How is knee osteoarthritis diagnosed and treated?

5 December 2020

Knee osteoarthritis is otherwise called gonarthrosis or deforming osteoarthritis. The disease can lead to serious consequences, including disability. At the first signs of gonarthrosis, you should consult a doctor for diagnosis and treatment. Therapy should be completed in full accordance with other terms and prescriptions.

General characteristics of the disease

Gonarthrosis is a progressive cartilage lesion that coats the surface of the article. As a result of such changes, the functionality of the joint is impaired and pain appears.

Osteoarthritis deformity is chronic. In most cases, the disease progresses slowly, but several factors can accelerate its progression. This mainly concerns the individual characteristics of the body, the activity and physical activity of the patient, the accompanying pathologies.

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

With gonarthrosis, the feeding mechanisms of cartilage break down, so its function gradually breaks down. Among osteoarthritis of various localizations, knee joint pathology occurs in every third patient.

Causes of Primary Knee Osteoarthritis

This is the most common form of the disease. Older women are at risk of developing primary pathology, especially in the presence of overweight - 2 or 3 degree overweight.

There is an opinion that primary gonarthrosis is associated with average life expectancy. Compared to past centuries, it has grown significantly and the joints are simply consumed over time.

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

Causes of Secondary Knee Osteoarthritis

Secondary gonarthrosis can be caused by the following factors:

genetic predisposition, provided it is clearly traceable;
foot fracture;
knee joint displacement;
meniscus damage;
congenital dysplasia of the knee joint;
extreme physical activity (typical of athletes);
constant static load;
rheumatism;
rheumatoid arthritis (not to be confused with rheumatism);
ankylosing spondylitis;
congenital deformity of the lower extremities - valgus or varus;
congenital shortening of one limb;
metabolic syndrome;
gout;
acromegaly;
osteomyelitis;
chondrokalcinosis;
pathologies associated with material exchange;
articular hypermobility - the ligament apparatus is essentially weak;
hemochromatosis;
diabetes mellitus;
pathology of the endocrine system.

There are many possible causes of osteoarthritis deformity, so this pathology is called polyetiological. Often, the exact cause of the disease can not be identified, therefore, a diagnosis of primary (idiopathic) gonarthrosis is made.

Symptoms of gonarthrosis

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

Chew and click.These symptoms usually occur during movement and are often ignored by patients. A knee crisis may mean that grooves, osteophytes, ulcers have appeared on the surfaces of the article.
Restrained movements.This symptom is very important during diagnosis, as it allows you to distinguish gonarthrosis from a number of other pathologies affecting the musculoskeletal system. The movement is usually stiff in the morning. When a person starts walking, this symptom disappears within half an hour. If stiffness persists for an hour or longer, this may indicate an inflammatory process or other pathology.
Reduced range of motion.This symptom means that the patient is not able to fully bend the knee. This is due to the pain syndrome, softening the intensity of which a person tries to move the leg less. Over time, this leads to a shortening of the ligaments, which are called contractures.
Blocked connection.Gonarthrosis can lead to joint blockage in a certain position and it is impossible to move it due to severe pain. This usually occurs due to changes in the articular surfaces, when the internal ligaments of the knee are pulled out of the pineal glands. In this case, only reverse ligament displacement can help. Rarely, the cause of joint blockage is the entry of a foreign body into the joint space. The source of the troubles may be a part of the meniscus or a fragment of an osteophyte.

Classification of the disease

Each of the phases has specific characteristics:

signs and symptoms of knee osteoarthritis

The first stageis initial, also called easy. The first signs of pathology are considered its onset and the transition to the next stage is characterized by the appearance of bone deformities. They can be detected by visual inspection or X-rays. In the first stage of the disease, the accumulation of fluid in the joints already begins - this phenomenon is called synovitis. Silent is the one who causes pain, which is manifested so far only when moving. Their intensity may vary.
In the second (moderate) stageof gonarthrosis, pathological changes are also visible 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 ends of the joints has grown and the joint space has narrowed. It is at this stage that the pain syndrome manifests itself from the slightest load, and when you walk or collect, the knee begins to chew.
Stage III (severe) Deforming osteoarthritis is diagnosed when there is virtually no cartilage tissue in the joint. If the pathology is severe, then the bones may grow together, which will cause complete immobility of the affected limb.

