Knee joint gonarthrosis: degrees, types, methods of treatment
What is gonarthrosis?
Gonarthrosis is a degenerative-dystrophic disease of the knee joint. The second name is osteoarthritis of the knee joint. The nature of the disease is not inflammatory, often leads to disability.
According to statistics, he is given one of the leading places among all types of arthrosis. In figures this is more than 20%.Of all the diseases that affect the knee joint, the frequency of manifestations of gonarthrosis is 53%.
Gonarthrosis is well known to doctors for more than 100 years, in everyday life it is called "salt deposition".In fact, with arthrosis, calcification occurs( deposition of calcium salts).However, such calcifications are of limited nature, of clinical importance. The painful process occurs after the pathology of the circulation in small bone vessels, after which changes in the cartilaginous cover of the joint begin.
In the initial stages, changes occur at the molecular level in the cartilaginous tissue, followed by changes in the hyaline cartilage: in some places it becomes cloudy, thinens, stratifies, splits in different directions. This process ends with the complete disappearance of the cartilage, larger and smaller, exposing the underlying bone. In turn, the bone reacts to the death of the cartilage by densification, that is, excessive overgrowth of the bone along the periphery, spines are formed, the foot is deformed and warped. For these reasons, this disease is called "deforming arthrosis".
Exchange processes in the cartilage tissue are carried out due to osmotic pressure. When squeezing the lubricant is released, and when unloading it absorbs. So, during the movement, the cartilage is constantly fed. With incomplete recovery, dictated by increased mechanical stress, metabolic processes are violated. In the place of greatest pressure, the cartilage begins to thin out.
There is a violation of the structure of collagen fibers, which leads to loss of damping properties, chondromalacia( softening of the patellar cartilage), disruption of the metabolic function of chondrocytes. The cartilage loses stability, elasticity.
There is a violation of congruence in the joint. The process is exacerbated by enhanced synthesis of bone substance, which manifests itself in the form of osteophytes( bone growths).The synovial membrane is irritated and inflammation begins. This leads to a restriction of mobility of the joint.
Arthrosis of the inner part of the knee joint and between the surface of the femur and the knee is more common. The disease is more susceptible to people of mature and advanced age, athletes.
Causes of gonarthrosis
The main causes of arthrosis of the knee joint include:
pathological changes in blood circulation, increased fragility of capillaries;
excess body weight, which leads to an increase in the axial load on the joint;
traumatization of the knee joints( ruptures of ligaments, menisci, fractures, cracks);
transferred inflammatory diseases( rheumatism, arthritis);
excessive load on the joint, which is more affected by athletes. Tennis players, football players, athletes, gymnasts are more often ill;
hormonal and endocrine disorders;
old injuries that are inadequately treated or whose treatment has not been completed;
abnormalities of the structure of the joint tissues;
Symptoms of gonarthrosis
The danger of gonarthrosis, like most arthrosis, is untimely diagnosis. At stage 1, the disease almost does not manifest itself at all, except for a slight pulling pain, which the patient writes off for fatigue.
A common symptom of gonarthrosis is a feeling of stiffness in the joint, "pulling" under the knee, pain in the knee after a long walk. Many patients with gonarthrosis( arthrosis of the knee joint) complain of difficulty in walking mostly in the morning, after a dream or after a long sitting. A person needs to "disperse" in order to become easier. With the development of gonarthrosis, pain in the knee, especially on the inner side, becomes more stubborn and permanent. Often, patients with gonarthrosis feel a crunch when moving the knee joint. Further, the limitations of flexion and extension of the leg develop. When the disease progresses, lameness develops. In more neglected cases, a person can not move without the help of outsiders, support or without crutches. Often in the lying position the pain subsides, but it happens that at night a person suffers from pain.
When examining the knee joint in the initial stage of the disease, external changes are usually not detected. With the course of the disease, the deformity of the knee joint, the contours of the bones forming the joint, the coarse, the contracture( incomplete flexion or extension), the curvature of the shin are very noticeable. Putting a palm on the front surface of the knee, you can feel the crunching or extensor movement crunch in the knee joint of varying intensity and duration. A similar sensation can be obtained by shifting the patella outward in the transverse direction( positive patello-cordillary symptom).
