Treatment of osteoarthritis of the knee joint

Osteoarthritis of the knee jointis a degenerative-dystrophic disease of the cartilage tissue, which leads to exposure of the bone heads and reduced mobility of the joint. The disease has a non-inflammatory nature and progresses slowly: the transition from the initial stage to disability takes from several years to several decades. Knee osteoarthritis is one of the top 5 causes of disability and disability in the world.

Osteoarthritis of the knee (gonarthrosis) affects more than 20% of people over the age of 55, but the disease is rapidly aging - more and more its symptoms appear at 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 of the 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 reduced joint mobility (warm-up is required upon awakening);
• pain and discomfort in the knees, which increase after physical exertion (long walking, running or standing) and lessen with rest;
• in the 2nd stage - the so-called. initial pain that occurs after a long stay in one position;
• increased fatigue, which is often attributed to age-related changes;
• dry and rough crunch, which is repeated regularly when bending and bending the knees;
• edema and other symptoms of inflammation that appear at the 2nd stage of the disease due to trauma to the periarticular tissues;
• meteosensitivity, increased symptoms in the cold season.

When an attempt is made to bend the knee affected by knee arthritis to the stop, there is severe pain and a sensation of physical obstruction. In the later stages, even with the treatment of osteoarthritis of the knee joint, patients have a disturbed gait (it becomes swaying, patients walk on stiff legs), the deformity of the lower limbs appears in the form of letters "O" or "X".

The insidiousness of the disease lies in the fact that it can proceed in a latent form for years, and the first significant symptoms often appear only at 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 the production of synovial fluid is insufficient. Remember: knee pain is not normal, regardless of age. Timely examination and treatment of 1st degree knee joint osteoarthritis can completely protect you from stabbing pain in the joints in old age.

What happens if knee osteoarthritis is not treated?

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

Especially important is the effective treatment of osteoarthritis of the knees in the acute stage. It can be provoked by wet cold, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in a word, any shock to the body. Exacerbation 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 areas of cartilage also suffer: cell membranes thin, foci of erosion appear on the synovial lining of the joint. This process, if not interrupted by the treatment of osteoarthritis of the knee with drugs, can last for several weeks, and with chronic stress, lack of sleep or insufficient diet, it can be permanent.

Ultimately, without treatment, osteoarthritis of the knee leads to a complete reduction of the lumen of the joint space due to the growth of osteophytes. The space required for normal movement closes and the patient cannot bend the leg even 30-45 °. The difficulty is not only climbing the stairs, but also trying to get up from the sofa or the normal movement. This condition is accompanied by pain, from which conventional analgesics do not help. In these cases, there is only one option for the treatment of osteoarthritis of the knee joint - surgical, with a complete replacement of the joint architecture with a prosthesis and subsequent long-term rehabilitation. But even then, most patients fail 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 osteoarthritis of the knee joint is used.

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

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 can decide on minor surgical interventions in the joint if the disease develops so aggressive 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 the joint's range of motion. For this, the patient is prescribed an orthopedic regimen of loads and rest, drugs of 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 bag. In this case, PRP (platelet rich plasma) injections and stem cell injections obtained from the patient's own adipose tissue are used. In parallel, auxiliary and rehabilitative methods are connected: physiotherapy, massage, manual therapy, therapeutic exercises.

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

• Knee arthroscopy. The collective name for a group of minimally invasive operations aimed at removing a ruptured piece of joint tissue or osteophyte, or partial excision of the joint membrane. It allows you to delay or exclude implants, 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 the age of 60.
• Osteotomy. An operation to cut part of the bone and correct the load axis on the affected knee, which allows to slow down degenerative changes. It is usually performed in the treatment of osteoarthritis of the 2nd degree knee joint.
• Endoprosthesis. 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 some risks. Recommended for patients over the age of 55.

All these operations require a recovery period and have a number of contraindications, so the best option is prevention (physical therapy, chondroprotectors) and treatment of osteoarthritis of the knee 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 orthoses are used (walking sticks, orthopedic insoles, etc. ).

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

Therapeutic exercises for osteoarthritis of the knee

Therapeutic exercise for the limbs of the lower girdle is considered the most effective method of reducing pain and treating osteoarthritis of the 1st degree knee joint. The first results of therapeutic exercises come after 2-4 weeks of continuous training. Continuity in the treatment of osteoarthritis of the knee joint is one of the main factors influencing the effectiveness of physical therapy. A full-fledged lesson 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 lower leg, maintain the elasticity of the ligaments and tendons, and combat muscle atrophy, which is characteristic of arthrosis. This allows you to transfer the load from the joint to the periarticular structures - and thus slow down 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 severe pain, the session should be stopped or continued at a more gentle pace.

