Treatment of osteoarthritis of the knee joint

Osteoarthritis of the knee jointis a degenerative-dystrophic disease of the cartilage tissue that leads to the exposure of the bone heads and restricted movement in the joint. The disease is non-inflammatory and progresses slowly - 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 the age of 55, but the disease is becoming younger and younger - more and more often its symptoms appear by the age of 25.

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

Signs of osteoarthritis of the knee

Wear and tear 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 reduced mobility in the joint (a warm-up period is required after waking up);
• Pain and discomfort in the knees, which increases after physical exertion (long walks, runs or standing) and subsides with rest;
• in the 2nd stage - the so-called. beginning pain that occurs after staying in one position for a long time;
• increased fatigue, which is often attributed to age-related changes;
• dry harsh crunch, periodically repeated when bending and releasing the knees;
• Edema and other inflammatory symptoms that appear in 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 limit, there is severe pain and a feeling of a physical obstacle. In later stages, including in the treatment of arthrosis of the knee joint, patients have a disturbed gait (will waddle, patients walk on stiff legs), deformities of the lower limbs appear in the form of the letter "O" or "X ".

The insidiousness of the disease lies in the fact that it can proceed latently for years, and the first significant symptoms often appear only in the 2nd stage - when complete restoration of the synovial cartilage is no longer possible.
Therefore, it is important to consult a doctor at the first sign of discomfort in the knees - for example, faint, aching pain that occurs when there is insufficient production of synovial fluid. Remember: Knee pain is not normal, regardless of age. Timely examination and treatment of osteoarthritis of the knee joint of the first 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, arthrosis of the knee joint progresses on average 3-8 times faster than with complex therapy. If osteoarthritis of the knee becomes aggressive, the patient may lose the ability to move normally before reaching retirement age.

The effective treatment of knee arthrosis in the acute stage is particularly important. It can be provoked by cold, damp weather, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in a word, any physical shock. Aggravation of arthrosis occurs with the destruction of a large number of chondrocytes. In response, the body produces enzymes designed to process and remove dead cells. However, if their concentration is too high, healthy cartilage areas also suffer – cell membranes become thinner, and foci of erosion develop on the synovial membrane. This process can last for several weeks if not stopped by drug treatment for knee osteoarthritis and can be permanent in the case of chronic stress, lack of sleep or inadequate nutrition.

Ultimately, without treatment, osteoarthritis of the knee joint leads to a complete narrowing of the lumen of the joint space through the growth of osteophytes. The gap necessary for normal movement closes, and the patient cannot bend the leg even 30-45 °. The difficulty is not only when climbing stairs, but also when getting 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 treatment with complete replacement of the articular architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients do not manage 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 carried out.

Treatment of arthrosis of the knee joint of the 1st degree is always carried out using conservative methods - with a successful combination of circumstances and good self-discipline of the patient, healing of the disease or stable remission is possible.

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 surgery in the joint if the disease develops aggressively or with complications.

Treatment of grade 3 knee osteoarthritis almost always involves surgery.

Comprehensive conservative treatment of arthrosis of the knee joint includes eliminating pain and inflammation, restoring cartilage tissue and increasing the range of motion in the joint. For this, the patient is prescribed an orthopedic regime of loads and rest, systemic and local drugs (hormonal and non-hormonal anti-inflammatory drugs, 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 sac. In this case, PRP injections (platelet-rich plasma) and injections of stem cells from the patient's own fat tissue are used. In parallel, auxiliary and rehabilitation methods are connected - physiotherapy, massage, manual therapy, therapeutic exercises.

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

• Arthroscopy of the knee. The collective term for a group of minimally invasive surgeries aimed at removing a broken piece of joint tissue or osteophytes, or partially removing the synovial membrane. It allows you to delay or exclude prosthetics, as well as eliminate discomfort in the early stages of the disease. Mainly used to treat knee osteoarthritis in patients under the age of 60.
• osteotomy. Surgery that cuts through part of the bone and corrects the weight-bearing axis of the affected knee, which can help slow degenerative changes. It is usually performed in the treatment of second degree arthrosis of the knee joint.
• endoprosthetics. Partial or total replacement of the knee joint with a titanium implant that lasts 15-20 years. This technique is a last resort as it involves certain risks. Recommended for patients over 55 years of age.

