The deforming osteoarthrosis of the knee joints (also known as gonarrosis or abbreviated doa) is a degenerative-disco disease of the knee joint, which is characterized by a constantly progressive chronic course, damage to all structural elements (Hyalin cartilage, periaestal bone structures, a sinóvicos shell, a capsulethe articulation) and a lead), the carignation of the HYG.and often disability.
The disease begins with changes in joint cartilage, due to which the joint surfaces of the bones are produced.The interruption and loss of elasticity leads to its dystrophy (thinning) and resorption, while the bone tissue of the articular surfaces is exposed, the slip is altered, the joint space is reduced, the joint biomechanical changes change.The synovial cover that covers the joint and production of the synovial fluid is irritated (which nourishes the cartilage and plays the role of physiological lubrication), which leads to an increase in its amount in the joint (synovitis).At the bottom of the narrowing of the joint gap, the volume of the joint decreases, the synovial fluid takes out the posterior wall of the joint capsule, the Becker cyst is formed (which, which reaches large sizes, can cause pain in the popliteal pit).The thin and delicate fabric of the joint capsule is replaced by a rough connective tissue, the shape of the joint changes.Periosurpital bone tissue is growing, osteophytes are formed (pathological bone growth).Blood circulation in periarticular tissues is disturbed, and underestimated metabolic products, irritating chemoreceptors, develops persistent pain syndrome.In the context of a change in the anatomy of the joint, there is a violation of the work of the surrounding muscles, hypotrophy and spasm appear, a march is altered.There is a persistent restriction of the volume of movements in the joint (contracture), sometimes so pronounced that only possible balancing movements (stiffness) or a complete absence of movements (ankylosis) are possible.
Gonarrosis is a fairly common disease: they suffer from 10% of the total population of the planet, and at the age of more than 60 years it affects each third person.
The causes of gonarrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, clamidia arthritis, drop).
- Violation of mineral metabolism with various endocrinopathies (diabetes mellitus, parathyroid disease, hemochromatosis).
- Muscle apparatus and neuropathy diseases (Charcot disease).
In addition to the main reasons, adverse background factors of gonarcrosis development are also distinguished, including:
- overweight (literally exerts pressure on the lower extremities);
- age (the disease is mainly subject to the elderly);
- female gender (according to a woman's statistics, get sick more frequently);
- Increase in sports and professional physical effort.
Osteoarthrosis symptoms of knee joints
- The pain that increases by walking and weakening alone.
- Difficulty of family and physiological movements in the joints.
- A "crunch" feature in the joints.
- The increase in joints in quantity and their visible deformation.
Gonartrosis stages
Clinical stages of osteoarthritis of the knee joint
The disease goes through several stages.
- In the first stage, a person only feelsA small feeling of discomfortor "severity" in the knee that bothers during the long walk of distance or the increase in physical effort.The radiological exam will be little informative: it is possible to identify only a small narrowing of the articular gap, there will be no other changes.
- The second stage is characteristicTangible pains, whose severity is reduced at rest.There is a difficulty in joints in the joints, when walking, a characteristic "crunch" is heard (from the patient can hear a conventional phrase in everyday life: "crispy knees").When performing the radiography, there is a clearly distinguishable narrowing of the articular gap and individual osteophytes.
- When the transition from gonarrosis to the next, third stage,Pain will constantly disturb the patientEven at rest, there is a violation of the configuration of the joints, that is, the deformation that intensifies due to edema at the time of inflammation connection.Radiographs determine the narrowing of the articular gap of a moderate degree and multiple osteophytes.In the third stage, many are already requesting medical assistance, because the quality of life suffers significantly due to pain and difficulty on normal walk.
- The fourth stage is accompaniedRodeo and exhausting pain.The minimal attempts to move become a difficult test for humans, the deformation of the joints is visually notable, walking is extremely difficult.X -Ray reveals significant changes: the articular gap in the images is practically not determined, multiple rude osteophytes, "joint mice" are detected (fragments of the destructive bone that fall into the joint cavity).This stage of gonarrosis almost always implies disability.
Who treats the osteoarthritis of the knee joint?
The therapist, rheumatologist and general practitioner (family doctor) can provide qualified medical care for gonarrosis (family doctor), but these experts are treating the knee joint with osteoarthritis without complications.When a synovitis occurs or the treatment prescribed by the therapist does not give the right effect, it cannot do without the help of an orthopedist.In situations where surgical care is required, the patient is sent to a specialized orthopedic traumatology department.
How and what to treat the osteoarthritis of the knee joint?
The methods to treat the osteoarthritis of the knee joint, currently known, are divided into conservatives, medications and surgical
Non -fragmentary methods
Many patients wonder: "How to cure the osteoarthritis of the knee joint without pills?"Responding to him, with regret it is necessary to affirm that gonarrosis is a chronic disease, it is impossible to eliminate it forever.However, many existing methods today can significantly stop their progression and improve patient quality, especially when used in the early stages of the disease.
With the timely search of a doctor and sufficient motivation of the patient for healing, it is sometimes sufficient to eliminate negative factors.For example, it is demonstrated thatOverweight reductionReduces the manifestation of the main symptoms of the disease.
