Treatment of osteoarthritis of the knee joint

Osteoarthritis of the knee jointis a degenerative-dystrophic disease of the cartilaginous tissue, which leads to the exposure of the bony heads and impairment of joint mobility. The disease is non-inflammatory in nature and progresses slowly - the transition from the early stage to disability takes from several years to several decades. Knee osteoarthritis is one of the top 5 causes of disability and disability worldwide.

Osteoarthritis of the knee (gonarthrosis) affects more than 20% of people over age 55, but the disease is getting younger and younger - more and more of its symptoms appear at age 25.

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

Signs of knee osteoarthritis

The wear and tear of articular cartilage is accompanied by characteristic signs, the intensity of which depends on the stage of the disease.Most often, patients complain of:

• morning stiffness and decreased joint mobility (warm-up required upon waking);
• knee pain and discomfort, which increase after physical exertion (long walk, run or stand) and decrease with rest;
• in the 2nd phase - the call. initial 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 repeated regularly when bending and bending the knees;
• edema and other symptoms of inflammation 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 end, there is a sharp pain and a feeling of physical obstacle. In later stages, even with the treatment of arthrosis of the knee joint, patients have a disturbed gait (becomes waddling, patients walk with stiff legs), the 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 go on latently for years, and the first significant symptoms usually appear only in the 2nd stage - when complete restoration of the 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 1st degree knee arthrosis can completely protect you from excruciating joint pain in old age.

What happens if knee osteoarthritis is not treated?

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

Especially important is the effective treatment of knee arthrosis in the acute phase. It can be brought on by cold damp weather, physical or emotional stress, allergies, poisoning, moving to a different climate - in a word, any shock to the body. The 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 its concentration is too high, healthy areas of cartilage also suffer - cell membranes become thinner, foci of erosion appear in the synovial lining of the joint. This process, if not stopped by treating osteoarthritis of the knee with medication, can continue for several weeks, and with chronic stress, lack of sleep, or poor diet, it can be permanent.

Ultimately, without treatment, osteoarthritis of the knee leads to a complete reduction of the joint space lumen due to the growth of osteophytes. The gap needed for normal movement closes and the patient cannot bend the leg even 30-45°. The difficulty is not just climbing stairs, but also trying to get up from the couch or normal movement. This condition is accompanied by pain, from which conventional painkillers do not help. In these cases, there is only one option for the treatment of arthrosis of the knee joint - surgical, with complete replacement of the joint architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients are unable to return to a completely normal life.

Treatment of knee osteoarthritis

Depending on the stage of the disease and the condition of the joint, conservative or surgical treatment of osteoarthritis of the knee joint is used.

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

The treatment of arthrosis of the knee joint of the 2nd degree, as a rule, is based on the use of all conservative treatment methods, however, the doctor may decide on minor surgical interventions on the joint if the disease develops aggressively or with complications.

Treatment for grade 3 osteoarthritis of the knee almost always involves surgery.

Comprehensive conservative treatment of osteoarthritis of the knee joint involves removing pain and inflammation, restoring cartilage tissue, and increasing range of motion in the joint. For this, the patient is prescribed an orthopedic regimen of loads and rest, drugs with systemic and local action (hormonal and non-hormonal anti-inflammatory drugs, analgesics, chondroprotectors and others). Innovative biological methods are also gaining popularity - drug injections for the treatment of osteoarthritis of the knee joint directly into the joint pouch. In this case, injections of PRP (platelet-rich plasma) are used, in addition to 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 impotent.With this pathology, the doctor can prescribe the following interventions:

• Knee arthroscopy. The collective name for a group of minimally invasive operations designed to remove a broken piece of joint tissue or osteophyte, or partial excision of the joint membrane. It allows you to delay or exclude dentures, as well as eliminate discomfort in the early stages of the disease. Mainly used for the treatment of osteoarthritis of the knee in patients under 60 years of age.
• osteotomy. An operation to cut off part of the bone and correct the load axis in the affected knee, which makes it possible to slow down degenerative changes. It is usually performed in the treatment of 2nd degree osteoarthritis of the knee joint.
• Endoprostheses. 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 several 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. To unload the diseased joint, bandages and other orthotics (canes, orthopedic insoles, etc. ) are used.

Treatment of osteoarthritis of the knee is prescribed by a rheumatologist or orthopedist. At the first appointment, he palpates the joint, does motor tests, and then refers the patient for a CT scan or x-ray.

Therapeutic exercises for osteoarthritis of the knee

Therapeutic exercise for lower waist limbs is considered the most effective method for pain reduction and treatment of 1st degree knee arthrosis. 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 class is held 1 time a day every day, it is also recommended to do at least 3-4 workouts during the day.

Therapeutic exercises for osteoarthritis of the knee 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 leg, maintain the elasticity of the ligaments and tendons, in addition to combating muscle atrophy, which is characteristic of osteoarthritis. This makes it possible to transfer the load from the joint to the periarticular structures - and thus delay the mechanical abrasion of the cartilage, reduce inflammation.

Exercises for the treatment of osteoarthritis of the knee are performed for both legs! If there is 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 of 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 our 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 is on the side. We swing up with one straight leg. We switch 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 "boat" exercise. If physical fitness does not allow, we place the palms of the hands on either side of the chest and bring the legs back, experiencing tension in the back of the thigh and in the lower part of the leg.
7. Starting position - lying on your back. We alternately rotate our feet, trying to describe the full circle with the socks.
8. Starting position - standing against the wall. We squat down slowly and smoothly, without lifting our backs from the wall, to distribute the load. When the legs are bent at the knees at 90°, we begin a smooth upward movement.
9. Starting position - standing. Alternately, we swing our legs forward, backward, and to the sides.

