Treatment of osteoarthritis of the knee joint

Osteoarthritis of the knee jointis a degenerative-dystrophic disease of cartilage tissue, which leads to the exposure of bone heads and reduced mobility in the joint. The disease has a non-inflammatory nature and progresses slowly - the transition from the initial stage to disability takes from several years to several decades. Osteoarthritis of the knee is one of the top 5 causes of disability and disability worldwide.

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

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

Signs of knee osteoarthritis

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

• morning stiffness and reduced mobility of the joint (a warm-up is necessary on waking);
• pain and discomfort in the knees, which increases after physical exertion (long walks, runs or standing) and subsides with rest;
• at the 2nd stage - the so-called. starting pain that occurs after a long stay in one position;
• increased fatigue, often attributed to age-related changes;
• dry, rough crunch, which is repeated regularly when bending and bending the knees;
• edema and other symptoms of inflammation appearing in the 2nd stage of the disease due to trauma to the periarticular tissues;
• meteosensitivity, increased symptoms during the cold season.

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

The insidious nature of the disease lies in the fact that it can proceed in a latent form for years, and the first significant symptoms often appear only in the 2nd stage - when the full restoration of the synovial cartilage is no longerpossible.
Therefore, it is important to consult a doctor at the first signs of discomfort in the knees - for example, weak, as if pulling pains occur when the production of synovial fluid is insufficient. Remember: knee pain is not normal at any age. Timely examination and treatment of arthrosis of the knee joint of the 1st degree can completely protect you from excruciating pain in the joints in the elderly.

What happens if knee osteoarthritis is left untreated?

With self-medication, non-compliance with doctor's recommendations or no treatment, arthrosis of the knee joint progresses on average 3-8 times faster than with complex therapy. If knee osteoarthritis progresses aggressively, the patient may lose the ability to move normally even before retirement age begins.

The effective treatment of osteoarthritis of the knees in the acute stage is particularly important. It can be caused by damp cold, physical or emotional stress, an allergy, poisoning, moving to a region with a different climate, in short, an upheaval in the body. Exacerbation of arthrosis occurs with the destruction of a large number of chondrocytes. In response, the body produces enzymes designed to process and eliminate dead cells. However, if their concentration is too high, healthy areas of cartilage also suffer - cell membranes thin, foci of erosion appear on the synovial mucosa of the joint. This process, if not stopped by drug treatment for osteoarthritis of the knee, can last for several weeks, and in cases of chronic stress, lack of sleep or insufficient nutrition, it can be permanent.

Eventually, without treatment, osteoarthritis of the knee leads to a complete reduction in the lumen of the joint space due to the growth of osteophytes. The gap necessary for normal movement closes, and the patient cannot bend the leg even 30-45°. The difficulty is not only climbing the stairs, but also trying to get up from the couch or from 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 then, most patients fail to return to a completely normal life.

Knee osteoarthritis treatment

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 1st 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 cure of the disease or remissionsteady.

As a rule, the treatment of arthrosis of the knee joint of the 2nd degree is based on the use of all methods of conservative treatment. However, the doctor may decide on minor surgical interventions in the joint if the disease develops aggressively or with complications.

Treatment for grade 3 knee osteoarthritis almost always involves surgery.

Full conservative treatment of arthrosis 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 of systemic and local action (hormonal and non-hormonal anti-inflammatory drugs, 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 joint 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 fatty tissue. In parallel, auxiliary and rehabilitation methods are connected - physiotherapy, massage, manual therapy, therapeutic exercises.

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

• Knee arthroscopy. The collective name for a group of minimally invasive operations to remove a piece of broken joint tissue or osteophyte, or partial excision of the joint membrane. It allows you to delay or exclude prostheses, as well as eliminate discomfort in the early stages of the disease. Used primarily for the treatment of osteoarthritis of the knee in patients under the age of 60.
• Osteotomy. An operation to cut part of the bone and correct the load axis on the affected knee, which helps to slow degenerative changes. It is usually performed in the treatment of osteoarthritis of the 2nd degree knee joint.
• Stents. Partial or complete replacement of the knee joint with a titanium implant, which lasts 15 to 20 years. This technique is a last resort because it involves certain risks. Recommended for patients over 55 years old.

All these operations require a recovery period and have a number of contraindications. The best option is therefore prevention (exercise therapy, chondroprotectors) and treatment of knee osteoarthritis at an early stage.

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

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

Therapeutic exercises for knee osteoarthritis

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

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

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

Exercises for the treatment of osteoarthritis of the knee are performed for both legs! In case of acute pain, the session should be stopped or continued at a gentler pace.