1. Starting position - lying on your back. One leg is stretched on the floor, the other is raised bent 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. We do the exercise on a bicycle.
3. Starting position - lying on your stomach. We swing our legs in turn, trying to bring the heels as close as possible to the buttocks.
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 get up with the straight leg. Let's change 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 "themselves".
6. Starting position - lying on your stomach. Let's do the "boat" exercise. If fitness does not allow, we put our palms on both sides of the chest and bring our legs back in turn, experiencing tension in the back of the thigh and lower leg.
7. Starting position - lying on your back. We rotate our feet alternately, trying to describe the full circle with socks.
8. Starting position - standing against the wall. We squat slowly and smoothly, without lifting our back from the wall, to distribute the load. When the legs are bent at the knees 90 °, we start a smooth upward movement.
9. Starting position - standing. Alternatively, we swing the legs forward, backward and sideways.

Note: Therapeutic exercises after joint surgery have their own specificities 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 10-12 sessions are usually necessary with a masseur-rehabilitator or with the help of hydromassage equipment, however it is possible to perform a simple restorative massage at home. It includes the following types of movement:

• superficial stroking and rubbing (up and down, clockwise and counterclockwise);
• probe and stretch the deeper tissues with the fingertips;
• pinch and tap on the skin.

Knee osteoarthritis massage should be performed by a specialist who does not damage the diseased joint

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

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

Diet therapy for arthritis

The standard nutritional protocol for the treatment of osteoarthritis of the knee requires:

• limit foods and dishes rich in simple carbohydrates (white bread, pastry, snacks, sweets, potatoes, sugar);
• exclude processed (ready-to-eat) and salt-rich dishes - fast food, semi-finished products, sausages;
• avoid alcohol, decaffeinated coffee and fatty meats.

Instead, include in the menu:

• dishes based on sprouted and whole grains;
• oily fish from the north seas and dietary poultry meat;
• cartilage (ears, nyushki, paws and other parts of farm animals rich in collagen), aspic and gelatin;
• 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 arthrosis of the knee joint with drugs - vitamin-mineral complexes (2 courses per year).

Physiotherapy for the treatment of osteoarthritis of the knee

The following physiotherapy procedures are used to effectively treat osteoarthritis of the knees and enhance the effect of drugs:

• magnetotherapy;
• laser therapy;
• UHF;
• ultrasound therapy;
• breadth;
• electrophoresis (including medicinal - with analgin, novocaine or chymotrypsin);
• applications of ozokerite and paraffin;
• thermotherapy (cryotherapy, inductothermy);
• phonophoresis (in particular, with hydrocortisone);
• balneological therapy (sulfur baths, hydrogen sulphide).

Acupuncture in the treatment of arthrosis of the knee joint of the 2nd degree, as a rule, is not used.

Before visiting the procedures, you need to consult with 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 arthrosis 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 the treatment of osteoarthritis of the knee - is usually prescribed in courses or as needed.

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

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

Non-steroidal anti-inflammatories

To relieve 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 ulcer. They should be taken with extreme caution in combination with glucocorticosteroids and drugs that affect blood clotting. Additional risk factors are age over 65, smoking, alcohol consumption during the course. In these cases, doctors usually recommend injecting drugs, bypassing the gastrointestinal tract. Together with NSAIDs, it is desirable to take gastroprotectors.

The maximum effect can be achieved with a combination of systemic (for internal use) and external NSAIDs, in the form of ointments, creams or gels. The second option provides a point effect on the affected joint and at the same time minimally affects digestion.

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

Hormonal drugs (HA) are usually used for so-called. steroid blockade of the knee in cases where NSAIDs are not sufficient to relieve pain and inflammation.

Injections of glucocorticoids are considered a last resort in treating osteoarthritis of the knee with medications. They provide relief as early as 20 minutes after administration, but can lead to hormonal imbalances and cartilage damage if taken improperly. Because of the 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 molluscs contribute to the restoration of the synovial cartilage, and therefore are indispensable for the effective treatment of osteoarthritis of the knee. Chondroprotectors contain a large number of glycosaminoglycans, natural polymers from which cartilage tissue is built. Thus, 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 and prolonged effect: the first improvements occur after 1-3 months after 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 irritating effect 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, chili extract.

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

Synovial fluid prosthesis

If there is too little synovial fluid in the joint, the sliding of the joint surfaces is disturbed. And most importantly, 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 cellular 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 arthrosis of the knee joint (viscosupplementation) are carried out directly into the joint capsule, which leads to rapid relief, which lasts from 3 to 12 months after the completion of the course. However, with the introduction of the prostheses, the risk of necrotic changes or infections of 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 pain, but do not relieve inflammation. You can use them or NSAIDs available without a prescription for up to 10 days, after which an examination is required.

Form of release 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 osteoarthritis of the knee have several forms of release: sachets, injections, ointments, tablets. Choose the one that 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 in oral form. In this case they are easy to dose, reception is possible without the participation of a health worker, it is easy to check which part of the course has already been completed. When taken orally, chondroprotectors and NSAIDs have a fairly 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 implants. This method of treating arthrosis of the knee joint with drugs demonstrates the maximum bioavailability.

This method of treating osteoarthritis of the knee with drugs is safe for digestion, but it is desirable that injections (intravenously, intramuscularly in the joint area or intra-articular) are 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 osteoarthritis of the knee joint. The advantage of this drug administration is the direct effect on the affected tissue. But the skin barrier hinders the active ingredients - unfortunately, often only 5% of the active ingredients reach the desired tissue layers.