Attention: 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.

Knee osteoarthritis massage

Therapeutic massage for osteoarthritis of the knee is performed on both legs. At the beginning, at least 10 to 12 sessions are usually needed with a massage therapist-rehabilitator or with the help of hydromassage equipment, however, a simple restorative massage can be performed at home. It includes the following types of moves:

• caressing and rubbing superficially (up and down, clockwise and counterclockwise);
• probing and fingertip stretching of deeper tissues;
• pinch and tap the skin.

Massage for osteoarthritis 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 medication: it will not be superfluous to apply a warming ointment or balm before or during the session. You can also take a hot shower 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:

• limiting 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, decaf coffee and fatty meats.

Instead, include in the menu:

• sprouted and whole grain dishes;
• fatty fish from the northern seas and dietary poultry meat;
• cartilage (ears, nyushki, legs and other collagen-rich farm animal parts), 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 Knee Osteoarthritis Diet provides a balanced diet that helps restore cartilage.

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

Physiotherapy for the treatment of knee osteoarthritis

The following physical therapy procedures are used to effectively treat osteoarthritis of the knees and enhance the effect of medications:

• magnetotherapy;
• laser therapy;
• UHF;
• ultrasound therapy;
• amplipulse;
• electrophoresis (including medicinal - with analgina, 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 your doctor - many types of physiotherapy are contraindicated in case of exacerbation of the disease.

Medicines for the treatment of osteoarthritis 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 drugs. Drug therapy - injections, ointments, or tablets for treating osteoarthritis of the knee - is usually prescribed in courses or as needed.

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

There are several directions in the treatment of osteoarthritis of the knee joint with drugs: to make the patient's life easier, to improve cartilage nutrition, to regenerate cartilaginous tissue and to maintain the normal musculoskeletal system.

Non-steroidal anti-inflammatory drugs

To alleviate exacerbations, NSAIDs in tablets or capsules are taken in cycles (about 12 days) or as needed, depending on the intensity of the pain syndrome. Uncontrolled intake of NSAIDs in violation of the doctor's instructions or recommendations is fraught with stomach or intestinal ulcers. They should be taken with extreme caution in combination with glucocorticosteroids and medications that affect blood clotting. Additional risk factors are age over 65 years, smoking, drinking alcohol during the course. In such cases, doctors often recommend injecting medication, bypassing the gastrointestinal tract. Along with NSAIDs, it is desirable to take gastroprotectants.

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 punctual effect on the affected joint and at the same time minimally affects digestion.

Corticosteroids (steroid medications used to treat osteoarthritis of the knee)

Hormonal drugs (HA) are generally used for so-called. Steroid blockage 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 knee osteoarthritis with drugs. They provide relief as early as 20 minutes after administration, but can lead to hormonal imbalances and cartilage damage if taken incorrectly. Due to side effects, many orthopedists prefer knee surgery to long-term HA therapy.

Chondroprotectors in the treatment of osteoarthritis 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 are therefore 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-inflammatories, chondroprotectors have practically no contraindications. They provide a cumulative and 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 osteoarthritis of the knee with a local irritant effect improve blood circulation and joint nutrition, as well as distract the patient from pain. For this, ointments, gels, creams and balms based on natural ingredients are used - bee venom, pepper extract.

In the presence of an allergic reaction (persistent redness and pain in the skin, rash), during pregnancy and lactation, as well as in the presence of other contraindications, it is better to avoid hot ointments for the treatment of arthrosis of the knee joint and limit warm baths, applications and external anti-inflammatories.

Synovial fluid prostheses

If there is too little synovial fluid in the joint, the sliding of joint surfaces is disturbed. Most importantly, the cartilage starvation begins, because the joint fluid that nourishes it like a sponge normally provides nutrients for the growth and maintenance of cartilage tissue. To prevent cell destruction and mechanical abrasion of the knee cartilage, the doctor may prescribe injections of high molecular weight hyaluronic derivatives. Injections of the drug in the treatment of osteoarthritis of the knee joint (viscosupplementation) are made directly into the joint capsule, which leads to rapid relief, which lasts for 3-12 months after 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 osteoarthritis of the knee joint, as they mask the pain but do not relieve the inflammation. You can use these or NSAIDs available without a prescription for up to 10 days, after which an exam is required.

Drug release form for the treatment of osteoarthritis of the knee joint

For the convenience of patients, drugs for the treatment of osteoarthritis of the knee joint are produced in various forms. Is there any difference between them and which one should I choose?

Preparations for the treatment of osteoarthritis of the knee have several forms of release: sachets, injections, ointments, tablets. Choose what suits you best.

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

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

Solutions for injections

In the form of injections, you can take the aforementioned NSAIDs, HA, chondroprotectors and muscle relaxants, as well as synovial fluid prostheses. This method of treating osteoarthritis of the knee joint with medications demonstrates maximum bioavailability.

This method of treating osteoarthritis of the knee with medication is safe for digestion, but it is desirable that the injections (intravenous, intramuscular in the joint area or intra-articular) be administered by qualified medical personnel. Intramuscular injections into 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 drug administration is the direct effect on the affected tissue. But the skin barrier gets in the way of active substances - unfortunately, often only 5% of active ingredients reach the desired tissue layers.