When you feel the joint of a patient with gonarthrosis, a painful area is detected, usually on the inside of the joint, at the level of the condyles of the thigh, the large burtz, and the joint slit. Often an effusion accumulates in the cavity of the knee joint, ie, synovitis is attached. Such a state is determined by the smoothness of the contours of the knee joint due to bulging, protrusion of the tissues above the patella and from the side of it and a sense of fluctuation when the protrusion is felt with both hands.
As the disease progresses, the symptoms appear brighter, become more pronounced. Timely correct diagnosis plays an important role in the further fight against gonarthrosis.
Degrees of development of gonarthrosis
1 degree of gonarthrosis
With 1 degree of gonarthrosis fatigue of limb, slight discomfort. During movement, a small crepitation can be traced. Sometimes there is a subtle restriction of movement in the joint.
Knee bones at this stage are not subject to significant changes. On the X-ray, you can see a slight narrowing of the joint space.
2nd degree of gonarthrosis
The second degree is characterized by the onset of pain, especially after you have been standing for long or walk. The characteristic crunch becomes more pronounced. There are problems with the extension and full bending of the limb. There is a so-called starting pain.
There may be atrophy of the quadriceps muscle of the thigh. The angle of full flexion and extension of the limb in the knee joint is severely limited. X-ray images clearly show a significant narrowing of the joint gap, the growth of osteophytes. The edges of the bones "flatten".
3 degree of gonarthrosis
At the third stage the character of pain changes, it increases, it can manifest itself at rest. In the joint area, there is often swelling, a local increase in temperature. Due to the possible presence in the joint of the "articular mouse"( fragments of breakaway osteophytes), symptoms of joint blockade may occur. They manifest acute pain, accompanied by a sense of jamming.
The patient in this case may be deprived of the possibility of bringing the joint into motion. There is a deformation of the knee joints with a change in the axis of the limbs, which is clearly seen in the pictures. The instability of the joint may manifest itself.
Types of gonarthrosis
Gonarthrosis is divided into species for reasons of occurrence:
Primary gonarthrosis of the knee joint proceeds against a background of comparative health. Mostly elderly people, especially women, are ill. In the risk group are people with excessive body weight, that is, obese, they are most often affected by arthrosis of the knee joint.
Secondary gonarthrosis of the knee joint develops mainly after a traumatized knee injury or after a previous illness. In the case of timely treatment of all of the above diseases of gonarthrosis can be avoided.
By localization of origin:
right-side gonarthrosis - affects the right knee joint. This type of arthrosis is more common for athletes, people whose professional activities are associated with excessive static and dynamic loads on the right leg;
left-sided gonarthrosis - affects the left knee joint. Also more characteristic of athletes, middle-aged people with excessive body weight;
bilateral gonarthrosis - destroys the joints of both legs. This species is the heaviest, since it significantly increases the risks of disability. Most often it affects older people, since the nature of bilateral gonarthrosis in most cases is idiopathic( age).
All these species do not differ from each other in the nature and origin of the disease. Double-sided gonarthrosis in advanced form can be more pronounced, since both patients suffer simultaneous axial load.
Diagnosis of gonarthrosis
There are many diagnostic methods, but their effectiveness can be greatest only with a comprehensive approach.
Orthopedic examination is the first and very important diagnostic measure. This includes:
palpation of the joint;
linear measurements of bones;
angular measurement( determination of mobility in the affected joint at various angles).
Clinical trials include:
study of blood formula, erythrocyte sedimentation rate;
levels of fibrinogen, urea and other biochemical indicators of blood and urine;
The main diagnostic method is the examination of the patient's joint radiographically. In the initial development of gonarthrosis, an x-ray examination can show nothing, and if it does, it will show minor changes. In the late stages of the disease, there is a narrowing of the joint gap, cartilage sclerosis, bone damage, and the deposition of salts.
Ultrasound examination of the
Ultrasound examination of the aching joint gives the best results, however, it can not completely replace the radiographic examination. Therefore, people suffering from joint disease must have an X-ray examination of the affected joint.
