The following factors may contribute to the development of osteoarthritis of the knee joints:
- excessive physical activity that does not meet the age requirements, leading to joint damage;
- sedentary lifestyle;
- slight damage to the knee joint - dislocations of the knee, fractures, fractures and tears in the ligaments, damage to the body of the meniscus, severe falls on the knee, bruising;
- increased body mass index, causing increased stress on the joints, meniscus rupture;
- heredity;
- arthritis or other joint diseases (inflammation can lead to the appearance of edema or accumulation of a large amount of synovial fluid in the joints, causing the destruction of cartilage tissue);
- metabolic disorders that lead to the excretion of calcium from the body;
- diabetes mellitus of any type, hormonal disorders and other pathologies of the endocrine system;
- chronic or previous diseases of an inflammatory and infectious nature;
- violation of blood flow;
- lupus erythematosus, rheumatoid, rheumatoid and psoriatic pathologies, ankylosing spondylitis;
- flat feet, due to which the center of gravity shifts and the load on the joint increases;
- nervous overload and stressful situations.
Why osteoarthritis of the knee joint occurs
Most often, people themselves become the culprits for the development of such a difficult disease. Often, when pain occurs in the knee joint, people ignore the painful sensations and prefer to go to the doctor to use medication that simply masks the pain.
After a few years, you should still consult a specialist, as self-medication does not give a result with such a diagnosis. However, the severity of osteoarthritis will be at least average. Here, ointments, intra-articular administration of hyaluronic acid and preventive physical exercise are no longer enough as one could do in the early stages of the disease course. Most likely, it will be necessary to act radically, including sometimes with the use of surgery.
Symptoms and diagnosis of osteoarthritis of the knee joints
The disease can be distinguished by the following features:
- Pain syndrome. Painful sensations usually occur suddenly, but most often by physical exertion, even a small one. The pain may be of a different nature. To begin with, these will be weak lumbago (unfortunately, few people are aware of them). Mild pain that occurs only periodically can last for months or even years until the disease progresses to a more severe stage.
- Pronounced knee deformity. A similar symptom is typical of the later stages. And in the beginning of the development of osteoarthritis, the knee swells and swells a little.
- The appearance of dense formations in the posterior wall of the knee joint. Accumulation of a large amount of synovial fluid in the cavity of Baker's cyst or in the joint itself.
- A sharp crunch of joints, which is accompanied by pain.
- Impaired joint mobility. This is especially pronounced in the last stages of osteoarthritis. In this case, flexion and elongation of the knee cause severe pain, and in the final stages, movement becomes almost impossible.
Pathogenesis of osteoarthritis of the knee joints
Specialists distinguish between primary and secondary osteoarthritis.
Primary osteoarthritis of the knee joints
For primary gonarthrosis, the following processes are characteristic:
- Articular cartilage is able to constantly deteriorate and at the same time quickly renew. Under normal circumstances, these two processes should balance each other. With age, the destruction of cartilage occurs at the same rate, but its recovery is slowed down. The mass of a person plays an important role here. In fact, if the mass of a person is 70 kg, in 10 steps on one leg he will transfer 700 kg and the one who weighs 120 kg will transfer as much as 1200 kg, which will be a significant load on the joints and cartilage, which will wear faster because of this.
- It is important to remember: the joint feeds only on useful elements when it moves. A sedentary lifestyle leads to a slowdown in metabolic processes, which is why the necessary nutrients do not reach their destination.
- The likelihood of developing gonarthrosis increases in people whose parents suffered from this disease.
Secondary osteoarthritis of the knee joint
It develops for the following reasons:
- Several injuries. In a person of all ages, they will cause excessive stress on the cartilage. When a bone covered with cartilage is broken, irregularities, the so-called "steps", occur. In this area, now, with every movement, the joint will wear off, leading to osteoarthritis.
- Development of rheumatoid arthritis, Koenig's disease, the appearance of purulent inflammation in the joint area.
- Vascular dysfunction.
Classification and developmental stages of osteoarthritis of the knee joints
Orthopedists divide gonarthrosis into stages on which further treatment of the disease depends. The course of treatment will of course also depend on other factors, for example the causes of the osteoarthritis' development, location and nature.
The main classification divides gonarthrosis into four stages of development:
- Preliminary phase. At this stage, the disease is just emerging. External symptoms are almost imperceptible or completely absent, the shape of the joint is in a satisfactory state. The symptoms include only mild discomfort or heaviness in the knee after long walks, as well as strong physical exertion. An X-ray examination will be of little information: an X-ray image can only show a small narrowing of the joint space. Unfortunately, a person at this stage does not seek medical attention due to the insignificance of the symptoms.
- The second stage is characterized by a noticeable pain syndrome, especially when walking and walking on stairs, as well as at night. The severity of pain decreases at rest. Joint movements become difficult. A crunch or creak in the knees is heard during walking. On the X-ray image, the narrowing of the joint space becomes noticeable, as well as osteophytes. The patient begins to limp.
