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 see a doctor for diagnosis and treatment. Therapy must be completed in strict compliance 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 such changes, the functionality of the joint is impaired and pain appears.

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

Two concepts are often confused: arthritis and osteoarthritis. These pathologies are similar in some features, but they differ in the nature of the course. Only a specialist can make an accurate diagnosis and prescribe the appropriate treatment.

With gonarthrosis, the nutrition mechanisms of the cartilage are disrupted, so its functioning is gradually stopped. Among arthrosis of various localizations, the 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 are at risk of developing primary pathologies, especially in the presence of overweight - obesity of 2 or 3 degrees.

Primary gonarthrosis is believed to be associated with average life expectancy. Compared to past centuries, it has increased dramatically and the joints simply wear out over time.

Gonarthrosis associated with natural aging is considered normal. If the joint cartilage is destroyed earlier or this process is too intense, 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 is clearly traceable;
• fracture of the leg;
• 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 limbs - valgus or varus;
• inborn shortening of a limb;
• metabolic syndrome;
• gout;
• acromegaly;
• osteomyelitis;
• chondrocalcinosis;
• pathologies associated with the exchange of material;
• joint hypermobility - the ligament apparatus is inherently weak;
• hemochromatosis;
• diabetes mellitus;
• pathology of the endocrine system.

There are many possible causes of deformation of osteoarthritis, so this pathology is called polyetiological. It is often not possible to identify the exact cause of the disease, therefore 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:

• Crunch and click.These symptoms usually appear during movement and are often ignored by patients. A crunch in the knee can mean that grooves, osteophytes, ulcerations on the joint surfaces have appeared.
• Limited movements.This symptom is very important during diagnosis, as it allows to differentiate gonarthrosis from a number of other diseases affecting the musculoskeletal system. Movement is usually stiff in the morning. When a person starts walking, this symptom disappears within half an hour. If stiffness persists for an hour or more, this may indicate an inflammatory process or other pathology.
• Reduced range of motion.This symptom implies that the patient is unable to fully bend the knee. This is due to the pain syndrome, which softens the intensity of which a person tries to move his leg less. Over time, this leads to a shortening of the ligaments, which are called contractures.
• Jammed joint.Gonarthrosis can lead to the joint being blocked in a certain position and it is impossible to move it due to severe pain. This usually occurs due to changes in the joint surfaces, when the internal ligaments of the knee are pulled, protruding from the pineal glands. In this case, only the reverse displacement of the ligament can help. Less commonly, the cause of joint jam is the entry of a foreign body into the joint space. The source of the problem can be a part of the meniscus or a fragment of an osteophyte.

Disease classification

Each of the phases has specific characteristics:

1. The first stageis ​​initial, it is also called easy. The first signs of pathology are considered its beginning, and the transition to the next stage is characterized by the appearance of bone deformities. They can be detected by visual inspection or X-rays. In the first stage of the disease, the accumulation of fluid in the joint already begins - this phenomenon is called synovitis. It is he who causes pain, which so far appears only when moving. Their intensity can vary.
2. At the second (moderate) stageof gonarthrosis, pathological changes are also visible visually. They are manifested by an increase in the size of the knee, its deformation. On X-rays, 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 pain syndrome manifests itself from the slightest load and when walking or squatting, the knee begins to creak.
3. Third stage (severe)deforming osteoarthritis is diagnosed when there is virtually no cartilage 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 this case, it is necessary to focus not on the symptoms of the disease, but on the received X-rays. Pathology does not always follow the standard pattern.

Diagnostics

Only instrumental diagnostics will help determine deforming osteoarthritis:

• x-rays;
• ultrasound scan;
tomography
• - magnetic resonance or computed imaging;
• arthroscopy;
• thermography;
• scintigraphy.

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

Which doctors should I seek help?

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

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

Treatment of gonarthrosis

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

Drug therapy

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

• Preparations of the non-steroidal anti-inflammatory group.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. Non-steroidal anti-inflammatory drugs not only fight inflammation but also reduce pain.
• Corticosteroids.These drugs are usually used when the disease is severe or drugs from the non-steroidal anti-inflammatory group are ineffective. They are usually used as injections, injecting the medicine into the joint capsule. Corticosteroids are used as symptomatic therapy to eliminate inflammation and severe pain.
• Analgesics.When prescribing such drugs, the severity of the pain syndrome is taken into account. If the pain syndrome is of high intensity, they resort to strong opiates.
• Chondroprotector.Thanks to these drugs, the 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 appropriate for pathologies of 1 or 2 degrees.
• Antispasmodics and muscle relaxants.Such drugs are needed when the disease is accompanied by muscle spasms.
• Vasodilating medicinal products.Such drugs improve blood flow, relieve spasm of small vessels. A combination of vasodilator and chondroprotective drugs is effective, since the cartilage tissue in this case is better saturated with nutrients.
• Warming ointmentsto improve blood circulation. Such funds are appropriate in the absence of synovitis.