MRI - Magnetic Resonance Tomography
The most progressive diagnostic method that allows you to layer-by-layer examine all parts and tissues of the joint, determine the earliest change in the cartilage tissue. The disadvantage of the method lies in the rather high cost of examining each segment. Therefore, it often turns out that gonarthrosis in a patient is far from the only disease of the musculoskeletal system.
How to treat gonarthrosis?
The procedure for the treatment of arthrosis of the knee differs little from the treatment of arthrosis of other joints.
Step 1 - we remove inflammation
For this traditionally used:
NSAIDs are non-steroidal anti-inflammatory drugs that are prescribed intramuscularly or intravenously. In the form of injections or candles, medications give a longer and stronger effect. These include drugs such as diclofenac, olfen, diclac, ibuprofen, indomethacin, ketoprofen.
NSAIDs COX-2, are the most effective and sparing compared to the COX-1 NVPD.They can be used for a long time, for several months. These are meloxicam, celecoxib, nimesulide.
Preparations of hormones. This group is used for intraarticular injections in the presence of synovitis. The purpose of the application is the removal of inflammation and pain syndrome as soon as possible. Minus of application is a damaging effect on cartilage tissue, a large number of contraindications and side effects. The most commonly used for gonarthrosis are representatives of this group: hydrocortisone, kenalog, diprospan.
Antiferment preparations. They neutralize the synthesis of certain enzymes and prevent further degeneration of the joints. The most famous drugs: counter-kal, ovomin, gordoks. When gonarthrosis they are administered intra-articularly.
Step 2. We have anabolic and anti-catabolic effect of
This group replaces the substances necessary for the synthesis of cartilage, has a narrowly specific effect on cartilaginous tissue. They are also called chondroprotectors. They contain substances that are part of the matrix of cartilage. These medicines are natural and well perceived by the body. Stimulate the synthesis of collagen.
To justified use of drugs include: structum, DONA, alflutop, rumalon, mucosate. All of them are slow-acting drugs that use long courses. Some of them are used as injections. This form of application is the most effective.
Step 3. Mage, heat, rub
We use various kinds of gels, ointments, creams. In their majority they are warming and anti-inflammatory. The purpose of their application is to activate local blood circulation, remove inflammation. The most famous of them: apizartron, finalgon, doloben, feloran, fastum gel, nicofleks.
Step 4. Improve blood circulation
Vasodilator drugs are used to reduce the tone of intravascular muscles. Allow to improve the internal blood flow, improve trophic tissue located near the joint. When gonarthrosis is recommended: Cavinton, Trental, Actovegin. To strengthen the vascular walls: upsavit, ascorutin.
Step 5. Remove excess tone
Such antispasmodics as: midolkalm, sirdalud, no-shpa, tyzalud, can remove unnecessary muscular tension in the damaged segment. Often it arises as a compensatory reaction of the body.
Step 6. Introduce synovial fluid prosthesis
The most progressive treatment in recent years has been the inclusion of hyaluronic acid-based drugs in the treatment protocol. It is a natural component of articular cartilage and synovial fluid. Therefore, its administration does not cause inflammation, rejection and other negative reactions.
At the same time, the use of such drugs as: otrovisk, sinocorm, hyalual, allow to soften movements in the joint and relieve the pain caused by friction of the joint surfaces. In gonarthrosis, the most recommended drug of this group is the fermatron.
The treatment sequence is determined by the attending physician, and leads him, according to the current protocols. At the same time, anti-inflammatory therapy can be conducted, a course of chondroprotectors, and a course of physiotherapy. Preparations of hyaluronic acid are allowed to enter the joint only when the inflammation is completely removed. Otherwise, instead of a curative effect, the course of the disease can be aggravated.
Author's and innovative methods of treatment of gonarthrosis
Author's methods include:
All of them have different principles of influence, but have proven themselves as effective means of supporting joints affected by gonarthrosis. Unfortunately, there is no question of recovery.
Oxygenotherapy is a method of filling the joint cavity with medical oxygen. It helps to eliminate puffiness, reduce pain syndrome. Can be used as an alternative to hormone therapy.
Treatment with stem cells .The essence of the method is the transplantation of the patient's stem cells into the joint. The method is developed in Germany and allows to postpone conservative treatment for many years. It is used only in large medical centers in Germany.
