How is knee osteoarthritis diagnosed and treated?

Osteoarthritis of the knee joint is also called gonarthrosis or deforming osteoarthritis. The disease can have serious consequences, including disability. At the first signs of knee osteoarthritis, 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 covers the joint surface. As a result of such changes, the functionality of the joint is affected and pain appears.

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

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

With knee osteoarthritis, the cartilage nutrition mechanisms are altered, so its function is gradually altered. Among osteoarthritis of various locations, 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. Elderly women are at risk of developing primary pathology, especially in the presence of overweight: obesity of 2 or 3 degrees.

There is an opinion that primary knee osteoarthritis is associated with average life expectancy. Compared to centuries past, it has increased dramatically and joints simply wear out over time.

Gonarthrosis associated with natural aging is considered normal. If the articular cartilage is destroyed earlier or this process is too intense, this condition is considered pathological.

Causes of secondary osteoarthritis of the knee joint

Secondary knee osteoarthritis can be triggered by the following factors:

• genetic predisposition, provided it can be clearly traced;
• leg fracture;
• 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 extremities - valgus or varus;
• congenital shortening of a limb;
• metabolic syndrome;
• drop;
• acromegaly;
• osteomyelitis;
• chondrocalcinosis;
• pathologies associated with the exchange of material;
• joint hypermobility: the ligamentous apparatus is inherently weak;
• hemochromatosis;
• diabetes mellitus;
• endocrine system pathology.

There are many possible causes of deforming osteoarthritis, which is why this condition is called polyetiological. Often the exact cause of the disease cannot be identified, so a diagnosis of primary (idiopathic) knee osteoarthritis is made.

Gonarthrosis symptoms

In addition to pain (the main symptom), the pathology can be accompanied by the following symptoms:

• Crunch and click.These symptoms often appear during movement and are often ignored by patients. A crack in the knee can mean that grooves, osteophytes, ulceration have appeared on the joint surfaces.
• Restricted movements.This symptom is very important during the diagnosis, since it allows to differentiate gonarthrosis from other pathologies that affect the musculoskeletal system. Movement is usually stiff in the morning. When a person begins to walk, this symptom disappears in half an hour. If the stiffness persists for an hour or more, this may indicate an inflammatory process or other pathology.
• Reduced range of movement.This symptom implies that the patient cannot fully bend the knee. This is due to pain syndrome, softening the intensity of which a person tries to move his leg less. Over time, this leads to a shortening of the ligaments, which is called contractures.
• Stuck board.Gonarthrosis can cause the joint to lock 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 knee ligaments are pulled, which protrude from the pineal glands. In this case, only 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 may be a part of the meniscus or a fragment of an osteophyte.

Disease classification

Each of the stages 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 by X-ray. 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 the pain, which until now appears only when moving. Its intensity can vary.
2. In the second (moderate) stageof knee osteoarthritis, pathological changes are visible even 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 is manifested by the least load, and when walking or squatting, the knee begins to creak.
3. Stage three (severe)of deforming osteoarthritis is diagnosed when there is virtually no cartilage tissue in the joint. If the pathology is difficult, the bones can grow together, which will lead to complete immobility of the affected limb.

The exact stage of knee osteoarthritis is determined by a specialist. In this case, you need to focus not on the symptoms of the disease, but on the received radiographs. Pathology does not always follow the standard pattern.

Diagnosis

Only instrumental diagnostics will help determine deforming osteoarthritis:

• radiography;
• ultrasound scan;
• tomography: magnetic resonance imaging or computerized;
• arthroscopy;
• thermography;
• scintigraphy.

An X-ray is often sufficient to detect knee osteoarthritis. It is done 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 from?

In the case of deforming osteoarthritis, different specialists may intervene. In a conventional clinic, they usually consult a surgeon.

Arthrologist, rheumatologist, orthopedist usually deal with the problems of gonarthrosis. In addition, the participation of a chiropractor, arthroscopist may be required. A physical therapist, a physical therapy instructor, a qualified massage therapist in the field is usually involved in the treatment process.

Treatment of knee osteoarthritis

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

Drug therapy

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

• Non-steroidal anti-inflammatory group preparations.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, and gels are preferred. Nonsteroidal anti-inflammatory drugs not only fight inflammation, but also reduce pain.
• Corticosteroids.These drugs are often 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 drug into the joint capsule. Corticosteroids are used as symptomatic therapy to eliminate inflammation and severe pain.
• Painkillers.When prescribing such medications, the severity of the pain syndrome is taken into account. If the pain syndrome is of high intensity, they turn to strong opioids.
• Chondroprotectors.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, therefore they are used for long therapeutic courses. Such drugs are appropriate for pathology of 1 or 2 degrees.
• Antispasmodics and muscle relaxants.These medications are necessary when the pathology is accompanied by muscle spasms.
• Vasodilator medications.These medications improve blood flow and 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.

