The deformation of the osteoarthritis of the knee joints (Aka Gonartrosi or Doa abbreviated) is a degenerative dyenerative disease of the knee joint, which is characterized by a constantly progressive chronic route and a joint of structural deviations, a disfuiting Lead, a joint of structural defers movements and often disabilities.
The disease begins with changes in the joint cartilage, due to which the joint surfaces of the bones occur.The interruption and loss of elasticity lead to its dystrophy (thinning) and to reabsorption, while the bone tissue of the joint surfaces is exposed, the sliding is disturbed, the joint gap is restricted, the joint biomechanics changes.The synovial shell that covers the joint and produces the synovial fluid is irritated (which nourishes the cartilage and plays the role of physiological lubrication), which leads to an increase in its quantity in the joint (synovite).Against the background of the narrowing of the joint gap, the volume of the joint decreases, the synovial fluid protrudes from the rear wall of the joint capsule, the Becker cyst is formed (which, reaching large dimensions, can cause pain in the poplitea pit).The thin and delicate tissue of the joint capsule is replaced by a raw connective tissue, the shape of the joint changes.The periosurpital bone tissue is growing, osteophytes are formed (pathological bone growths).Blood circulation in periarticular tissues is disturbed and underestimated metabolic products, irritating chemiorecerators, develops persistent pain syndrome.Against the background of a change in the anatomy of the joint, there is a violation of the work of the surrounding muscles, hypotrophy and spasm appear, a pace is disturbed.There is a persistent restriction of the volume of movements in the articulation (contracture), sometimes so pronounced that only rocking movements (rigidity) or a complete absence of movements (ankylosis) are possible.
Gonartrosis is a fairly common disease: they suffer from 10% of the total population of the planet and at the age of over 60, it affects every third person.
The causes of gonartrosis
- Bone injuries and joints.
- Inflammatory joint diseases (rheumatoid, clamidia arthritis, gout).
- Violation of mineral metabolism with various endocrinopathies (diabetes mellitus, paratiroid disease, bloodocromatosis).
- Diseases of the muscle system and neuropathy (chacot disease).
In addition to the main reasons, the adverse basic factors of the development of gonartrosis are also distinguished, which include:
- overweight (literally exerts pressure on the lower limbs);
- age (the disease is mainly subject to the elderly);
- female gender (according to statistics in a woman, they get sick more often);
- Increase in sport and professional physical effort.
Symptoms of osteoarthritis of the knee joints
- The pain that increases when walking and weakens alone.
- Difficulty of family and physiological movements in the joints.
- A "creaking" feature in the joints.
- The increase in the joints of the quantity and their visible deformation.
Gonartrosis phase
Clinical phase of the arthrosis of the knee joint
The disease crosses several phases.
- In the first phase, a person feels aloneA small feeling of discomfortOr "gravity" in the knee that disturbs himself during the long -term walk or an increase in physical effort.The radiological examination will not be an information: it is possible to identify only a small narrowing of the joint gap, there will be no other changes.
- The second stage is characteristicTangible pains, whose gravity is reduced to rest.There is a difficulty in the joints in the joints, when walking, you feel a characteristic "creaking" (from the patient you can feel a conventional phrase in everyday life - "the knees crunch").When leading the X -ray, there is a clearly distinguishable narrowing of the joint gap and individual osteophytes.
- When the transition of gonartrosis to the next, third phase,Pain will constantly disturb the patientIncluding at rest, there is a violation of the configuration of the joints, i.e. the deformation that intensifies due to the Edema at the time of the connection of the inflammation.Radiographies determine the narrowing of the joint gap of moderate and osteophytes.In the third phase, many are already requesting medical assistance, because the quality of life suffers significantly due to pain and difficulty in normal walking.
- The fourth phase is accompaniedSurrounding and grueling pain.The minimum attempts to move become a difficult test for humans, the deformation of the joints is visually evident, the walk is extremely difficult.X -Ray reveals significant changes: the articular gap in the images is not practically determined, multiple multiple osteophytes rude osteophytes, "joint mice" (fragments of the destructive bone that fall into the joint cavity).This phase of gonartrosis almost always involves disability.
Who treats the arthrosis of the knee joint?
The therapist, the rheumatologist and the generic doctor (family doctor) can provide qualified medical assistance for gonartrosis (family doctor), but these experts are treating the knee joint with simple arthrosis.When a synovitis occurs or the treatment prescribed by the therapist does not give the adequate effect, it is not possible to do without the help of an orthopedist.In situations where surgical assistance is required, the patient is sent to a specialized orthopedic traumatological department.
How and what to treat the arthrosis of the knee joint?
The methods for the treatment of arthrosis of the knee joint, known to the present day, are divided into conservative, drugs and non -drugs.
Non -pharmacological methods
Many patients ask themselves: "How to cure the arthrosis of the knee joint without pills?"By responding to him, with regret it is necessary to say that gonartrosis is a chronic disease, it is impossible to eliminate it forever.However, many existing methods today can significantly slow down its progression and improve the quality of the patient, especially if used in the early stages of the disease.
With the timely research of a doctor and the sufficient motivation of the patient for healing, sometimes it is sufficient to eliminate negative factors.For example, it is demonstratedOverweight reductionIt reduces the manifestation of the main symptoms of the disease.