Method of intra-articular laser therapy. Performed with a low-intensity helium-neon laser, which penetrates into the joint with the help of a waveguide introduced into the needle. It allows to reduce painful sensations, to increase the amplitude of motion in the joints. The method was developed in Russia, clinically investigated, but not widely used.
Ortokin is a biological technique for the treatment of gonarthrosis, which has been used in Europe since 2003.Autologous serum obtained by selecting specific proteins from the patient's own blood. These proteins have an anti-inflammatory effect. After the selection of blood and production of serum, the drug is again administered to a person intra-articularly, under the supervision of ultrasound or computed tomography.
The drug allows:
to slow down the process of destruction of cartilaginous tissue;
reduce pain syndrome;
to stop inflammation;
to increase mobility in the joint.
One or two injections are sufficient for treatment. About 70% of patients experience pain after the first injection.
At different stages of gonarthrosis, conservative therapy may not give positive dynamics. In such cases, they begin to consider the need for surgical intervention.
There are several types of operations for gonarthrosis:
Arthrodesis. With this technique, remove the deformed cartilage tissue with the joint. The method does not allow preserving the physiological mobility of the limb. They resort to it quite rarely.
Arthroscopic debridement. The technique is to release the joint from the deformed cartilage tissue with the help of an arthroscope. It is used in the early stages of the disease. Thanks to arthroscopy, pain is eliminated. The operation is simple. The effect of the procedure is temporary, 2-3 years.
Periarticular osteotomy. This is a technically complex and rare type of surgical intervention. It lies in the preliminary filing and fixing the bones of the joint from a different angle. This is done to redistribute the load. Rehabilitation is long enough, the effect is from 3 to 5 years. It is used rarely in the early and middle stages of gonarthrosis.
Nowadays it is the most common and effective type of surgical intervention. It allows you to keep the mobility of the limb, which provides the patient the opportunity to lead a full life. Prosthetics in gonarthrosis is a complex operation. It lasts about an hour, but after it it is necessary to undergo a course of rehabilitation and joint development. This is one of the main features of knee arthroplasty. The effect is retained for up to 20 years, depending on the modification of the material. After this, the joint will have to be changed again, since the prosthesis is blown under the influence of axial and mechanical loads.
Do not forget about possible complications such as:
marginal necrosis of the skin
paresis of the peroneal nerve;
thrombosis of the subcutaneous femoral vein;
risk of rejection.
Similar troubles occur extremely rarely and account for about 1% of the total number of transactions. Therefore, it must be taken into account that the effect of endoprosthetics, sometimes, is the only way to improve the quality of life.
Physical training in gonarthrosis - curative and not only
The goal of physical exercises with gonarthrosis is several factors:
preservation and increase of joint mobility;
formation of compensation by strengthening the musculoskeletal system;
increased blood circulation and improved trophism of adjacent tissues and the joint itself;
preservation of the physiological tone of the muscles.
Exercises and the method of their execution are selected depending on the surviving active movements.
exercises with violent interventions, accompanied by pain;
performing exercises with the maximum load;
sharp and high-amplitude execution of exercises with great speed;
exercises with full axial load on the affected joint.
Complex of exercises for gonarthrosis
Shaking. Standing, try to relax completely, hands down. Perform shaking movements with your whole body. Make sure that your knees are shaken with a small amplitude.
While holding the support, bend the leg in the knee, point the heel to the buttock, then straighten the leg forward, put it on the heel in front of you. Execute 15-20 times. Then make the other leg.
Put your palms on your knees. Perform small circular movements in the knee joint in one and the other side. Amplitude adjust for sensations. Do at least 20 times.
Exercise on the folded blanket. The surface should not be too hard. Stand on your knees and perform shaking as in 1 exercise.
From the position, as in the previous exercise, go on your knees, following several steps in different directions.
Stand at point-blank position, lying on your lap( the floor should touch the palms and knees).Drop your chest on the floor, stretching your arms forward, then move the hips and buttocks to the heels, making the heel on the heels, without lifting the chest from the floor. Again, go straight up and repeat the exercise several times.
Lie down on the left side, take the right leg up, bend the leg in the knee, straighten and stretch the heel to the wall as much as possible. Perform up to 12 times and change your foot.