The exact stage of gonarthrosis is determined by a specialist. In this case, you should focus not on the symptoms of the disease, but on the X-rays taken. Pathology does not always follow the standard pattern.

Diagnosis

Only instrumental diagnosis will help determine deforming osteoarthritis:

x-ray;

ultrasound scanning;
tomography
- magnetic resonance imaging or computer imaging;

arthroscopy;

thermography;

scintigraphy.

Often an x-ray is enough to detect gonarthrosis. Performed in two projections. If only one knee is affected, an image of a healthy limb is still taken to compare the results.

Which doctors should I seek help with?

In the case of osteoarthritis deformities, different specialists may be involved. In a conventional clinic, they usually consult a surgeon.

Arthologist, rheumatologist, orthopedist usually deal with gonarthrosis problems. Furthermore, the participation of a chiropractor, arthroscopist may be required. A physiotherapist, a physical therapy instructor, a massage therapist qualified in the field are usually involved in the treatment process.

Treatment of gonarthrosis

Therapy for knee osteoarthritis lasts a long time. In most cases, outpatient treatment is sufficient. This implies a whole range of measures. Treatment is based on medication therapy, physiotherapy and physiotherapy exercises. In some cases, surgery is required. With gonarthrosis, it is also permissible to use folk recipes, but they must be combined with traditional medicines.

Drug therapy

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

Nonsteroidal anti-inflammatory drugs.These drugs are produced in different forms, but for osteoarthritis, tablets for oral administration, solutions for injections, agents for external use in the form of creams, oils, gels are preferred. Nonsteroidal anti-inflammatory drugs not only fight inflammation but also reduce pain.
Corticosteroids.

Analgesics.When prescribing such drugs, the severity of the pain syndrome is taken into account. If the pain syndrome is of high intensity, then they turn to strong opiates.
Chondroprotectors.Thanks to these drugs, cartilage tissue is saturated with nutrients that stimulate cell growth. The effect of chondroprotectors is manifested for a long time, so they are used for long therapeutic courses. Such medications are suitable for grade 1 or 2 pathology.
Antispasmodics and muscle relaxants.Such drugs are necessary when the pathology is accompanied by muscle spasms.
vasodilator drugs.Such drugs improve blood flow, relieve spasm of small vessels. A combination of vasodilators and chondroprotectors is effective, as the cartilage tissue in this case is better saturated with nutrients.
Heating ointmentsto improve blood circulation. Such funds are appropriate in the absence of synovitis.

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

Physiotherapy

In deforming osteoarthritis, various physiotherapeutic methods are actively used. They are used for various purposes: to reduce pain, relieve inflammation, activate the blood supply and speed up healing.

The following methods of physiotherapy are effective for knee osteoarthritis:

Phonophoresis.This technique is an ultrasound therapy combined with the effects of medication. Due to the high-frequency vibrations, the tissues of the knee joints are heated, 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 their action, the blood supply to the periarticular region is activated, which stimulates the restoration of cartilaginous and bony structures.
Ozone Therapy.This procedure involves the use of active oxygen. It provides analgesic and anti-inflammatory effects on tissues.
Electromyostimulatory stimulation.This technique is often used during rehabilitation, as well as in the presence of contraindications to exercise. Under the influence of electrical impulses, muscle tone increases and blood circulation improves.
Diathermy.This technique refers to electrotherapy and involves the use of high frequency currents with high strength for deep heating.
Cryotherapy.This technique is also called cold treatment. The affected area of skin 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, relieves muscle spasm.
Hirudotherapy.This technique is considered an alternative. Lilacs are placed around the affected joint. The procedure relieves pain, relieves swelling and stimulates regeneration.
Laser therapy.This technique is commonly used at an early stage of pathology. Provides anti-inflammatory, analgesic and stimulating effects.
Plasma therapy.This procedure is also called joint plasmolifting. It includes injections within the article. For them, the patient's own blood plasma is used, which is saturated with platelets. This procedure relieves inflammation, promotes cartilage tissue regeneration.
Healing baths- turpentine, radon, hydrogen sulfide.
Acupuncture.Such a procedure is usually used in the early stages of pathology. This technique relieves swelling, eliminates pain, and allows you to restore joint movement.

