How is knee osteoarthritis diagnosed and treated?

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

General characteristics of the disease

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

Osteoarthritis deformity is chronic. In most cases, the disease progresses slowly, but certain factors can accelerate its progression. This mainly refers to the individual characteristics of the organism, the activity and physical activity of the patient, the accompanying pathology.

Two terms are often confused - arthritis and osteoarthritis. These pathologies are similar in certain features, but differ in the nature of the flow. Only an expert can make an accurate diagnosis and prescribe the appropriate treatment.

In gonarthrosis, the mechanisms of cartilage nutrition are disturbed, so its functioning is gradually impaired. Among arthrosis of various 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. Older women have a risk of developing primary pathology, especially in the case of overweight - obesity of 2 or 3 degrees.

There is an opinion that primary gonarthrosis is associated with an average life expectancy. Compared to past centuries, it has increased significantly and the joints simply wear out over time.

Gonarthrosis associated with natural aging is considered normal. If the articular cartilage has been destroyed earlier or this process is too intense, then this condition is considered pathological.

Causes of secondary osteoarthritis of the knee joint

Secondary gonarthrosis can be triggered by the following factors:

• genetic predisposition, provided it can be clearly traced;
• leg fracture;
• dislocation of the knee joint;
• meniscus injury;
• congenital dysplasia of the knee joint;
• extreme physical activity (typical of 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 one limb;
• metabolic syndrome;
• gout;
• acromegaly;
osteomyelitis; chondrocalcinosis;
• pathologies associated with material exchange;
• joint hypermobility - the ligament apparatus itself is weak;
hemochromatosis;
• diabetes mellitus;
• pathology of the endocrine system.

There are many possible causes of deforming osteoarthritis, so this pathology is called polyetiological. It is often not possible to determine the exact cause of the disease, so a diagnosis of primary (idiopathic) gonarthrosis is made.

Symptoms of gonarthrosis

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

• Press and click.These symptoms usually occur during movement and are often ignored by patients. Cracking in the knee may mean that grooves, osteophytes, and ulcerations have appeared on the joint surfaces.
• Restrained movements.This symptom is very important during diagnosis, because it allows to distinguish gonarthrosis from a number of other pathologies that affect the musculoskeletal system. 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 longer, it may indicate an inflammatory process or other pathology.
• Reduced range of motion.This symptom implies that the patient is unable to bend the knee completely. This is due to the pain syndrome, softening the intensity that the person tries to move less with the foot. Over time, this leads to shortening of the ligaments, which are called contractures.
• Stuck joint.Gonarthrosis can lead to blockage of the joint in a certain position and it is impossible to move it due to severe pain. This usually occurs due to a change in the articular surfaces, when the internal ligaments of the knee, protruding from the pineal gland, are retracted. In this case, only the reverse movement of the ligament can help. Less commonly, the cause of joint obstruction is the entry of a foreign body into the joint space. The source of the problem may be a part of the meniscus or a fragment of an osteophyte.

Classification of Diseases

Each of the phases has specific characteristics:

1. The first phaseis ​​initial, it is also called easy. The first signs of pathology are considered to be its onset, and the transition to the next stage is characterized by the appearance of bone deformities. They can be detected by visual inspection or X-ray. In the first phase of the disease, the accumulation of fluid in the joint has already begun - this phenomenon is called synovitis. He is the one who causes pain, which so far manifests itself only when moving. Their intensity can vary.
2. In the second (moderate) stageof gonarthrosis, pathological changes are visible even visually. They are manifested by an increase in the knee, its deformation. You can see on the X-rays that the bone tissue at the edges of the joint has grown, and the joint space has narrowed. It is at this stage that the pain syndrome manifests itself from the slightest load, and when walking or squatting the knee begins to crunch.
3. The third (severe) stagedeforming osteoarthritis is diagnosed when there is practically no cartilage tissue in the joint. If the pathology is severe, then the bones can grow together, which will cause complete immobility of the affected limb.

The exact stage of gonarthrosis is determined by a specialist. In that case, you don’t have to focus on the symptoms of the disease, but on the X-rays received. Pathology does not always follow a standard pattern.

