Treatment of arthrosis of the knee joint

Arthrosis of the knee jointis a degenerative-dystrophic disease of the cartilage tissue, which leads to the exposure of the bone heads and impaired mobility in the joint. The disease has a non-inflammatory nature and slowly progresses - 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 years old, but the disease is rapidly getting younger - more and more often its symptoms appear at the age of 25 years.

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

Signs of osteoarthritis of the knee

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

• morning stiffness and decreased mobility in the joint (a warm-up is required upon awakening);
• pain and discomfort in the knees, which increase after physical exertion (long walking, running or standing) and subside with rest;
• at the 2nd stage - the so-called. starting pain that occurs after a long stay in one position;
• increased fatigue, which is often attributed to age-related changes;
• dry rough crunch, which is regularly repeated when bending and unbending the knees;
• edema and other symptoms of inflammation that appear at the 2nd stage of the disease due to trauma to the periarticular tissues;
• meteosensitivity, increased symptoms in the cold season.

When trying to bend the knee affected by gonarthrosis to the stop, there is a sharp pain and a feeling of 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 insidiousness 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 at the 2nd stage - when the complete restoration of synovial cartilage is no longer possible.
Therefore, it is important to see a doctor at the first sign of discomfort in the knees - for example, weak, as if pulling pains that occur when there is insufficient production of synovial fluid. Remember: knee pain is not normal, regardless of 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 old age.

What happens if osteoarthritis of the knee is not treated?

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

Especially important is the effective treatment of arthrosis of the knees in the acute stage. It can be provoked by damp cold weather, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in a word, any shake-up for the body. Exacerbation of arthrosis occurs with the destruction of a large number of chondrocytes. In response, the body produces enzymes that are designed to process and remove dead cells. However, if their concentration is too high, healthy areas of cartilage also suffer - cell membranes become thinner, erosion foci appear on the synovial lining of the joint. This process, if not stopped by the treatment of arthrosis of the knee with drugs, can proceed for several weeks, and with chronic stress, lack of sleep or insufficient diet, it can be permanent.

Ultimately, 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 by 30-45 °. The difficulty is not only climbing stairs, but also trying to get up from the sofa or normal movement. This condition is accompanied by pain, from which conventional analgesics 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 articular architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients fail to return to a completely normal life.

Treatment of osteoarthritis of the knee

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.

The 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 a cure for the disease or a stable remission.

Treatment of arthrosis of the knee joint of the 2nd degree, as a rule, 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.

Comprehensive conservative treatment of arthrosis of the knee joint involves the removal of pain and inflammation, the restoration of cartilage tissue, and an increase in the range of motion in 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, 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 articular bag. In this case, PRP injections (platelet-rich plasma) are used, as well as injections of stem cells obtained from the patient's own adipose tissue. In parallel, auxiliary and rehabilitation methods are connected - physiotherapy, massage, manual therapy, therapeutic exercises.

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

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

All these operations require a recovery period and have a number of contraindications, so the best option is prevention (exercise therapy, chondroprotectors) and treatment of knee arthrosis in the early stages.

In addition to the main treatment methods, 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 of knee arthrosis is prescribed by a rheumatologist or orthopedist. At the first appointment, he palpates the joint, does motor tests, and then directs the patient to a tomography or radiography.

Therapeutic exercises for arthrosis of the knee

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

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

The main task of physical exercises in the treatment of osteoarthritis of the knee joint is to strengthen the muscles of the thigh and lower leg, maintain the elasticity of the ligaments and tendons, as well as combat muscle atrophy, which is characteristic of arthrosis. 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 arthrosis of the knee are performed for both legs! If there is a sharp pain, the session should be stopped or continued at a more gentle pace.

1. Starting position - lying on your back. One leg is extended on the floor, the other is raised bent at 90 ° (lower leg parallel to the floor). We perform movements with the lower leg up and down, as far as the range of motion in 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 our legs in turn, trying to bring the heels as close to the buttocks as possible.
4. Starting position - lying on your 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 up 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 "at themselves".
6. Starting position - lying on your stomach. We do the exercise "boat". If physical fitness does not allow, we put our palms on both sides of the chest and take our legs back in turn, experiencing tension in the back of the thigh and lower leg.
7. Starting position - lying on your back. We alternately rotate the feet, trying to describe the full circle with the socks.
8. Starting position - standing against the wall. We squat slowly and smoothly, without lifting our backs from the wall, in order to distribute the load. When the legs are bent at the knees by 90 °, we begin a smooth upward movement.
9. Starting position - standing. Alternately we swing our legs forward, backward and sideways.

Please note: therapeutic exercises after surgery on the joint has its own specifics and varies depending on how many days have passed since the surgery. It is prescribed by a doctor - a surgeon or a rehabilitation specialist.

