How is knee arthrosis diagnosed and treated?

5 December 2020

Arthrosis 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 see a doctor for diagnosis and treatment. Therapy must be carried out in strict accordance with the terms and other prescriptions.

General characteristics of the disease

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

Deforming osteoarthritis is chronic. In most cases, the disease progresses slowly, but certain factors can accelerate its progression. This mainly concerns the individual characteristics of the body, the activity and physical activity of the patient, concomitant pathologies.

Two concepts are often confused - arthritis and arthrosis. These pathologies are similar in certain characteristics, but differ in the nature of the course. Only a specialist can make an accurate diagnosis and prescribe the appropriate treatment.

With gonarthrosis, the cartilage's nutrition mechanisms are disrupted, so its functioning is gradually disrupted. Among osteoarthritis of various locations, pathology of the knee joint occurs in every three patients.

Causes of primary knee joint arthrosis

This is the most common form of the disease. Older women are at risk of developing primary pathology, especially in the presence of overweight - obesity of 2 or 3 degrees.

There is an opinion that primary gonarthrosis is associated with average life expectancy. Compared to previous 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 is destroyed earlier or if this process is very intense, this condition is considered pathological.

Causes of secondary arthrosis of the knee joint

Secondary gonarthrosis can be triggered by the following factors:

genetic predisposition, provided it can be clearly traced;
fracture in the leg;
dislocation of the knee joint;
;
congenital dysplasia of the knee joint;
extreme physical activity (typical for athletes);
constant static charges;
rheumatism;
rheumatoid arthritis (not to be confused with rheumatism);
;
congenital deformity of the lower limbs - valgus or varus;
congenital shortening of a limb;
;
drop;
acromegaly;
chondrocalcinosis;
pathologies associated with the exchange of materials;
joint hypermobility - the ligamentous apparatus is inherently weak;
;
pathology of the endocrine system.

There are several possible causes for deforming osteoarthritis, so this pathology is called polyethiological. It is often not possible to identify the exact cause of the disease, therefore, the 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:

Crunch and click.These symptoms usually appear during movement and are often ignored by patients. Knee compression may mean that ridges, osteophytes or ulceration have appeared on joint surfaces.
Contained movements.This symptom is very important during diagnosis, as it allows to differentiate gonarthrosis from a series of other pathologies that affect the musculoskeletal system. The movement is generally stiff in the morning. When a person starts walking, this symptom disappears in half an hour. If the stiffness persists for an hour or more, it may indicate an inflammatory process or other pathology.
Reduced range of motion.This symptom indicates that the patient is unable to fully bend the knee. This is due to the pain syndrome, which softens the intensity with which the person tries to move the leg less. Over time, this leads to a shortening of the ligaments, which are called contractures.
Joint locked.Gonarthrosis can lead to joint blockage in a certain position, making it impossible to displace it due to severe pain. This usually occurs due to a change in the joint surfaces, when the internal knee ligaments are pulled, leaving the pineal glands. In this case, only reverse ligament displacement can help. Less commonly, the cause of joint block 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 the disease

Each of the stages has specific features:

The first stageis initial, it is also called easy. The first signs of the pathology are considered to be onset, and the transition to the next stage is characterized by the appearance of bone deformities. They can be detected by visual inspection or on X-rays. In the first stage of the disease, the accumulation of fluid in the joint begins - a phenomenon called synovitis. It is he who causes pain, which until now only appears when he moves. Its intensity may vary.
In the second (moderate) stageof gonarthrosis, pathological changes are visible even visually. They are manifested by an increase in the size of the knee, its deformation. On radiographs, you can see 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 painful syndrome manifests with the lowest load and, when walking or crouching, the knee starts to crack.
Third-stage (severe) deforming osteoarthritisis diagnosed when there is virtually no cartilage tissue in the joint. If the pathology is difficult, 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 need to focus not on the symptoms of the disease, but on the radiographs received. Pathology does not always follow the standard pattern.