Diagnostics

Only instrumental diagnostics will help determine deforming osteoarthritis:

• X-ray;
• ultrasound scan;
• tomography - computed tomography or magnetic resonance imaging;
• arthroscopy;
• thermography;
• scintigraphy.

Often one X-ray is enough to detect gonarthrosis. It is performed in two projections. If only one knee is affected, an image of a healthy limb is still taken to compare the results.

Which doctors should I seek help from?

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

An arthrologist, rheumatologist or orthopedist usually deals with gonarthrosis problems. In addition, the participation of chiropractors, arthroscopists may be required. The treatment usually involves a physiotherapist, a physical therapy instructor, and a massage therapist who is qualified in the field.

Treatment of gonarthrosis

The treatment of osteoarthritis of the knee joint takes quite a long time. In most cases, outpatient treatment is sufficient. It involves a whole range of measures. Treatment is based on drug therapy, physiotherapy and physiotherapy exercises. In some cases, surgery is needed. In gonarthrosis it is also allowed to use folk recipes, but they must be combined with traditional medicine.

Drug Therapy

The use of various drugs is a major component of gonarthrosis treatment. Such a disease requires an integrated approach that includes the possibility of using the following drugs:

• Preparations of non-steroidal anti-inflammatory group.These drugs are produced in various forms, but for osteoarthritis are preferred tablets for oral administration, solutions for injection, means for external use in the form of creams, ointments and gels. Nonsteroidal anti-inflammatory drugs not only fight inflammation but also reduce pain.
• Corticosteroids.Such drugs are usually resorted to when the disease is severe or non-steroidal anti-inflammatory drugs are ineffective. They are usually used as injections, by injecting the medicine into a 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 of high intensity, then they resort to strong opiates.
• Chondroprotectors.Thanks to these drugs, cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors is manifested for a long time, so they are used for long therapeutic courses. Such drugs are suitable for grade 1 or 2 pathology.
• Spasmolytics and muscle relaxants.Such drugs are necessary when the pathology is accompanied by muscle cramps.
• Vasodilator drugs.Such drugs improve blood flow, relieve spasm of small blood vessels. The combination of vasodilating drugs and chondroprotectors is effective, because the cartilage tissue in this case is better saturated with nutrients.
• Warming fatsto improve blood circulation. Such agents are suitable in the absence of synovitis.

Medicines are prescribed by a doctor. Only he can determine which drugs are needed in each case, according to which scheme they should be taken and what should be the duration of the therapeutic course for each prescribed drug.

Physiotherapy

Various physiotherapeutic methods are actively used in the deformation of osteoarthritis. They are used for various purposes: to reduce pain, relieve inflammation, activate the blood supply and speed up recovery.

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

• Phonophoresis.This technique is ultrasound therapy combined with the effects of drugs. Due to the high frequency vibrations, the tissues of the knee joint heat up, which ensures a deeper penetration of medicinal substances into them.
• Shock wave therapy.The procedure uses a special device that generates radial acoustic waves. Under their action, the blood supply in the periarticular area is activated, which stimulates the regeneration of cartilage and bone structures.
• Ozone therapy.This procedure involves the use of active oxygen. Provides analgesic and anti-inflammatory effects on tissues.
• Electromyostimulation.This technique is often used during rehabilitation, as well as in the presence of contraindications for 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 high frequency currents for deep heating.
• Cryotherapy.This technique is also called cold treatment. The affected area of ​​skin is exposed to low temperature for a short time. This method restores metabolic processes, increases blood circulation, reduces the severity of inflammation, removes pain, and relieves muscle spasms.
• Hirudotherapy.This technique is considered an alternative. Leeches are placed around the affected joint. The procedure relieves pain well, relieves swelling and promotes regeneration.
• Laser therapy.This technique is usually used in the early stages of pathology. Provides anti-inflammatory, analgesic and stimulant effects.
• Plasma therapy. This procedure is also called joint plasmolifting. Includes intra-articular injections. They use the patient's own blood plasma, which is saturated with platelets. This procedure relieves inflammation, promotes the regeneration of cartilage tissue.
• Medicinal baths- turpentine, radon, hydrogen sulfide.
• Acupuncture.Such a procedure is usually resorted to in the initial stages of pathology. This technique relieves swelling, removes pain and allows you to restore joint mobility.

exercise therapy

Physiotherapy is necessary for gonarthrosis. The various exercises must 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 muscle strength and endurance.