Exclusion of pathological physical effort and, on the contrary,Therapeutic gymnastics classesWith the use of rational physical programs, they reduce pain intensity.It is demonstrated that the exercises to strengthen the strength of the four -headed hip muscle are comparable in effect with anti -inflammatory drugs.
If we treat the osteoarthritis of the knee joint, then we must fight foradequate nutrition: to improve the elastic properties of articulage will help products containing Large amount of animal collagen (dietary varieties of meat and fish) and chondroitin (shrimp, crabs, kril), saturated with vegetable collagen and antioxidants, fresh vegetables and fruits, and passion for smokes,Conservatives, Sweet and Perechen Dishes, Sweet and Paved Dishes, Sweet and Paved Dishes ON On the contrary, a violation of metabolic processes in the body and the accumulation of excess weight until obesity is enhanced.
The complex treatment of the osteoarthritis of the knee joint also implies the appointment of very effective ways even with advanced forms of the diseasePhysiot -Proeding.With generalized use in different categories of patients suffering from this disease, it has demonstrated its effectivenessMagnetotherapy: After several procedures, pain intensity decreases, as a result of improving blood circulation, reducing edema and eliminating muscle spasm increases joint mobility.The effect of magnetotherapy is especially vivid during the development of active inflammation in the articulation: the severity of edema is significantly reduced, the phenomena of the regression of synovitis.Not so popular, but no less effective in the treatment of knee joint with osteoarthritis are physiotherapy methods thatLaser therapy and cryotherapy(Exposure to the cold), which has a pronounced analgesic effect.
Drug treatment
In the effective treatment schemes of the osteoarthritis of the knee joint, the medications are used below.
Non -steroid anti -inflammatory drugsProduced in the forms for external use (several gels, ointments) and systemic (tablets, candles, solutions), they have long demonstrated their effectiveness in the treatment of osteoarthrosis and doctors recipe it widely.Blocking inflammation at the enzymatic level, they eliminate pain in the joints and their swelling, slow down the progression of the disease.It should be remembered that a prolonged systemic technique can cause the development and exacerbation of ulcer processes in the gastrointestinal tract, and also negatively affect the functions of the kidneys and liver.Therefore, patients, who take the medication for a long time, should also prescribe medications that protect the gastric mucosa and regularly control the work indicators of the work of the internal organs.
Glucocorticosteroids (GKS)- Hormonal drugs with a pronounced anti -inflammatory effect.Being a powerful anti -inflammatory agent, GCs have certain contraindications, because they can call a series of significant side effects.In the forms of the system for gonarrosis, they are practically not prescribed.As a general rule, the effective treatment of osteoarthritis implies GC injections in periods of perihuman pain, which increases the intensity of the fight against inflammation and minimizes the risk of undesirable side effects of the medication.With a single introduction of the GCS, the effect of its use lasts up to 1 month.According to national recommendations for the treatment of osteoarthritis, it should not perform more than three injections of the drug per year in the same articulation.
With "careless" osteoarthritis ", when a person experiences unbearable pains that do not even decrease at rest, violating normal sleep, the recipe is possibleOpioid analgesics.These medications are used only according to the doctor's recipe, which considers the viability of your appointment in each case.
Condroprotectors(With a literal translation - "cartilage protection").This name is understood as several medications united by a property, a modifying structural effect, that is, the ability to slow down the degenerative changes in the cartilage and narrowing of the articular gap.They occur in both forms for oral administration (glucosamine, chondroitin sulfate, piataline) and for the introduction to joint cavity (hyaluronates).Of course, these medications do not perform a miracle and do not "grow" a new cartilage, but they can suspend their destruction.To achieve a persistent effect, regular courses should be used for a long time several times a year.
Surgical treatment of joint osteoarthritis
The most popular type of surgical attention for gonarrosis isEndoprotetics, that is, eliminate its own articulation with a simultaneous installation of a metalloprothesis that replaces it, whose design is similar to the anatomy of the knee joint of a person.At the same time, a previous requirement for this type of surgical treatment is: the absence of gross deformations of the letter, formed "false joints", muscle contractures and pronounced muscular atrophy.With severe osteoporosis (a significant decrease in the mineral density of the bones), the endoprotetics do not show: the bone of the "sugar" will not resist the introduction of the metal pins, and in the place of the installation, the rapid renewal (resorption) of the bone tissue, the pathological fractures, can occur.Therefore, a timely solution to the issue of the need to install an endoprosthesis is so significant: it must be accepted when the age and the general condition of the human body still allow it to perform surgery.
Despite the generalized prevalence of endoprotetics of the knee joint, the results of such operations are often unsatisfactory, and the percentage of complications is high.This is due to the design characteristics of the endoprosthesis and the complexity of the surgical intervention itself (replacing the hip joint is much easier in technical terms).
Arthromedular derivation- Connection of the bone marrow channel of the femur with the cavity of the knee joint using a derivation: a hollow metal tube.Due to this, the fat marrow of the lower third of the femur enters the knee joint, nourishing the cartilage and lubricating, which achieves a significant decrease in pain.
In short, I would like to keep in mind that the treatment of gonarrosis is a complex social task.And although today medicine cannot offer a medication that eliminates it forever, or other ways to completely cure this ailment, a healthy lifestyle, timely medical help and the implementation of the doctor's recommendations can suspend their progression.