Diagnosis

Only instrumental diagnoses will help to determine deforming osteoarthritis:

;
ultrasound scan;
tomography - magnetic resonance or computerized image;
arthroscopy;
thermography;
scintigraphy.

Often, an X-ray is sufficient to detect gonarthrosis. It is carried out in two projections. If only one knee is affected, an image of the healthy limb is still obtained to compare the results.

Which doctors should I seek help from?

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

Arthrologist, rheumatologist, orthopedist usually deal with gonarthrosis problems. In addition, the participation of a chiropractor or arthroscopist may be required. A physiotherapist, a physiotherapy instructor, a qualified massage therapist in the field is usually involved in the treatment process.

Treatment of gonarthrosis

Therapy for osteoarthritis of the knee joint is very time-consuming. In most cases, outpatient treatment is sufficient. It involves a whole range of measures. Treatment is based on drug therapy, physiotherapy and physical therapy exercises. In some cases, surgery is necessary. In gonarthrosis, the use of folk recipes is also allowed, but they must be combined with traditional medicine.

Medical therapy

The use of various medications is the main component of the treatment of gonarthrosis. With such a disease, an integrated approach is necessary, which implies the possibility of using the following drugs:

Nonsteroidal anti-inflammatory drugs.These drugs are produced in various forms, but for osteoarthritis, tablets for oral administration, solutions for injections, agents for external use in the form of creams, ointments, gels are preferred. Nonsteroidal anti-inflammatory drugs not only fight inflammation, but also reduce pain.
Corticosteroids.These drugs are generally used when the disease is severe or drugs in the group of non-steroidal anti-inflammatory drugs are ineffective. They are usually used as injections, injecting the medication into the joint capsule. Corticosteroids are used as symptomatic therapy to eliminate inflammation and severe pain.
Painkillers.When prescribing these drugs, the severity of the pain syndrome is taken into account. If the pain syndrome is of high intensity, they turn to strong opiates.
Chondroprotectors.Thanks to these drugs, the cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors has been manifesting for a long time, as they are used for long therapeutic courses. These drugs are appropriate for grade 1 or 2 pathology.
Anti-spasmodics and muscle relaxants.These drugs are necessary when the pathology is accompanied by muscle spasms.
Vasodilator drugs.These medications improve blood flow and relieve spasm of small vessels. A combination of vasodilator and chondroprotective drugs is effective, as the cartilage tissue, in this case, is more saturated with nutrients.
Warming ointmentsto improve blood circulation. These funds are appropriated in the absence of synovitis.

The medication is prescribed by a doctor. Only he can determine which medications are needed in each particular case, according to what regimen should be taken and how long the therapeutic course of each prescribed medication should be.

Physiotherapy

In deforming osteoarthritis, several physiotherapeutic methods are actively used. They are used for several purposes: to reduce pain, relieve inflammation, activate the blood supply and speed up recovery.

The following physiotherapy methods are effective for knee arthrosis:

Phonophoresis.This technique is an ultrasound therapy combined with the effects of medications. Due to the high frequency vibrations, the tissues of the knee joint are heated, which guarantees a deeper penetration of medicinal substances in them.
Shockwave therapy. For the procedure, a special apparatus is used that generates radial acoustic waves. Under its action, the blood supply of the periarticular region is activated, which stimulates the restoration of the cartilaginous 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 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 intensity high frequency currents for deep heating.
Cryotherapy.This technique is also called cold treatment. The affected skin area is exposed to low temperature for a short period of time. This method restores metabolic processes, increases blood circulation, reduces the severity of inflammation, eliminates pain and relieves muscle spasm.
Hirudotherapy.This technique is considered an alternative. Leeches are placed around the affected joint. The procedure relieves pain, relieves swelling and stimulates regeneration.
Laser therapy.This technique is generally used at an early stage of pathology. It has anti-inflammatory, analgesic and stimulating effects.
Plasma therapy.This procedure is also called common plasmolifting. It involves intra-articular injections. For them, the patient's own blood plasma, saturated with platelets, is used. This procedure relieves inflammation, promotes the regeneration of cartilage tissue.
Healing baths- turpentine, radon, hydrogen sulfide.
Acupuncture.This procedure is generally used in the early stages of pathology. This technique relieves swelling, eliminates pain and restores joint mobility.