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

Physiotherapy

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

The following physiotherapy methods are effective for knee osteoarthritis:

• Phonophoresis.This technique is ultrasound therapy combined with the effects of drugs. Due to high-frequency vibrations, the tissues of the knee joint are heated, which ensures a deeper penetration of medicinal substances into them.
• Shock wave therapy.The procedure uses a special apparatus that generates radial acoustic waves. Under their action, the blood supply in the periarticular region is activated, which stimulates the restoration of cartilage and bone structures.
• Ozone therapy.This procedure involves the use of active oxygen. Provides analgesic and anti-inflammatory effects on tissues.
• Electromy-stimulation.This technique is often used during rehabilitation, as well as in the presence of contraindications to 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-intensity currents for deep heating.
• Cryotherapy.This technique is also called cold treatment. The affected skin area is exposed to a low temperature for a short period of time. This method restores metabolic processes, increases blood circulation, reduces the severity of inflammation, eliminates pain, 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 usually used at an early stage of the disease. Provides anti-inflammatory, analgesic and stimulating effects.
• Plasma therapy.This procedure is also called joint plasmolifting. It includes intra-articular injections. For them, the patient's blood plasma is used, which is saturated with platelets. This procedure relieves inflammation, promotes the regeneration of cartilage tissue.
• Healing baths- turpentine, radon, hydrogen sulfide.
• Acupuncture.This procedure is usually used in the early stages of the disease. This technique relieves swelling, eliminates pain and allows you to restore joint mobility.

physical therapy

Physiotherapy is necessary for gonarthrosis. The various exercises must be supervised by a qualified professional. The main goal of physical therapy is to restore joint mobility and achieve some freedom of movement. It is also necessary to increase muscle strength and endurance.

Physical therapy is not used during periods of exacerbation of the disease. At this time, the joint needs rest and maximum relief. Locomotor activity is allowed when inflammation and pain are relieved, at least 5 days should pass by this time.

The physical therapy program should be developed individually for each patient. It is necessary to take into account the features 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 independently perform some exercises. You need to do this in stages: first you need to warm up, then do strength exercises and finish with stretching.

Warming up is performed as follows:

• Spread your feet shoulder-width apart and lower your arms to your body or lean back in a chair. Slowly rise on your toes, lingering at the extreme point for 3 seconds, then gently transfer your weight to your heels, lifting your toes as high as possible. Do 10 repetitions without making any sudden movements.
• The starting position remains the same. It is necessary to raise the leg bent at the knee to the level of the waist, and then lower it. Do 15 repetitions alternately on each leg. Movements should be slow and smooth.
• Lie on your back, lift your bent knees and simulate the rotation of the bicycle pedals. It takes half a minute to rotate in one direction, then the other. Move slowly.
• Put your feet shoulder-width apart, straighten your back and bend your elbows. Simulate running in place, alternately shifting your weight from one leg to the other. The movements should be performed on the toes, not resting on the heels. Do the exercise for about 5 minutes.

Surgery

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

• Sting.This surgery is minimally invasive. They resort to it not only to study intra-articular fluid, but also to remove 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 a standalone operation or be one of its phases. This technique is endoscopic and does not require dissection of the joint cavity. Thin and flexible special tools are used for the operation, and all manipulation is controlled by means of a micro-camera. If arthroscopy is used as an independent operation, then during it the articular 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 decreases and the joint becomes more mobile. During the operation, the bone, which is involved in the formation of the knee joint, is sawn off and then fixed in a different position. Such surgery is appropriate for grade 1 or 2 deforming osteoarthritis.
• Endoprosthesis.This is done 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 patient's previous mobility and normal quality of life. Endoprosthesis is a rather complicated operation and therefore requires a long rehabilitation period.

