Complex treatment of knee osteoarthritis.

6 December 2020

Diseases of the musculoskeletal system cause significant restrictions on human mobility. In order not to complicate the situation, the treatment should be carried out in a timely manner. Osteoarthritis of the knee joint is the most common form of damage to the joints of the skeletal bones and the most common cause of disability. But with a timely visit to a doctor, you can get rid of the disease.

GENERAL INFORMATION

Osteoarthritis of the knee joint is the unofficial name of the disease. In medicine, it is known as osteoarthritis. The word is made up of two ancient Greek words: bone and joint. Other synonyms:

deforming osteoarthritis or DOA in abbreviated form (the first word of the name reflects the main clinical symptom: joint deformity);
gonarthrosis (from a combination of the ancient Greek words "knee" and "joint").

Sometimes the disease is mistakenly called arthritis, although traditionally this term refers to a connective tissue disease that has nothing to do with osteoarthritis.

The essence of osteoarthritis is that the cartilage tissue that lines the surface of the joint is damaged, as a result of which inflammation begins, the work of the bone joints is interrupted, and pain appears. Unfortunately, this is a very common pathology, which is diagnosed mainly in older people (especially overweight) and in young athletes due to injuries.

For effective treatment, it is necessary to conduct a comprehensive examination of the patient with osteoarthritis, in particular, to identify the reasons that caused the problem with the musculoskeletal system. Most often, the following factors lead to the disease:

CAUSES AND SYMPTOMS

leg fractures;
dislocations, cartilage injuries, inflammation;
altered metabolism;
endocrine diseases;
weakness of the ligamentous apparatus;
hereditary predisposition;
autoimmune diseases and infections that cause damage to joint tissue.

Delayed access to a doctor threatens constant pain in the knee area and complete loss of joint mobility.To avoid this, you should sign up for a consultation with a specialist if you experience a cracking knee when walking and painful sensations that increase when descending or climbing stairs. If treatment is not started at this stage, the situation will get worse: the pain will stop passing, movements will be limited and the knee will deform.

The longer you do not see a doctor, the more difficult, slow and expensive the treatment of knee osteoarthritis will be.

DEGREE OF DISEASE

Osteoarthritis is diagnosed by a doctor. It not only identifies the disease, but also determines its degree. There are three of them:

First. It is possible to cure the disease at the initial stage, since at this time there are no morphological disorders of the tissue, the muscles are weakened, but have not yet changed, and the joint begins to tolerate the load worse due to dysfunctions of the synovial membrane andthe biochemical composition of the cavity fluid that feeds the cartilage ymenisci. Overuse causes inflammation and pain.

Second. At this stage, the cartilage and menisci begin to collapse, the load on them leads to pathological growths in the bone tissue, narrowing of the joint space. Due to this, the knee increases in size and looks deformed. Treatment of bilateral gonarthrosis of the second degree knee joint is already more difficult compared to the first stage. The pain and inflammation become chronic.
Third. This degree is already considered severe. At the same time, bone deformation is clearly expressed, the axis of the limb is changed, so the mechanical load is not distributed correctly. The ligaments of the joint are shortened, natural movements are limited due to this, and then the leg can be completely immobile. Treatment of grade 3 osteoarthritis of the knee joint without surgery is impossible as the disease is very advanced.

If the pain seems to be bearable for a long time, people think that they have osteoarthritis only in the first stage and put off going to the doctor. But this opinion is not correct. Every day, the load on the main elements of the joint, already beginning to collapse, increases, and pathological changes can lead to complete destruction of the joint and severe limb dysfunction.

CLINICAL PRESENTATION

The progression of the disease is accompanied by characteristic symptoms. The pain occurs in the middle of the night, even if the leg is standing. The stiffness is felt in the morning.

Walking becomes difficult when passing a certain distance, then at the beginning of the movement. In severe cases, a person cannot walk 100 meters normally, it becomes painful for him to stand and sit. You have to move with the help of special equipment.

The slight lameness in the first stage later becomes pronounced. As a result, walking, using public transportation, performing professional tasks, daily functions, and even self-service can become completely impossible.

TREATMENT METHODS

Folk recipes, pharmaceutical compresses and ointments will not help to get rid of the disease, as the approach should be comprehensive.In general, recovery is only possible in a hospital, where a doctor will treat osteoarthritis of the knee.What kind of recommendations to give the patient, he decides on the basis of the indicated complaints and associated pathologies. Generally, the following points are required to comply:

reducing the load on the joints;
compliance with the orthopedic regimen;
physical therapy (exercise therapy);
in physiotherapy.

All of this helps to slow down the progression of osteoarthritis and prevent loss of motor function. It should be understood that the methods used will largely depend on the capabilities of the hospital and the availability of one or another physiotherapy equipment. It is better if the patient has the opportunity to go to a spa treatment or a specialized orthopedic clinic, where he will be given a modern approach to the choice of drugs, diet, methods, etc.