Exclusion of pathological physical effort and on the contrary,Therapeutic gymnastics classesWith the use of rational physical programs, they reduce the intensity of pain.It has been shown that the exercises to strengthen the force of the hip muscle to four tested are comparable in force with anti -inflammatory drugs.
If we deal with the arthrosis of the knee joint, then we have to fightadequate nutrition: Improve the elastic properties of the joint cartilage will help the products containing a large amount of animal collagen (dietary meat and fish varieties) and chondroitin (shrimp, crabs, kril), saturated with vegetable collagen and papacchi dishes and papacchi floors, dessert dishes and pavoncini.On the contrary, a violation of metabolic processes in the body and the accumulation of excess weight up to obesity are enhanced.
The complex treatment of arthrosis of the knee joint also involves the appointment of very effective even with advanced forms of the diseasePhysiota -procedura.With widespread use in different categories of patients with this disease, it has shown its effectivenessMagnetotherapy: After several procedures, the intensity of the pain decreases, following the improvement of blood circulation, of the reduction of Edema and eliminating muscle spasm increases the mobility of the joint.The effect of magnetotherapy is particularly vivid during the development of active inflammation in the articulation: the gravity of Edema is significantly reduced, the phenomena of synovitis regresses.Not so popular, but no less effective in the treatment of knee joint with arthrosis are such methods of physiotherapy such asLaser and cryotherapy therapy(Cold exposure), in possession of a pronounced pain reliever effect.
Pharmacological treatment
In the effective treatment of the arthrosis of the knee joint, the following drugs are used.
Non -pounding anti -inflammatory drugsProducts in the forms for outsiders (various gels, ointments) and systemic use (tablets, candles, solutions), have long demonstrated their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By blocking inflammation at an enzymatic level, they eliminate joint pain and their swelling, they slow down the progression of the disease.It should be remembered that a prolonged systemic technique can cause the development and exacerbation of ulcerative processes in the gastrointestinal tract and also negatively influence the functions of the kidneys and the liver.Therefore, patients, taking the drug for a long time, should also prescribe drugs that protect the gastric mucosa and regularly monitor the laboratory indicators of the work of the internal organs.
Glucocorticosteroids (GKS)- hormonal drugs with a pronounced anti -inflammatory effect.Being a powerful anti -inflammatory agent, the GC have some contraindications, because they are able to call a series of significant side effects.In the forms of system for gonartrosis, they are practically not prescribed.As a rule, an effective treatment of osteoarthritis involves GC injections in weak points -mumans, which increases the intensity of the fight against inflammation and minimizes the risk of unwanted side effects of the drug.With a single introduction of the GCS, the effect of its use lasts up to 1 month.In accordance with national recommendations for the treatment of osteoarthritis, it is not necessary to perform more than three injections of the drug per year in the same articulation.
With "neglected" arthrosis, when a person experiences unbearable pains who do not even attenuate themselves at rest, violating normal sleep, the prescription is possiblepainkillers from opiates.These drugs are used only on the basis of the prescription of the doctor, which considers the feasibility of their appointment in any case.
Condroprotectors(with a literal translation - "Cartilage protection").This name is intended as various drugs united by a property - an effect that changes structural, i.e. the ability to slow down the degenerative changes in the cartilage and the narrowing of the joint gap.They are produced in forms both for oral administration (glucosamine, condroitin sulfate, plasties), and for the introduction to the joint cavity (IARLONATI).Of course, these medicines do not make up a miracle and do not "grow" a new cartilage, but they can suspend its destruction.To obtain a persistent effect, regular courses must be used for a long time.
Surgical treatment of joint illegal knee
The most popular type of surgical care for gonartrosis isEndopropostetic, that is, removing its articulation with a simultaneous installation of a metalloplostese that replaces it, whose design is similar to the anatomy of the knee joint of a person.At the same time, a prerequisite for this type of surgical treatment is: the absence of serious deformations of the paper, formed "false joints", muscle contractures and pronounced muscle atrophy.With a serious osteoporosis (a significant reduction in the mineral density of the bones), even endoprothetics does not show: the "sugar" bone will not remain the introduction of metal pins and the place of the installation, the rapid renewal (reabsorption) of the bone tissue will begin, pathological fractures may occur.Therefore, a timely solution to the problem of the need to install an endoprotesis is so significant: it should be accepted when the age and general conditions of the human body still allow you to perform surgery.
Despite the widespread prevalence of the endoprothetic of the knee joint, the results of these operations are often unsatisfactory and the percentage of complications is high.This is due to the design characteristics of endoprotesis and the complexity of the surgery itself (the replacement of the hip joint is much easier in technical terms).
Shunt arthromedula- Connection of the bone marrow channel of the femur with the knee joint cavity using a shunt - a cable metal tube.For this reason, the bone marrow of fat from the lower third of the femur enters the joint of the knee, nourishing and lubricating it, which reaches a significant reduction in pain.
In summary, the above, I would like to note that the treatment of gonartrosis is a complex social task.And although today medicine is not able to offer a drug that eliminates it forever, or other ways to completely treat this disorder, a healthy lifestyle, in a timely search for medical assistance and the implementation of the doctor's recommendations can suspend his progression.