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

Physiotherapy

With deforming osteoarthritis, various physiotherapeutic methods are actively used. They are used for various purposes: reducing pain, relieving inflammation, activating the blood supply, and speeding up recovery.

The following physiotherapy methods are effective for osteoarthritis of the knee:

• Phonophoresis.This technique is an ultrasound therapy combined with the effects of medication. Due to high-frequency vibrations, the tissues of the knee joint heat up, which ensures a deeper penetration of medicinal substances into them.
• Shock wave therapy.The procedure uses a special device that generates radial acoustic waves. Under its action, the blood supply in the periarticular region is activated, which stimulates the restoration of cartilaginous and bone structures.
• Ozone therapy.This procedure involves the use of active oxygen. Provides analgesic and anti-inflammatory effects on tissues.
• Electrostimulation.This technique is often used during rehabilitation, as well as in the presence of contraindications to exercise. Under the influence of electrical impulses, it increases muscle tone and improves blood circulation.
• Diathermy.This technique refers to electrotherapy and involves the use of high-frequency, high-resistance 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 syndrome, relieves muscle spasm.
• Hirudotherapy.This technique is considered an alternative. Leeches are placed around the affected joint. The procedure provides good pain relief, relieves swelling and stimulates regeneration.
• Laser therapy.This technique is generally used at an early stage of the pathology. Provides anti-inflammatory, analgesic and stimulating effects.
• Plasma therapy.This procedure is also called joint plasmolifting. It involves intra-articular injections. For them, the patient's own 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 pathology. This technique relieves swelling, eliminates pain, and allows you to restore joint mobility.

exercise therapy

Physical therapy is necessary for knee osteoarthritis. The different exercises must be supervised by a qualified professional. The main goal of exercise therapy is to restore joint mobility and achieve a certain range of motion. You also need to increase muscle strength and endurance.

Exercise therapy is not used during periods of disease exacerbation. At this time, the joint needs rest and maximum relief. Locomotor activity is allowed when inflammation and pain are relieved, from this moment at least 5 days must elapse.

The exercise therapy program should be developed individually for each patient. It is necessary to take into account the peculiarities of the course of the disease, the degree of severity, the individual characteristics of the patient.

Gymnastics

At home, a patient with knee osteoarthritis can do some exercises independently. You should do it in stages: first you need to warm up, then do strength exercises, and finish with stretching.

Heating is carried out as follows:

• Spread your feet shoulder-width apart and lower your arms along your body or lean against the back of a chair. Slowly rise up onto your toes, stopping at the extreme point for 3 seconds, then gently transfer the weight to your heels, lifting your toes as high as possible. Do 10 repetitions without making 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. The movements should be slow and fluid.
• Lie on your back, raise your bent knees and simulate the rotation of the bicycle pedals. It takes half a minute to perform rotational movements in one direction and then in the other. Move slowly.
• Place your feet shoulder-width apart, straighten your back, and bend your elbows. Simulate running in place, alternating weight from one leg to the other. The movements should be performed on the toes, not leaning on the heels. Do the exercise for about 5 minutes.

Surgery

Deforming osteoarthritis may require surgical treatment. They resort to the following options:

• Puncture.This procedure is minimally invasive. It is used not only to study intra-articular fluid, but also to remove its 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 separate operation or be one of its stages. This technique is endoscopic and does not require dissection of the joint cavity. Thin and flexible special instruments are used for the operation, and all manipulation is controlled by a micro video camera. If arthroscopy is used as a separate operation, during the arthroscopy, the joint 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 cut and then fixed in a different position. This surgical procedure is appropriate for grade 1 or 2 deforming osteoarthritis.
• Endoprosthesis.This operation is used when the third degree of knee osteoarthritis is diagnosed. During surgery, the knee joint is replaced with a biocompatible construction. It is necessary to restore the previous range of motion and the normal quality of life of the patient. Endoprosthesis is quite a complicated operation and therefore requires a long period of rehabilitation.