1. Starting position - lying on your back. One leg is stretched on the ground, the other is raised bent at 90° (lower leg parallel to the ground). We perform movements with the lower 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 on your stomach. We swing the legs in turn, 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 on the side. We swing 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 "on their own".
6. Starting position - lying on your stomach. We do the "boat" exercise. If physical condition does not allow it, place the palms on either side of the chest and bring the legs back in turn, experiencing tension in the back of the thigh and lower leg.
7. Starting position - lying on your back. We alternately turn the feet, trying to describe the full circle with the socks.
8. Starting position - standing against the wall. We squat slowly and smoothly, without raising our backs from the wall, in order to distribute the load. When the legs are bent at the knees at 90 °, we begin a smooth upward movement.
9. Starting position - standing. We alternately swing our legs forward, backward and sideways.

Please note: the therapeutic exercises after surgery on the joint have their specificities and vary according to the number of days that have elapsed since the operation. It is prescribed by a doctor - a surgeon or a rehabilitation specialist.

Massage for osteoarthritis of the knee

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

• superficial caresses and rubbing (up and down, clockwise and counterclockwise);
• probing and stretching the deeper tissues with the fingertips;
• pinch and pat the skin.

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

Self-massage can be combined with drug treatment of osteoarthritis of the knee joint: it will not be superfluous to apply ointment or warming 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 necessary.

Diet therapy for arthritis

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

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

Instead, include in the menu:

• dishes made from sprouted cereals and whole grains;
• fatty fish from the North Seas and dietary poultry meat;
• cartilage (ears, nyushki, paws and other collagen-rich farm animal parts), aspics and jelly;
• 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 Knee Osteoarthritis Diet provides a balanced diet that helps restore cartilage.

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

Physiotherapy for the treatment of osteoarthritis of the knee

The following physiotherapy procedures are used to effectively treat osteoarthritis of the knees and improve the effect of medication:

• magnetic therapy;
• laser therapy;
• UHF;
• ultrasound therapy;
• amplipulse;
• electrophoresis (including medicinal - with analgin, novocaine or chymotrypsin);
• ozokerite and paraffin applications;
• thermotherapy (cryotherapy, inductothermy);
• phonophoresis (especially with hydrocortisone);
• balneological therapy (sulphur baths, hydrogen sulphide).

Acupuncture in the treatment of arthrosis of the knee joint of the 2nd 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 arthrosis 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 osteoarthritis of the knee - is usually prescribed on-going or as needed.

In order 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 medication: to make life easier for the patient, to improve cartilage nutrition, to regenerate cartilage tissue and to maintain the normal musculoskeletal system.

Nonsteroidal anti-inflammatory drugs

To relieve exacerbations, NSAIDs in tablets or capsules are taken in cures (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 a stomach or intestinal ulcer. They should be taken with extreme caution in combination with glucocorticosteroids and drugs that affect blood clotting. Additional risk factors are age over 65, smoking, drinking alcohol during the course. In these cases, doctors usually recommend injecting drugs, bypassing 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 one-time effect on the affected joint and at the same time minimally affects digestion.

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

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

Glucocorticoid injections are considered a last resort in the drug treatment of knee osteoarthritis. They provide relief as early 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 treatment of HA.

Chondroprotectors in the treatment of arthrosis of the knee joint

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

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

Skin irritants

External preparations for the treatment of arthrosis of the knee with a local irritant 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 warming ointments forthe treatment of osteoarthritis of the knee joint and limit yourself to hot baths, applications and external anti-inflammatories.

Synovial fluid prostheses

If there is too little synovial fluid in the joint, the sliding of the articular surfaces is disturbed. And above all, 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 leads to rapid relief, which lasts from 3 to 12 months after the end of the course. However, with the introduction of prostheses, the risk of necrotic changes or infection of 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 painkillers are not used in the treatment of arthrosis of the knee joint, as they mask pain, but do not relieve inflammation. You can use them or available NSAIDs without a doctor's prescription for up to 10 days, after which an examination 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 a difference between them and which one should I choose?

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

Capsules, sachets and tablets for the treatment of osteoarthritis of the knee

Nonsteroidal anti-inflammatories, corticosteroids, chondroprotectors and muscle relaxants are available in oral form. In this case, they are easy to dose, reception is possible without the involvement of a medical professional, it is easy to control which part of the course has already been carried out. Taken orally, chondroprotectors and NSAIDs have a fairly high bioavailability (especially in sachet form).

Injectables

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 arthrosis of the knee joint with drugs demonstrates maximum bioavailability.

This method of treating osteoarthritis of the knee with drugs is safe for digestion, but it is desirable that injections (intravenously, intramuscularly in the joint area or intra-articularly) are administered by qualified medical personnel. Intramuscular injections in the buttock or thigh can be done 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 - alas, often only 5% of the active ingredients reach the desired tissue layers.