Massage for osteoarthritis of the knee

Therapeutic massage for arthrosis of the knee is performed on both legs. At first, at least 10-12 sessions are usually required 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 stroking and rubbing (up and down, clockwise and counterclockwise);
• probing and stretching with the fingertips of deeper tissues;
• pinching and tapping on the skin.

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

Self-massage can be combined with the treatment of arthrosis of the knee joint with drugs: it will not be superfluous to apply a warming ointment or 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 arthrosis). In this case, acute phase therapy is required.

Diet therapy for arthritis

The standard nutritional protocol for treating osteoarthritis of the knee 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 from sprouted and whole grain cereals;
• fatty fish of the northern seas and dietary poultry meat;
• cartilage (ears, nyushki, legs and other parts of farm animals rich in collagen), 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 diet for osteoarthritis of the knee provides a balanced diet that helps restore cartilage.

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

Physiotherapy for the treatment of osteoarthritis of the knee

The following physiotherapy procedures are used to effectively treat arthrosis of the knees and enhance the effect of medications:

• magnetotherapy;
• laser therapy;
• UHF;
• ultrasound therapy;
• amplipulse;
• electrophoresis (including medicinal - with analgin, novocaine or chymotrypsin);
• ozokerite and paraffin applications;
• thermotherapy (cryotherapy, inductothermy);
• phonophoresis (in particular, with hydrocortisone);
• balneological therapy (sulfur, hydrogen sulfide baths).

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.

Medicines for the treatment of arthrosis of the knee joint

Treatment of osteoarthritis of the knee joint with drugs is carried out symptomatically and taking into account the patient's individual response to the selected medications. Drug therapy - injections, ointments or tablets for the treatment of arthrosis of the knee - is usually prescribed in courses or as needed.

In order to choose the right medicines for the treatment of arthrosis of the knee joint, consult a doctor who, after research, will select the necessary medicines.

There are several directions in the treatment of arthrosis of the knee joint with drugs: making life easier for the patient, improving the nutrition of cartilage, regenerating cartilage tissue, and maintaining the normal musculoskeletal system.

Non-steroidal anti-inflammatory drugs

To relieve exacerbations, NSAIDs in tablets or capsules are taken in courses (about 12 days) or as needed, depending on the intensity of the pain syndrome. Uncontrolled intake of NSAIDs in violation of the instructions or recommendations of the doctor 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 injection of drugs, bypassing the gastrointestinal tract. Together with NSAIDs, it is desirable to take gastroprotectors.

The maximum effect can be achieved with a combination of systemic NSAIDs (for internal use) and external ones - in the form of ointments, creams or gels. The second option provides a point effect on the affected joint and at the same time minimally affects digestion.

Corticosteroids (steroid drugs 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 enough to relieve pain and inflammation.

Glucocorticoid injections are considered a last resort in the treatment of osteoarthritis of the knee with drugs. They provide relief as early as 20 minutes after administration, but can lead to hormonal imbalances and cartilage damage if taken improperly. Due to side effects, many orthopedists prefer knee surgery to long-term HA therapy.

Chondroprotectors in the treatment of arthrosis of the knee joint

Chondroprotective agents based on extracts from the veins and cartilage of cattle, marine fish and shellfish contribute to the restoration of synovial cartilage, and therefore are indispensable for the effective treatment of knee arthrosis. 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 the synovial fluid.

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

Skin irritants

External preparations for the treatment of arthrosis of the knee with a local irritating 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 soreness of the skin, rash), during pregnancy and lactation, as well as in the presence of other contraindications, it is better to avoid warming ointments for the treatment of arthrosis of the knee joint and limit yourself to warm baths, applications and external anti-inflammatory.

Synovial fluid prostheses

If there is too little synovial fluid in the joint, the sliding of the articular surfaces is disturbed. And most importantly, starvation of the cartilage begins, because the joint fluid that nourishes it like a sponge normally supplies nutrients for the growth and maintenance of cartilage tissue. To prevent cellular 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 completion of the course. However, with the introduction of prostheses, the risk of necrotic changes or infection in 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 analgesics are not used in the treatment of arthrosis of the knee joint, since 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 knee arthrosis have several forms of release: sachets, injections, ointments, tablets. Choose what suits you the most.

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

Non-steroidal anti-inflammatory drugs, corticosteroids, chondroprotectors and muscle relaxants are available in oral forms. In this case, they are easy to dose, reception is possible without the participation of a medical worker, it is easy to control which part of the course has already been completed. When taken orally, chondroprotectors and NSAIDs have a fairly high bioavailability (especially in the form of a sachet).

Solutions for injections

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 osteoarthritis of the knee joint with drugs demonstrates maximum bioavailability.

This method of treating knee arthrosis with drugs is safe for digestion, but it is desirable that injections (intravenously, intramuscularly into the joint area or intra-articular) be given by qualified medical staff. 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 administration of drugs 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.