All of 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 methods of treatment, diet therapy and other methods of reducing body weight are used. Bandages and other orthoses (canes, orthopedic insoles, etc. ) are used to relieve the diseased joint.

The treatment of knee osteoarthritis is prescribed by a rheumatologist or orthopedist. At the first appointment, they will palpate the joint, perform motor tests, and then refer the patient for a tomography or x-ray.

Therapeutic exercises in osteoarthritis of the knee

Therapeutic exercise for the lower girdle limbs is considered the most effective method of pain relief and treatment of arthrosis of the knee joint of the first degree. The first results of therapeutic exercises appear after 2-4 weeks of continuous training. Continuity in the treatment of osteoarthritis of the knee joint is one of the main factors affecting the effectiveness of exercise therapy. A full-fledged lesson takes place every day 1 time a day, it is also recommended to do at least 3-4 workouts during the day.

Therapeutic exercises for knee osteoarthritis in periods of remission will help relieve pain.

The main task of physical exercises in the treatment of arthrosis 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 wasting 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 to treat knee arthrosis are performed for both legs! If the pain is severe, the session should be stopped or continued at a gentler pace.

1. Starting position - lying on your back. One leg is stretched on the floor, the other is bent at 90° and lifted (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 alternately swing our legs, 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 stretched above the head in line with the body. The other hand rests on the side. We swing up with our legs stretched out. We change sides.
5. Starting position - lying on your back. We pull the legs along the floor with the heel forward (away from you), the socks "look at each other".
6. Starting position - lying on your stomach. We do the "boat" exercise. If physical fitness does not allow it, we put our palms on both sides of the chest and take our legs back in turn, feeling tension in the back of the thighs and lower legs.
7. Starting position - lying on your back. We alternately turn our feet and try to describe the full circle with the socks.
8. Starting position - standing against the wall. We squat slowly and evenly, without lifting our backs from the wall to distribute the load. When the legs are bent 90 ° at the knees, we begin a smooth upward movement.
9. Starting position - standing. Alternately we swing our legs forwards, backwards and sideways.

Please note: therapeutic exercises after joint surgery have their own specifics and vary 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. Initially, at least 10-12 sessions with a masseur-rehabilitologist or with the help of hydromassage devices are usually required, but a simple relaxing massage can be done at home. It includes the following types of movements:

• superficial stroking and rubbing (up and down, clockwise and counterclockwise);
• probing and stretching with fingertips in deeper tissues;
• Pinching and throbbing on the skin.

Massage for osteoarthritis of the knee should be performed by a specialist who will not damage the diseased joint

Self-massage can be combined with the treatment of arthrosis of the knee joint with medication: it will not be superfluous to apply warming ointment or balm before or during the session. You can also take a warm bath before the procedure.

Important: The massage is contraindicated in patients with symptoms of inflammation (osteoarthritis or arthrosis aggravation). In this case, acute phase therapy is required.

Nutritional 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, snack foods, sweets, potatoes, sugar);
• excluding processed (ready-to-eat) and high-salt dishes - fast food, semi-finished products, sausages;
• Avoid alcohol, decaffeinated coffee and fatty meats.

Instead, paste the following into the menu:

• sprouted and whole grain dishes;
• fatty fish of the northern seas and dietary poultry meat;
• cartilage (ears, nyushki, legs and other collagen-rich parts of farm animals), aspic 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.

Diet for knee osteoarthritis provides a balanced diet that helps repair cartilage.

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

Physiotherapy for the treatment of knee osteoarthritis

The following physiotherapeutic procedures are used to effectively treat knee arthrosis and enhance the effect of medication:

• magnetotherapy;
• laser therapy;
• UHF;
• ultrasound therapy;
• amplipulse;
• electrophoresis (including medicines - with analgin, novocaine or chymotrypsin);
• ozokerite and paraffin applications;
• thermotherapy (cryotherapy, induction thermal);
• phonophoresis (especially with hydrocortisone);
• Balneological therapy (sulphur, hydrogen sulfide baths).