Diet and general recommendations

Although the pathology affects the knee joint, its treatment implies adherence to diet. It must comply with the following principles:

• If necessary, normalize body weight. The BMI should not be higher than 20. Weight loss should be gradual: 2-3 kg per month.
• Cut down on carbohydrates and animal fats.
• Most of the fat you eat should be plant-based.
• You should eat fish at least 1-2 times a week.
• You should eat little. The portion should be small, but there should be between 5 and 6 meals a day.
• Finish each meal with a vegetable or fruit.
• To cook, you must choose to cook, including steaming, stewing, and baking.
• Observe the drinking regimen. On average, a person needs 2 liters of liquid a day and, for the most part, it should be clean non-carbonated water.
• 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, hot peppers, white cabbage, sour fruits should be excluded from the diet.
• It is useful to eat jelly meat, jelly jelly, cheese, cottage cheese, chicken, legumes.

Traditional medicine

In the treatment of deforming osteoarthritis, unconventional methods are also appropriate. In this case, it is advisable to consult a specialist, since even the use of natural remedies has contraindications.

Use the following popular recipes effectively:

• Lubricate the back of the burdock leaf with honey, apply to the affected area, fix with cellophane and isolate. Keep the compress up to 4 hours.
• You can use a cabbage leaf instead of burdock. You can knead it with your hands or poke it in various 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 insist. Drink a tablespoon 5 times a day.
• Rinse the potato sprouts, place in a glass container and cover with rubbing alcohol. Let stand in the dark for 3 weeks, strain and use three times a day to rub the affected areas.
• Heat the honey in a water bath to a liquid state and rub into the affected knee, massaging it. Cover the treated area with a 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 over low heat. Wrap the cooled mixture in a natural cloth, apply to the affected area and fix with polyethylene. Prepare a new mixture each time.
• Also mix iodine with honey and glycerin, leave to act for 3 hours. Dip a cotton ball in the resulting composition and process the knee and the 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, strain and apply to the affected areas before going to bed.
• Grind white school chalk and mix it with yogurt or sour cream to make a thick porridge. Wrap it in natural cloth and make a compress for 2. 5 hours, insulating it with polyethylene. Repeat the procedure every day.
• Boil two large onions with peel in a liter of distilled water, strain. Drink the resulting infusion three times a day before meals.

The treatment of knee osteoarthritis should not be limited to traditional medicine. This disease requires an integrated approach, which necessarily includes drug therapy and exercise.

Prognosis, possible complications

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

The following factors influence the prognosis of knee osteoarthritis:

• Age of the patient.The younger you are, the less favorable the prognosis. The pathological process develops gradually, therefore, with joint damage in young people, the disease can reach the last stage in old age and cause various complications.
• Type of osteoarthritis.In primary pathology, only the joint is affected and the disease usually progresses slowly. With a secondary disease, there are other disorders that can accelerate this process or cause complications.
• Compliance with doctor's orders.It is about taking the necessary medications, undergoing physiotherapy procedures, exercise therapy, ensuring the discharge of the joint. It is also important to observe the duration of drug therapy, since most drugs need to be taken regularly in certain courses.
• Body mass.If the patient is heavy, 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 subjected to regular stress or who are constantly on their feet, always suffer more. Sedentary work, when the joint is in one position for a long time, can also negatively affect the course of the disease.

Deforming osteoarthritis progresses slowly, but without proper treatment it can cause a number of complications:

• Joint deformity.This occurs in the late stage of the disease. The leg can be bent at an unnatural angle, which is not only aesthetically unpleasant, but can also cause a complete loss of joint functionality.
• Infection.A microtrauma, for example a crack in the cartilage tissue, can cause such a complication. The pathogen can enter the joint along with the current or lymph from the focus of infection. Surgical intervention: arthroscopy, diagnostic puncture can also be the cause of infection. The introduction of infections into the joint can lead to aseptic necrosis.
• Dislocation, fracture.Such complications occur against the background of a violation of the functionality 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 missing joint grow together. This is one of the most serious disorders, since due to the fixation of the lower leg in one position, motor function is lost.

In most cases, complications arise because of the patient, who neglected her illness or ignored the doctor's orders.

Prevention

To avoid knee osteoarthritis, some preventive measures should be taken:

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

Secondary prevention measures should also be highlighted. They are necessary when gonarthrosis has already been diagnosed and it is necessary to slow down its development. In this case, you must take the following actions:

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

Osteoarthritis of the knee joint is a serious pathology that has a poor prognosis and can cause a series of complications. It is necessary to start treatment as soon as possible to slow down the pathological process. The therapy must be comprehensive, some techniques must be part of the lifestyle: diet, exercise, taking certain medications.