exercise therapy

physiotherapy exercises for knee osteoarthritis

Physiotherapy is necessary for gonarthrosis. The various exercises should be supervised by a qualified professional. The main goal of exercise therapy is to restore joint movement and achieve a certain range of motion. It is also necessary to increase muscle strength and endurance.

Exercise therapy is not used during periods of disease exacerbation. At this time, the node needs maximum rest and discharge. Locomotor activity is allowed when the inflammation and pain subside, from this moment at least 5 days must pass.

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 its severity, the individual characteristics of the patient.

Gymnastics

At home, a gonarthrosis patient can do some exercise independently. You need to do it in stages - first you need to warm up, then do strength exercises and finish with stretching.

Heating is performed as follows:

Place your feet shoulder-width apart and lower your arms along your body or lean on the back of a chair. Lift slowly on your toes, staying at the extreme point for 3 seconds, then lightly transfer the weight to the heel, raising the toes as high as possible. Do 10 reps without making any sudden moves.
The starting position remains the same. It is necessary to raise the leg bent at the knee at waist level, then lower it. Do 15 repetitions alternately on each leg. Movements should be slow and flowing.
Lie on your back, raise your knees bent at the knees and simulate the rotation of the bicycle pedals. You need to rotate for half a minute in one direction, then in the other. Moves slowly.
Place your feet shoulder-width apart, straighten your back, and bend your elbows. Simulate running in place, alternately shifting the weight from one foot to the other. Movements should be performed on the toes, not resting on the heel. Perform the exercise for about 5 minutes.

Surgery

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

Son.This intervention is minimally invasive. Used not only to study the fluid inside the article, but also to remove its excess. As a result of such manipulations, inflammation is reduced and joint movement is restored, but sometimes only partially.
Arthroscopy.This procedure can be performed as an independent operation or be one of its stages. This technique is endoscopic and does not require dissection of the article cavity. For the operation, special thin and flexible instruments are used, and all manipulation is controlled by means of a micro-video camera. If arthroscopy is used as an independent operation, then during it the articular surfaces are cleaned of fragments of affected cartilage tissue.
Periarticular osteotomy.This type of surgery is quite traumatic. Used to redistribute the load on the knee, so that the pain syndrome is reduced and the joint becomes more mobile. During the operation, the bone, which is involved in the formation of the knee joint, is sawn and then fixed in another position. Such a surgical intervention is suitable for grade 1 or 2 deforming osteoarthritis.
Endoprosthetics.Such an operation is performed when the third degree of gonarthrosis 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 a very complicated operation and therefore requires a long period of rehabilitation.

Diet and general recommendations

Despite the fact that the pathology affects the knee joint, its treatment implies adherence to diet. Must comply with the following principles:

If necessary, normalize body weight. BMI should be no more 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 of plant origin.
You should eat fish at least 1-2 times a week.
You should eat partially. The portion should be small but should have 5-6 meals a day.
Finish each meal with a vegetable or fruit.
For cooking, you need to choose cooking, including steaming, boiling, baking.
Observe the drinking regime. On average, a person needs 2 liters of fluid per day, and for the most part it should be pure still water.
Drink water before eating. One glass is enough half an hour before meals.
Reduce salt intake.
Beef, pork, semi-finished products, chili peppers, white cabbage, sour fruits should be excluded from the diet.
useful it is useful to eat favorite meats, jellies in gelatin, cheese, cottage cheese, chicken, legumes.