USE OF MEDICINES

Inflammatory processes and painful sensations make it impossible to treat knee osteoarthritis without drugs in the form of tablets, creams, ointments and injections. In the first stage, you can use non-steroidal anti-inflammatory drugs: diclofenac, indomethacin, nimesulide, etc. In the second and third, you often have to fight inflammation with steroid drugs - triamcinolone, hydrocortisone. These same hormones are used during periods of acute pain.

In addition, intramuscular and intra-articular injections of drugs that improve the condition of cartilage tissue (vasodilators and chondroprotectors) will be required.

PHYSIOTHERAPY METHODS

Substantial improvements can be made through physical therapy. The following techniques are considered the most effective:

Shock wave therapy. This method has worked well for the past 20 years. Its essence lies in the effect on the affected area with a special device that emits radial acoustic waves that activate the blood supply and stimulate tissue repair.
Myostimulation. This therapy targets the muscles that surround the joint. Low-current pulses increase leg mobility, relieve pain, and increase stamina during physical exertion.
Phonophoresis. This technique harmoniously combines ultrasound therapy and the use of products in the form of ointments, gels and creams. Typically, such dosage forms are absorbed only 5-7%, but high-frequency ultrasound vibrations heat the tissues, and the absorption increases several times. In addition to a good therapeutic effect, this saves the consumption of expensive drugs.
Ozone therapy. The anti-inflammatory and analgesic effect can be achieved by acting on the joint with active oxygen. This is a nice addition, and in some cases, an alternative to hormonal medications.

MEDICAL EXERCISE

Pain during physical exertion in a joint leads to the fact that the person tries to avoid it. In the long term, this threatens physical inactivity, causing muscle atrophy and ligament weakness. Of course, during the period of exacerbation, the load on the joint should be completely removed, but after a few days after the inflammation and pain are relieved, it is necessary to start physiotherapy exercises.

It is believed that exercise therapy exercises performed correctly and consistently can prevent the patient from having to undergo surgery. Today, experienced specialists have developed many special methods of daily training that strengthen muscles and increase their strength and endurance, inhibit pathological tissue destruction, restore joint mobility and range of motion.

The most important thing about this type of treatment is regularity.A good effect is only achieved by those patients who understand the need for changes in lifestyle and strictly follow the doctor's recommendations on the proportion of physical activity and periods of joint rest.

PASSIVE KINESITHERAPY

Lymphatic drainage, massage, and manual therapy are a nice addition to medication, physical therapy, and exercise therapy. They are essential for sedentary patients and can improve the condition of their muscles, joints and ligaments.

Another method of passive kinesitherapy is mechanotherapy. It uses special devices: vibration simulators, weight materials, mechanical massagers, which improve the effectiveness of the treatment.

The extension of the joints, in which the space of their cavity is mechanically increased, allows you to get rid of pain and stop destructive processes. Regular use of this therapy will prolong knee health for years.

DIET COMPLIANCE

Since obesity is often the cause of osteoarthritis, patients with this diagnosis should take care of weight loss. Losing weight will reduce stress on the joint and make exercise therapy easier. Sometimes diet is not enough, then bariatric surgery is required, but such situations are rare.

Another indication of adherence to a certain diet can be any pathology associated with osteoarthritis. If there is no obesity or other diseases accompanied by the need to change eating habits, a special diet is not necessary. However, you can help the body strengthen affected cartilage tissue by including foods rich in collagen, including gelatin and jellied meat, fish oil, berries, and fruits in your diet. It is better to refrain from consuming unhealthy foods like sugar, carbonated and alcoholic beverages.

SURGICAL INTERVENTION

In advanced cases, a quick solution to problems with the musculoskeletal system is to perform operations. With osteoarthritis, the following types of surgical intervention are prescribed:

The puncture allows you to remove the accumulated fluid in the joint cavity. As a result, inflammation is reduced, so knee mobility is restored.
Arthroscopy allows the surface of the joint to be cleaned of pieces of destroyed tissue. It is performed with thin and flexible instruments using a video camera, thus avoiding dissection of the joint cavity.
Periarticular osteotomy allows you to change the angle of one of the bones that make up the knee joint, thereby redistributing the load, increasing mobility, and relieving pain. This intervention is quite traumatic, since the bone has to be cut.
The endoprosthesis allows to replace a diseased joint with a biocompatible structure. At the same time, the previous range of motion is restored, but the operation is quite new and very complicated, after which a long rehabilitation is required.

Rarely is surgery required in the first stage. In the second, it is necessary only occasionally, but in the third it cannot be done without.

PATIENT OPINIONS

Which of the many treatments will be applied in each case depends on the doctor. The specialist will choose the best method, and the patient's task is to strictly follow the orthopedist's recommendations. This is the only way to get a good result quickly. This is confirmed by patients who have been diagnosed with gonarthrosis.