Diet and general recommendations

Although the disease affects the knee joint, its treatment involves adherence to the diet. It must respect the following principles:

• If necessary, normalize your body weight. The BMI should not be higher than 20. Weight loss should be gradual - 2-3 kg per month.
• Cut back on carbohydrates and animal fats.
• Most of the fats you eat should be of plant origin.
• You must eat fish at least 1-2 times a week.
• You should eat fractionally. The portion should be small, but there should be 5-6 meals a day.
• Finish each meal with a vegetable or fruit.
• For cooking, you should choose cooking, including steaming, stewing, baking.
• Observe the drinking regime. On average, a person needs 2 liters of liquid per day, and for the most part it should be clean water without gas.
• Drink water before eating. One glass is enough half an hour before meals.
• Reduce your salt intake.
• Avoid alcohol, carbonated and sugary drinks.
• Beef, pork, semi-finished products, red pepper, white cabbage, sour fruit should be excluded from the diet.
• It is useful to eat meat in jelly, jelly on jelly, cheese, cottage cheese, chicken, legumes.

Traditional medicine

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

Use the following popular recipes effectively:

• Lubricate the back of the burdock leaf with honey, apply to the affected area, fix with cling film and isolate. Store the compress for up to 4 hours.
• You can use a cabbage leaf instead of the burdock. You can knead it with your hands or prick it in several places. Honey is optional.
• For internal use, you can use a tincture of burdock root. Raw materials need to be finely chopped, steamed with boiling water and insisted. Drink one tablespoon 5 times a day.
• Rinse the potato sprouts, put them in a glass container and cover them with alcohol. Stand in the dark for 3 weeks, strain and use three times a day to scrub affected areas.
• Heat the honey in a water bath to a liquid state and rub on the affected knee, massaging it. Cover the treated area with gauze or bandage and isolate. The procedure is repeated every day for a week and a half.
• 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. Prepare a fresh mixture each time.
• Mix iodine with honey and glycerin in the same way, leave for 3 hours. Dip a cotton swab into the resulting composition and process the knee and adjacent area with movements from the bottom up.
• Chop a head of garlic and add a glass of vegetable oil. Insist a week in the dark, filter and apply on affected areas before bedtime.
• Grind the white chalk and mix with yogurt or sour cream to make a thick paste. Wrap it in natural fabric and make a compress for 2, 5 hours, isolating it with polyethylene. Repeat the procedure every day.
• Boil two large onions with their skins in a liter of distilled water, drain. Drink the resulting infusion three times a day before meals.

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

Prognosis, possible complications

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

The following factors influence the prognosis of gonarthrosis:

• Age of the patient.The younger you are, the less favorable the prognosis. The pathological process develops gradually, therefore, with damage to the joints in young people, from old age, the disease can reach the last stage and cause various complications.
• Type of osteoarthritis.In primary disease, only the joint is affected and the disease usually progresses slowly. With a secondary disease, there are other ailments that can speed up this process or provoke complications.
• Compliance with physician orders.This applies to taking the necessary medications, physiotherapy, physical therapy, and joint unloading. It is also important to observe the duration of drug therapy, since most drugs must be taken regularly in certain courses.
• Body mass.If the patient has a lot of weight, the joints experience increased 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 on their feet, suffer more and more. Sedentary work, when the joint is in one position for a long time, can also adversely affect the course of the disease.

The deformation of 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 unsightly, but can also cause complete loss of joint function.
• Infection.A microtrauma, for example a crack in the cartilage tissue, can cause such a complication. The pathogen can enter the joint along with current or lymph from the focus of infection. Surgery: Arthroscopy, diagnostic puncture can also be the cause of the infection. The introduction of infections into the joint can lead to aseptic necrosis.
• Dislocation, fracture.Such complications arise against the background of a functional impairment of the knee joint, in which the load is not distributed correctly and excess can lead to injury.
• Ankylosis.In this case, the bones at the site of the disappeared joint grow together. This is one of the most serious ailments, since due to the fixation of the lower leg in one position, motor function is lost.

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

Prevention

To avoid osteoarthritis of the knee, it is necessary to take some preventive measures:

• maintain a normal body weight;
• avoids heavy loads and strong pressure on the knees;
• ensure regular and sufficient physical activity;
• avoid joint injuries;
• if you receive an injury, prompt, competent and comprehensive treatment is required;
• Strengthens the periarticular muscles.

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

• resort to a course of chondroprotectors every six months or a year;
• treats arthritis in a timely, fast and efficient manner.

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