as far as the range of motion of the joint allows.
2. Starting position: lying on your back. Let's do the bike exercise.
3. Starting position: lying face down. We swing our legs in turns, trying to bring the heels as close as possible to the buttocks.
4. Starting position: lying on the side, the arm is bent under the head or extended above the head in line with the body. The other hand rests at the side. We swing up with a straight leg. We change sides.
5. Starting position: lying on your back. We pull the legs along the floor forward with the heel (away from you), the socks look "themselves".
6. Starting position: lying face down. We do the "boat" exercise. If the physical condition does not allow it, we place the palms of the hands on both sides of the chest and, in turn, bring the legs back, experiencing tension in the back of the thigh and lower leg.
7. Starting position: lying on your back. We alternately rotate the feet, trying to describe the full circle with the socks.
8. Starting position: standing against the wall. We crouch down slowly and gently, without lifting our backs from the wall, to spread the load. When the legs are bent at the knees 90 °, we begin a smooth upward movement.
9. Starting position: standing. Alternately, we swing our legs forward, backward and to the sides.

Please note: Therapeutic exercises after surgery on the joint have their own specifics and vary depending on how many days have passed since the surgery. It is prescribed by a doctor, surgeon, or rehabilitation specialist.

Knee osteoarthritis massage

Therapeutic massage for knee osteoarthritis is performed on both legs. At first, at least 10-12 sessions with a masseuse-rehabilitator or with the help of hydromassage equipment are usually required, however, a simple restorative massage can be performed at home. It includes the following types of movements:

• Superficial stroking and rubbing (up and down, clockwise and counterclockwise);
• palpate and stretch with the fingertips the deeper tissues;
• pinching and tapping on the skin.

Massage for osteoarthritis of the knee should be performed by a specialist who does not damage the diseased joint.

Self-massage can be combined with the treatment of arthrosis of the knee joint with drugs: it will not be superfluous to apply a warming ointment or balm before or during the session. You can also take a warm bath before the procedure.

Important: massage is contraindicated in patients with symptoms of inflammation (osteoarthritis or exacerbation of osteoarthritis). In this case, acute phase therapy is required.

diet therapy for arthritis

The standard nutritional protocol for the treatment of osteoarthritis of the knee requires:

• limit foods and dishes rich in simple carbohydrates (white bread, confectionery, snacks, sweets, potatoes, sugar);
• exclude processed (ready-to-eat) and high-salt dishes: fast food, semi-finished products, sausages;
• avoid alcohol, decaf coffee, and fatty meats.

Instead, include on the menu:

• whole grain and sprouted cereal dishes;
• fatty fish from the North Seas and dietary poultry;
• cartilage (ears, nyushki, legs and other parts of farm animals rich in collagen), gelatin and gelatin;
• fruits and vegetables rich in vitamins and antioxidants (especially vitamins A, B12, C, E);
• nuts and other sources of omega fatty acids and valuable minerals.

The diet for knee osteoarthritis provides a balanced diet that helps restore cartilage.

It is also recommended to treat osteoarthritis of the knee joint with drugs - vitamin-mineral complexes (2 courses a year).

Physiotherapy for the treatment of knee osteoarthritis

The following physical therapy procedures are used to effectively treat osteoarthritis of the knees and enhance the effect of medications:

• magnet therapy;
• laser therapy;
• ultrahigh frequency;
• ultrasound therapy;
• amplipulse;
• electrophoresis (including medicinal - with analgin, novocaine or chymotrypsin);
• ozokerite and paraffin applications;
• thermotherapy (cryotherapy, inductothermy);
• phonophoresis (in particular, with hydrocortisone);
• balneological therapy (sulfur, hydrogen sulfide baths).

Acupuncture in the treatment of arthrosis of the knee joint of the second degree, as a rule, is not used.

Before visiting the procedures, it is necessary to consult with your doctor; many types of physiotherapy are contraindicated in case of exacerbation of the disease.

Drugs for the treatment of arthrosis of the knee joint.

Treatment of osteoarthritis of the knee joint with drugs is carried out symptomatically and taking into account the individual response of the patient to the selected drugs. Drug therapy (injections, ointments or tablets for the treatment of arthrosis of the knee) is usually prescribed in courses or as needed.

To choose the right drugs for the treatment of arthrosis of the knee joint, consult a doctor who, after research, will select the necessary drugs.

There are several directions in the treatment of arthrosis of the knee joint with drugs: to make the patient's life easier, to improve cartilage nutrition, to regenerate cartilage tissue, and to maintain the normal musculoskeletal system.

Non-steroidal anti-inflammatory drugs

To relieve exacerbations, NSAIDs in tablets or capsules are taken in courses (about 12 days) or as needed, depending on the intensity of the pain syndrome. Uncontrolled intake of NSAIDs in violation of the doctor's instructions or recommendations is fraught with stomach or intestinal ulcers. They should be taken with extreme caution in combination with glucocorticosteroids and drugs that affect blood coagulation. Other risk factors are age over 65 years, smoking and alcohol consumption during the course. In these cases, doctors generally recommend injecting medication without going through the gastrointestinal tract. Along with NSAIDs, it is desirable to take gastroprotectors.