Acupuncture in the treatment of arthrosis of the knee joint of the second degree is usually not used.

Before attending the procedures, it is necessary to consult your doctor - many types of physiotherapy are contraindicated in case of exacerbation of the disease.

Drugs used to treat osteoarthritis of the knee joint

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

To choose the right drugs to treat osteoarthritis of the knee joint, consult a doctor who, after research, will select the necessary drugs.

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

Non-steroidal anti-inflammatory drugs

To relieve exacerbations, depending on the intensity of the pain syndrome, NSAIDs in tablets or capsules are taken coursewise (about 12 days) or as needed. Uncontrolled intake of NSAIDs in violation of the doctor's orders or recommendations is fraught with an ulcer of the stomach or intestines. They should be taken with extreme caution in combination with glucocorticosteroids and drugs that affect blood clotting. Other risk factors are age over 65, smoking, drinking alcohol during the course. In these cases, doctors usually recommend injecting medication, bypassing the gastrointestinal tract. Along 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 - in the form of ointments, creams or gels. The second option provides a point effect on the affected joint, while having a minimal effect on digestion.

corticosteroids (steroid medicines 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 sufficient to reduce pain and inflammation.

Glucocorticoid injections are considered the last resort in the medical treatment of knee osteoarthritis. They provide relief just 20 minutes after ingestion, but can lead to hormonal imbalances and cartilage damage if taken improperly. Many orthopedists prefer knee surgery to long-term HA therapy because of side effects.

Chondroprotectors in the treatment of arthrosis of the knee joint

Chondroprotective active ingredients based on extracts from veins and cartilage of bovine, marine fish and shellfish contribute to the restoration of synovial cartilage and are therefore indispensable for 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 appear after 1-3 months after admission, and the duration of the course is 3-6 months.

skin irritants

External preparations for the treatment of knee arthrosis with local irritation improve blood circulation and nutrition of the joint, and also distract the patient from pain. For this purpose, ointments, gels, creams and balms based on natural ingredients are used - bee venom, paprika 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 andtopical anti-inflammatory agents.

synovial fluid prostheses

If there is too little synovial fluid in the joint, the gliding of the joint surfaces is disturbed. And above all, the cartilage begins to starve because the synovial fluid that nourishes it like a sponge normally provides nutrients for the growth and maintenance of the cartilage tissue. In order to prevent cell destruction and mechanical abrasion of the knee cartilage, the doctor can prescribe injections with high-molecular hyaluronic derivatives. Injections of the drug in the treatment of arthrosis of the knee joint (viscosupplementation) are made directly into the joint capsule, which provides rapid relief, which lasts from 3 to 12 months after the course is completed. However, when inserting prostheses, the risk of necrotic changes or infections in the joint remains.

Antispasmodics, analgesics, muscle relaxants

In cases where spasms and muscle tension prevent falling asleep, cause pain when moving, the doctor prescribes antispasmodic and muscle relaxants.

Simple analgesics are not used in the treatment of arthrosis of the knee joint, as 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 evaluation 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 osteoarthritis have different forms of release: sachets, injections, ointments, tablets. Choose what suits you best.

Capsules, sachets and tablets for the treatment of knee osteoarthritis

Nonsteroidal 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 staff, 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 drug treatment of arthrosis of the knee joint has maximum bioavailability.

This method of drug treatment of osteoarthritis of the knee is safe for digestion, but it is desirable that injections (intravenous, intramuscular to the joint area or intra-articular) be administered by qualified medical personnel. Intramuscular injections in the buttocks or thighs can be done independently.

Products for external use

Locally irritating, anti-inflammatory and chondroprotective ointments are used externally to treat osteoarthritis of the knee joint. The advantage of this drug administration is the direct effect on the affected tissue. But the skin barrier stands in the way of the active ingredients - unfortunately often only 5% of the active ingredients get into the desired tissue layers.