Traditional medicine

In the treatment of osteoarthritis deformities, unconventional methods are also appropriate. In this case, you should consult a specialist, as the use of natural remedies also has contraindications.

folk remedies for the treatment of osteoarthritis of the knee

Use the following popular recipes effectively:

Lubricate the back of the burdock leaf with honey, place on the affected area, cover with cellophane wrap and insulate. Hold the compress for up to 4 hours.
You can use a cabbage leaf instead of burdock. You can cook it by hand or pierce it in several places. Honey is optional.
For internal use, you can use a solution of burdock root. The raw materials should be finely chopped, steamed with boiling water and insisted. Drink a tablespoon 5 times a day.
Rinse the potato cabbage, place in a glass jar and cover with alcohol. Stay in the dark for 3 weeks, drain and use three times a day to rub the affected areas.
Heat the honey in a liquid water bath and rub it on the affected knee, massaging it. Cover the treated area with gauze or bandage and insulate. The procedure is repeated daily for a week and a half.
Steam 5 tbsp. wrapped oats and cook for 5-8 minutes on low heat. Wrap the cooled mixture in a natural cloth, place on the affected area and fix with polyethylene. Whenever you need to prepare a fresh mix.
Mix iodine evenly with honey and glycerin, leave for 3 hours. Dip a cotton ball into the resulting mixture and work your way up and down the aisle.
Chop a clove of garlic and add a glass of vegetable oil. Insist a week in the dark, strain and apply to affected areas before bed.
Grind white school chalk and mix with yogurt or sour cream to make a thick particle. Wrap in natural fabric and make a compress for 2. 5 hours, insulating it with polyethylene. Repeat the procedure every day.
Boil two large peeled onions in a liter of distilled water, drain. Drink the resulting infusion three times daily before meals.

Treatment of gonarthrosis should not be limited to traditional medicine. This disease requires an integrated approach, which necessarily includes medication therapy and exercise.

Prediction, possible complications

The general prognosis of deforming osteoarthritis is unfavorable due to the progressive nature of the disease. The process of tissue degradation and deformation of the joints can not be reversed, but can be significantly stopped or slowed down.

The following factors affect the prognosis of gonarthrosis:

Age of the patient.The younger he is, the less he favors the prognosis. The pathological process develops gradually, therefore, with joint damage in young people, from old age, the disease can reach the final stage 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 speed up this process or provoke complications.
Compliance with doctor's orders.This applies to taking the necessary medication, performing physiotherapy, exercise therapy, and securing the discharge of the item. It is also important to observe the duration of medication therapy, as most medications must be taken regularly in certain courses.
Body mass.If the patient is overweight, then the joints experience increased stress, which negatively affects the course of the disease.
Professions.This factor is very important for the prognosis of the disease. Professional athletes, people who are under regular stress or constantly on foot, 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 can cause a number of complications:

Deformity of the wrist.This occurs in the last stage of the disease. The foot can bend at an unnatural angle, which is not only aesthetically uncomfortable, but can also cause a complete loss of joint functionality.
Infection.Microtrauma, for example, a rupture in cartilage tissue, can provoke such a complication. The pathogen can enter the joints along with the stream 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 joints can provoke aseptic necrosis.

Displacement, fracture.Such complications occur against the background of a violation of the functionality of the knee joints, in which the load is not distributed correctly, and the excess can lead to injury.
Ankylosis.

In most cases, complications arise through the fault of the patient who neglected his illness or ignored the doctor's orders.

Prevention

To prevent 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 adequate physical activity;
avoid joint damage;
if an injury is received, then timely, competent and complete treatment is needed;
Strengthen the periarticular muscles.

Secondary prevention measures should also be noted. They are needed when gonarthrosis has already been diagnosed and it is necessary to reduce the rate of its development. In this case, you must take the following measures:

use a course of chondroprotectors every six months or a year;
treat arthritis timely, quickly and effectively.

Knee osteoarthritis is a serious pathology that has a poor prognosis and can cause a range of complications. It is necessary to start treatment as soon as possible in order to slow down the pathological process. Therapy should be comprehensive, some techniques should become part of the lifestyle: diet, exercise, taking some medication.