Exercise therapy is not used during periods of disease exacerbation. At this point, the joint needs rest and maximum relief. Locomotor activity is allowed when the inflammation and pain subside, at least 5 days should pass from this moment.

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

Gymnastics

At home, a patient with gonarthrosis can do some exercises on their own. You need to do this in stages - you need to warm up first, then do strength exercises and finish stretching.

Warming up is done as follows:

• Put your feet shoulder-width apart and lower your arms along your body or lean on the back of a chair. Slowly lift yourself on your toes, holding on to the extreme point for 3 seconds, then smoothly transfer the weight to your heels, lifting your toes as high as possible. Do 10 reps without sudden movements.
• The starting position remains the same. The leg bent at the knee should be raised to waist level, and then lowered. Do 15 reps alternately on each leg. The movements should be slow and fluid.
• Lie on your back, lift your knees bent at the knees and simulate the rotation of a bicycle pedal. It takes half a minute for rotational movements in one direction and then in the other. Move slowly.
• Put your feet shoulder-width apart, straighten your back and bend your elbows. Simulate running in place, alternating weight transfer from one leg to the other. The movements should be performed on the toes, not leaning on the heels. Perform the exercise for about 5 minutes.

Surgery

Deforming osteoarthritis may require surgical treatment. They resort to the following options:

• Breakthrough.This intervention is minimally invasive. It is used not only to study the intra-articular fluid, but also to remove its 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 be one of its phases. This technique is endoscopic and does not require dissection of the joint cavity. Special thin and flexible instruments are used for the operation, and all manipulations are controlled by a micro-video camera. If arthroscopy is used as an independent operation, then during it the joint surfaces are cleaned of fragments of the affected cartilage tissue.
• Periarticular osteotomy.This type of surgery is quite traumatic. It is used to redistribute the load on the knee, so that the pain syndrome is reduced and the joint becomes more mobile. During surgery, the bone involved in creating the knee joint is sawn and then fixed in another position. Such surgery is suitable for osteoarthritis that deforms grade 1 or 2.
• Endoprosthetics.Such surgery is resorted to when the third degree of gonarthrosis is diagnosed. During surgery, the knee joint is replaced with a biocompatible construction. It is necessary to restore the previous range of motion and the patient's normal quality of life. Endoprosthetics is a rather complicated operation and therefore requires a long period of rehabilitation.

Diet and general recommendations

Despite the fact that the pathology affects the knee joint, its treatment involves respecting the child. It must comply with the following principles:

• If necessary, normalize your body weight. BMI should not be higher than 20. Weight loss should be gradual - 2-3 kg per month.
• Reduce carbs and animal fats.
• Most of the fat you eat should be of plant origin.
• You must eat fish at least 1-2 times a week.
• You should eat a portion. The portion should be small, but should have 5-6 meals a day.
• Finish each meal with vegetables or fruit.
• For cooking you should choose cooking, including steaming, stewing, baking.
• Follow a drinking regimen. On average, a person needs 2 liters of fluid a day, and this should generally be clean water without gas.
• Drink water before meals. One glass half an hour before a meal is enough.
• Reduce your salt intake.
• Avoid alcohol, carbonated 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 jelly meat, gelatin jelly, cheese, cottage cheese, chicken, legumes.

Traditional medicine

In the treatment of osteoarthritis deformities, unconventional methods are also appropriate. In that case, you should consult an expert, because even the use of natural remedies has contraindications.