- Once osteoarthritis has entered the third stage, the pain syndrome will be felt constantly, even in the absence of movement. The processes of deformation and degeneration go into an irreversible stage. Distortion of the joint is pronounced, the distance between the articular surfaces is markedly reduced, numerous osteophytes increase in size. Painful sensations now disturb the patient even in a state of complete rest. A person becomes dependent on outside support (walkers, canes) and requires help from other people. Conservative treatment at this stage is less effective.
- The fourth stage is characterized by constant debilitating pain. Osteophytic growths increase in number and size, the cartilage is completely destroyed, the joint space is hardly traced or completely absent, the bones are severely deformed. Even weak movements turn into torture for the patient. At this stage of gonarthrosis, the patient is recognized as disabled. In the absence of surgery, the disease can lead to disability.
Complications of osteoarthritis of the knee joints
Advanced osteoarthritis can lead to dislocations and subluxations of the knee joint. In dislocation, the epiphysis of the femur extends completely outside the joint, due to which movement in the joint becomes impossible, and the axis of the bone is significantly displaced to the side. Fortunately, such a negative variant of the development of the disease is quite rare.
Subluxations are more common. They are characterized by a partial displacement of the joints relative to each other and a slight deviation of the tibial axis. In this case, subluxations are accompanied by severe pain and dysfunction of the joints.
Neglect of the disease can lead to a complete loss of functionality of the lower extremities.
Consequences of neglected gonarthrosis
The advanced stage of gonarthrosis is almost always characterized by the following adverse symptoms:
- pain around the clock that no painkiller can save;
- loss of support for a limb (it is impossible to stand on a sore leg or at least lean on);
- immobilization of articular block;
- pronounced curvature of the bones around the knee;
- severe swelling around the affected area.
Methods of treating osteoarthritis of the knee joint
The prescribed treatment depends on the degree of development of the disease. There are several therapy options.
Hormones
These drugs are prescribed for severe exacerbation, accompanied by synovitis and severe pain. Hormones are usually given by injection. The following drugs are most commonly used:
- Flosteron;
- Diprosfan;
- Hydrocortisone.
The course of treatment with hormones is usually short; injections are performed only during a period of severe exacerbation. Hormones are administered at an average frequency of once every 10 days.
Chondroprotectors
Chondroprotectors are prescribed in the initial stage of the development of the disease. This therapy is currently considered the most effective and safest: there are virtually no contraindications, and side effects occur in the rarest of cases.
The drugs are aimed at restoring cartilage, improving metabolic processes, nourishing cartilage tissue and protecting it from further destruction. But in the last stages of osteoarthritis, chondroprotectors are also powerless.
This group of drugs is prepared in the form of injections, ointments, gels, tablets.
Vasodilatory drugs
These agents are necessary to eliminate spasms from small vessels, increase blood circulation and the supply of nutrients to the area of the affected joint. Prescribed to take vasodilators along with chondroprotectors.
If articular fluid does not accumulate during gonarthrosis (there is no synovitis), it is recommended to use warming ointments.
Hyaluronic acid
In another way, this tool is called an intra-articular fluid prosthesis, as the composition of the acid resembles the intra-articular fluid. When acid is injected into the joint, it forms a membrane that prevents heavy friction of the cartilage during movement, affects the extracellular matrix, improves metabolic processes in the joint, and also triggers the production of its own hyaluronic acid in the joint - ie. the function of the joint returns to normal, which stops the pathological processes that destroy cartilage. . . .
Acid treatment is only prescribed when exacerbation - synovitis is eliminated.
Physiotherapy
A course of physiotherapy exercises will only give positive results if it was prescribed by a doctor after a complete examination of the medical history and all exercises are performed under the supervision of a specialist.
Self-medication often leads to a worsening of the joint situation. Exercise therapy is designated for the following purposes:
- slow the development of stiffness;
- prevention of further destruction of cartilage tissue;
- elimination of muscle spasms, leading to pain.
Physiotherapy
As an additional therapy, various procedures can be prescribed: electrophoresis, acupuncture, laser therapy, UHF as well as diadynamic currents. Local massage will also give a good result.
Physiotherapy is aimed at reducing the severity of pain, eliminating inflammation, normalizing metabolic processes inside the affected joint and restoring its normal function.
Forecast. Prophylaxis
With an advanced stage of the disease, the prognosis is disappointing. Therefore, it is recommended that if even minor symptoms of osteoarthritis occur, consult a physician for advice.
People at risk (elderly, athletes as well as overweight) must follow the doctor's recommendations and adhere to the following rules:
- Eat right and control your weight. Follow a weight loss diet as needed.
- Reduce the strain on the joints while exercising, monitor it constantly.
- Timely treatment of infectious diseases, prevents their transition to the chronic phase.
- Get adequate rest, avoid stressful situations if possible.
- Increase the body's protective functions (take periodic vitamins, temperament).
- Avoid hypothermia in the body, especially the lower extremities.