exercise therapy

physiotherapy exercises for knee arthrosis

Physiotherapy is necessary for gonarthrosis. The various exercises must be supervised by a qualified professional. The main objective 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 exacerbation of the disease. At that time, the joint needs rest and maximum relief. Locomotor activity is allowed when inflammation and pain are relieved, from that moment on, at least 5 days must pass.

The exercise therapy program must 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 independently. You need to do this in stages - first you need to warm up, then do strength exercises and finish with the stretch.

Heating is carried out as follows:

Move your feet shoulder width apart and lower your arms along your body or lean on the back of a chair. Stand up slowly on tiptoe, lingering at the extreme point for 3 seconds, then gently transfer the weight to your heels, lifting your fingers as high as possible. Do 10 repetitions without making sudden movements.
The starting position remains the same. It is necessary to raise the bent leg from the knee to the waist, then lower it. Do 15 repetitions alternately on each leg. The movements must be slow and fluid.
Lie on your back, raise your knees bent and simulate the rotation of the bicycle pedals. It takes half a minute to make rotational movements in one direction and then the other. Move slowly.
Place your feet shoulder-width apart, straighten your back and bend your elbows. Simulate running without moving, changing the weight alternately from one leg to the other. The movements should be performed on the tip of the feet, not resting on the heels. Do the exercise for about 5 minutes.

Surgery

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

Puncture.This intervention is minimally invasive. They resort to it 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 in one of its stages. This technique is endoscopic and does not require dissection of the joint cavity. For the operation, special thin and flexible instruments are used, and all manipulation is controlled by means of a micro-video camera. If arthroscopy is used as an independent operation, during it the joint surfaces will be 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 decreases and the joint becomes more mobile. During the operation, the bone, which is involved in the formation of the knee joint, is sawn and then fixed in a different position. This surgical intervention is appropriate for grade 1 or 2 deforming osteoarthritis.
Endoprosthesis.This operation is performed when the third degree of gonarthrosis is diagnosed. During surgery, the knee joint is replaced by a biocompatible construction. It is necessary to restore the patient's previous range of motion and normal quality of life. The stent is a very complicated operation and therefore requires a long period of rehabilitation.

Diet and general recommendations

Although the pathology affects the knee joint, its treatment implies adherence to the diet. 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.
Cut out animal carbs and fats.
Most of the fat you eat must be of plant origin.
You need to eat fish at least 1-2 times a week.
You must eat fractionally. The portion should be small, but there should be 5-6 meals a day.
End each meal with a vegetable or fruit.
To cook, you must choose to cook, including steam cooking, stew and roast.
Observe the drink regime. An average person needs 2 liters of liquid a day, and for the most part it should be clean, still water.
Drink water before eating. A glass is sufficient half an hour before meals.
Reduce your salt intake.
Avoid alcohol, carbonated and sugary drinks.
Beef, pork, semi-finished products, pepper, white cabbage and sour fruits should be excluded from the diet.
It is useful to eat gelatinous meat, gelatin with gelatin, cheese, cottage cheese, chicken, vegetables.