Use the following folk recipes effectively:

• Lubricate the back of the burdock leaf with honey, apply to the affected area, fix with cellophane foil and insulate. Hold the compress for up to 4 hours.
• You can use a cabbage leaf instead of burdock. You can knead it with your hands or prick it in several places. Honey is not required.
• You can use burdock root tincture for internal use. The raw materials must be finely chopped, steamed with boiling water and insisted. Drink a spoonful 5 times a day.
• Rinse the potato sprouts, place in a glass jar and pour over the alcohol. Stand in the dark for 3 weeks, strain and rub the affected areas three times a day.
• Heat the honey in a water bath to a liquid state and rub into the affected knee by massaging it. Cover the treated area with gauze or bandage and insulate. The procedure is repeated every day for one and a half weeks.
• Steam 5 tbsp. l. rolled oats and cook for 5-8 minutes on low heat. Wrap the cooled mixture in a natural cloth, apply to the affected area and fix with polyethylene. Each time you need to prepare a fresh mixture.
• Mix equal amounts of iodine with honey and glycerin, leave for 3 hours. Dip a cotton pad into the resulting composition and treat the knee and adjacent area with bottom-up movements.
• Chop a clove of garlic and add a glass of vegetable oil. Insist for a week in the dark, strain and apply to the affected areas before bed.
• Grind white school chalk and mix with yogurt or sour cream to make a thick paste. Wrap it in natural fabric and make a wrap for 2. 5 hours, insulating it with polyethylene. Repeat the procedure every day.
• Boil two large onions with shells in a liter of distilled water, drain. Drink the resulting infusion three times daily before meals.

Treatment of gonarthrosis should not be limited to traditional medicine. This disease requires an integrated approach, which necessarily includes drug therapy and exercise.

Prognosis, possible complications

The general prognosis of deforming osteoarthritis is unfavorable due to the progressive nature of the disease. The process of tissue breakdown and joint deformation cannot be reversed, but it can be stopped or significantly slowed down.

The prognosis of gonarthrosis is influenced by the following factors:

• Patient's age.The younger he is, the worse the prognosis. The pathological process develops gradually, therefore, by damaging the joints in young people, the disease can reach the last stage by old age and cause various complications.
• Type of arthrosis.In primary pathology, only the joint is affected, and the disease usually progresses slowly. With secondary disease, there are other disorders that can speed up this process or cause complications.
• Follow doctor's instructions.This refers to taking the necessary medications, going through physiotherapy, exercise therapy and ensuring unloading of the joint. It is also important to respect the duration of drug therapy, as most medications should be taken regularly in certain courses.
• Body weight. If the patient weighs a lot, then the joints experience increased stress, which negatively affects the course of the disease.
• Occupation.This factor is very important for the prognosis of the disease. Professional athletes, people under regular stress or constantly on their feet, always suffer more. Sedentary work, when the joint is in one position for a long time, can also negatively affect the course of the disease.

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

• Joint deformity.This happens in the last stage of the disease. The leg can bend at an unnatural angle, which is not only aesthetically uncomfortable, but can also cause a complete loss of joint functionality.
• Infection.Microtrauma, for example, a crack in cartilage tissue, can cause such a complication. The pathogen can enter the joint together with the current or lymph from the focus of the infection. Surgical intervention - arthroscopy, diagnostic puncture can also be the cause of infection. Infection of the joint can cause aseptic necrosis.
• Dislocation, fracture.Such complications occur in the background of functional damage to the knee joint, in which the load is not properly distributed, and the excess can lead to injury.
• Ankylosis.In this case, the bones at the site of the missing joint grow together. This is one of the most serious disorders, because due to the fixation of the lower leg in one position, motor function is lost.

In most cases, complications arise through the fault of a patient who has neglected the disease or disobeyed the doctor's orders.

Prevention

To avoid osteoarthritis of the knee, some preventive measures should be taken:

• maintain a normal body weight;
• avoid heavy loads and strong pressure on the knees;
• ensure regular and sufficient physical activity;
• avoid joint injuries;
• if an injury is sustained, then timely, competent and comprehensive treatment is required;
• Strengthen your periarticular muscles.

Secondary prevention measures should also be emphasized. They are necessary when gonarthrosis has already been diagnosed and it is necessary to reduce the speed of its development. In this case, you must take the following measures:

• resort to a course of chondroprotectors every six months or a year;
• Treat arthritis in a timely, fast and effective way.

Osteoarthritis of the knee joint is a serious pathology that has a poor prognosis and can cause numerous complications. It is necessary to start treatment as early as possible in order to slow down the pathological process. Therapy should be comprehensive, some techniques should become part of the lifestyle: diet, exercise, taking certain medications.