The maximum effect can be achieved with a combination of systemic (for internal use) and external NSAIDs, in the form of ointments, creams or gels. The second option provides a point effect on the affected joint and at the same time minimally affects digestion.

Corticosteroids (steroidal medicines used to treat osteoarthritis of the knee)

Hormonal drugs (HA) are usually used for so-called. Steroid blockade of the knee in cases where NSAIDs are not enough to relieve pain and inflammation.

Glucocorticoid injections are considered the last resort in the treatment of knee osteoarthritis with drugs. They provide relief as soon as 20 minutes after administration, but can lead to hormonal imbalances and cartilage damage if taken incorrectly. Due to side effects, many orthopedists prefer knee surgery to long-term HA therapy.

Chondroprotectors in the treatment of osteoarthritis of the knee joint

Chondroprotective agents based on extracts of veins and cartilage from bovines, marine fish and shellfish contribute to the restoration of synovial cartilage, and are therefore essential for the effective treatment of osteoarthritis of the knee. Chondroprotectors contain a large amount of glycosaminoglycans - natural polymers from which cartilage tissue is built. Thus, they make the chondrocytes (cartilage cells) more stable, promote their growth and enrich the synovial fluid.

Unlike anti-inflammatory drugs, chondroprotectors have practically no contraindications. They provide a cumulative and prolonged effect: the first improvements occur after 1-3 months of admission, and the duration of the course is 3-6 months.

skin irritants

External preparations for the treatment of arthrosis of the knee with a local irritating effect improve blood circulation and nutrition of the joint, and also distract the patient from pain. For this purpose, ointments, gels, creams and balms are used based on natural ingredients: bee venom, hot pepper extract.

In the presence of an allergic reaction (persistent redness and pain of the skin, rash), during pregnancy and lactation, as well as in the presence of other contraindications, it is better to avoid hot ointments for the treatment of arthrosis of the hip joint. knee. and limit yourself to lukewarm baths, applications, and external anti-inflammatories.

synovial fluid prosthesis

If there is too little synovial fluid in the joint, the gliding of the joint surfaces is impaired. And most importantly, cartilage starvation begins, because the joint fluid that nourishes it like a sponge normally provides nutrients for the growth and maintenance of cartilage tissue. To prevent cell destruction and mechanical abrasion of the knee cartilage, the doctor may prescribe injections of high molecular weight hyaluron derivatives. Injections of the drug in the treatment of arthrosis of the knee joint (viscosupplementation) are made directly into the joint capsule, which brings rapid relief, lasting 3-12 months after the completion of the course. However, with the introduction of prostheses, the risk of necrotic changes or infection in the joint remains.

Antispasmodics, analgesics, muscle relaxants

In cases where spasms and muscle tension prevent the patient from falling asleep, create pain during movement, the doctor prescribes antispasmodics and muscle relaxants.

Simple analgesics are not used in the treatment of osteoarthritis of the knee joint, since they mask the pain, but do not relieve the inflammation. You can use them or NSAIDs available without a prescription for up to 10 days, after which an exam is required.

Release form of drugs for the treatment of arthrosis of the knee joint.

For the convenience of patients, drugs for the treatment of arthrosis of the knee joint are produced in various forms. Is there any difference between them and which one should I choose?

Preparations for the treatment of knee arthrosis have various forms of release: sachets, injections, ointments, tablets. Choose what suits you best.

Capsules, sachets and tablets for the treatment of knee osteoarthritis

Nonsteroidal anti-inflammatory drugs, corticosteroids, chondroprotectors, and muscle relaxants are available in oral forms. In this case, they are easy to dose, reception is possible without the involvement of a medical worker, it is easy to control what part of the course has already been completed. When taken orally, chondroprotectors and NSAIDs have a fairly high bioavailability (especially in sachet form).

injection solutions

In the form of injections, you can take the already mentioned NSAIDs, HA, chondroprotectors and muscle relaxants, as well as synovial fluid prostheses. This method of treating osteoarthritis of the knee joint with drugs demonstrates the maximum bioavailability.

This method of treating osteoarthritis of the knee with drugs is safe for digestion, but it is desirable that injections (intravenous, intramuscular in the joint area or intra-articular) be administered by qualified medical personnel. Intramuscular injections in the buttock or thigh can be performed independently.

Products for external use

Locally irritating, anti-inflammatory and chondroprotective ointments are applied externally for the treatment of arthrosis of the knee joint. The advantage of this drug administration is the direct effect on the affected tissue. But the skin barrier gets in the way of the active substances; Unfortunately, often only 5% of the active substances reach the desired tissue layers.