Traditional medicine

In the treatment of deforming osteoarthritis, unconventional methods are also appropriate. In this case, you should consult a specialist, as even the use of natural remedies has contraindications.

folk remedies for the treatment of osteoarthritis of the knee joint

Use the following popular recipes effectively:

Lubricate the back of the burdock leaf with honey, apply to the affected area, fix 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 prick in several places. Honey is optional.
For indoor use, you can use a burdock root tincture. The raw materials must be finely chopped, steamed with boiling water and insisted. Drink a tablespoon 5 times a day.
Wash the potato sprouts, place in a glass container and cover with alcohol. Stay in the dark for 3 weeks, strain and use three times a day to rub the affected areas.
Heat the honey in a water bath to a liquid state and rub it on the affected knee, massaging it. Cover the treated area with gauze or bandage and insulate. The procedure is repeated every day for a week and a half.
Steam 5 tablespoons. I. rolled oats and cook for 5-8 minutes over 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 new mixture.
Also mix iodine with honey and glycerin, leave for 3 hours. Dip a cotton wool in the resulting composition and process the knee and the surrounding area with movements from the bottom up.
Chop the garlic head and add a glass of vegetable oil. Insist a week in the dark, strain and apply to the affected areas before bedtime.
Grind the white chalk and mix it with yogurt or sour cream to make a thick paste. Wrap in natural fabric and make a compress for 2, 5 hours, isolating it with polyethylene. Repeat the procedure every day.
Boil two large, unpeeled onions in a liter of distilled water, strain. Drink the resulting infusion three times a day before meals.

The 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 degradation and joint deformity cannot be reversed, but it can be stopped or significantly reduced.

The following factors influence the prognosis of gonarthrosis:

Age of the patient.The younger you are, the less favorable the prognosis is. The pathological process develops gradually, therefore, with joint damage in young people, the disease can reach the last stage in old age and cause several complications.
Type of arthrosis.In primary pathology, only the joint is affected and the disease usually progresses slowly. With a secondary disease, there are other disorders that can speed up this process or cause complications.
Compliance with medical prescriptions.This involves taking the necessary medications, undergoing physiotherapy procedures, exercise therapy, ensuring the discharge of the joint. It is also important to note the duration of drug therapy, as most drugs need to be taken regularly in certain courses.
Body mass.If the patient is very heavy, the joints present greater stress, 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 regular stress or constantly standing, always suffer more. Sedentary work, when the joint is in the same position for a long time, can also negatively affect the course of the disease.

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

Joint deformity.This occurs in the last stage of the disease. The leg can bend at an unnatural angle, which is not only aesthetically unpleasant, but can also cause a complete loss of joint functionality.
Infection.A microtrauma, for example, a crack in the cartilage tissue, can cause this complication. The pathogen can enter the joint along with the current or lymph from the source of the infection. Surgical intervention - arthroscopy, diagnostic puncture can also be the cause of the infection. The introduction of infections in the joint can cause aseptic necrosis.
Dislocation, fracture.These complications occur in the context of a violation of the functionality of the knee joint, in which the load is not distributed correctly and the excess can lead to injuries.
Ankylosis.In this case, the bones at the location of the missing joint grow together. This is one of the most serious disorders, because due to the fixation of the leg in one position, the motor function is lost.

In most cases, complications arise because of the patient, who neglected his illness or ignored the doctor's orders.

Prevention

To prevent knee arthrosis, some preventive measures must be taken:

maintain a normal body weight;
avoid heavy loads and strong pressure on the knees;
ensure regular and sufficient physical activity;
avoid injury to the joints;
if an injury is received, then adequate, competent and thorough treatment is necessary;
Strengthens periarticular muscles.

Secondary prevention measures should also be highlighted. They are necessary when gonarthrosis has already been diagnosed and it is necessary to reduce the rate of its development. In that case, you need to take the following steps:

use a semiannual or annual chondroprotective course;
treat arthritis timely, quickly and efficiently.

Arthrosis of the knee joint is a serious condition, with a poor prognosis and that can cause a series of complications. It is necessary to start treatment as early as possible to delay the pathological process. Therapy must be comprehensive, some techniques must be part of the lifestyle: diet, exercise, taking certain medications.