Sit down, put your bent legs in front of you. Stretch the knee of the right leg to the left, then straighten it, unbending the knee up, bend and return to the starting position. After 12 repetitions, change your leg.
From the same initial position, straighten the legs alternately without lifting the heels off the floor, then simultaneously bend again, also without tearing off the floor. Repeat 12-14 times.
Lie on your back, pull your bent leg to your chest, grip your toe of the foot and smoothly move your legs as straight as possible. Try to do it without jerks.
Also, lying on your back, tie a rubber shock absorber to the ankles, and fix the other end to the battery. Smoothly bend and unbend your legs, pulling your knees to your chest.
Stand on the knees. One end of the rubber damper is tied to the ankle foot, the other is fixed to the battery. Slowly( smoothly) bend and unbend the leg at least 10-15 times. The shock absorber should not be too rigid.
Physiotherapy for gonarthrosis
All types of physiotherapy can be prescribed in the phase of remission or a slight exacerbation, but not in the most acute phase, with inflammation.
The most effective are:
electrophoresis with such drugs as bischofite, caripain. Deeper penetration of the drug in such cases is provided with the help of dimexide;
application of radon and hydrogen sulfide baths;
To maintain and prolong the phase of remission, it is necessary to undergo a course of physiotherapy 2-4 times a year. Depending on the degree of the disease.
Electrophoresis with karipainom allows you to remove excess tone, promotes resorption of contractures and adhesions. It is necessary to perform at least 20 procedures, since the drug is cumulative. It works only when the body receives the maximum concentration. A course of 10 procedures does not justify the costs spent.
The course of mud therapy for gonarthrosis should be performed 2 times a year, for 10-15 procedures. You can carry it at home using the dirt bought in the chemist's system. Before use, it must be heated to 38-40 degrees.
Massage, manual therapy for gonarthrosis
These kinds of effects on the knee joint are aimed at stretching, warming and improving blood circulation in the joint area. Massage is performed in the region of the knee, along the lymph flow from the periphery to the center, but without affecting the popliteal fossa. Manual therapy is performed after the massage, an experienced specialist. Its main thrust is the traction and stabilization of the joint. The following exercise can be performed independently.
Stand up with a healthy side to the support. Take your foot off the aching joint forward, then back, then with a sharp movement, "throw it" out of the way.
Prevention of deforming gonarthrosis
Gonarthrosis belongs to a group of diseases that are better and easier to prevent than expensive and long to treat.
To the list of preventive measures it is possible to attribute:
doing dances, sports, try to beware of serious injuries( ruptures of ligaments, fractures, severe knee injuries);
moderately engage in sports, since movement is the mechanical basis of cartilage nutrition;
correctly make up the diet;
watch the body weight;
When getting injured, or showing discomfort in the knee area, immediately seek qualified medical attention;
since 35 years, pass preventive courses of treatment with chondroprotectors;
daily, drink plenty of water.
Useful advices for
Begin the treatment of gonarthrosis with accurate diagnosis. It is better to get advice from several leading experts.
Do not self-medicate. All drugs, their dosage and duration of use should be prescribed and monitored by a physician.
Begin and end your day with gymnastics.
If you want to play sports, consult a doctor about the type recommended for you. Even some yoga asanas can be disastrous.
Eliminate from your diet salty, sharp, fatty dishes. Give preference to natural home products. Lactic acid products should have an average fat content, otherwise calcium will be poorly absorbed. Include in the diet low-fat jelly( cooked on turkey meat), natural jelly. Do not forget about the need to eat sea fish, seafood.
If a week of use of the anti-inflammatory drug does not bring relief, consult a doctor to review the treatment protocol.
If there is a remission and the disease does not bother, do not exceed the permissible loads. The absence of pain does not mean that you are completely healed.
Try not to overcool the joints. Although, gonarthrosis and non-inflammatory disease, the joint can react to hypothermia with a new relapse.
The main thing, remember! You can not help even the best doctor, if you do not want to make an effort and help yourself. In case of need of an operative intervention, it is better to delay this moment to more mature or advanced age. It is important that by the time of the surgery you were in good physical condition, so that postoperative rehabilitation was easier. And it depends only on you.
Author of the article: Candidate of Medical Sciences Volkov Dmitry Sergeevich, surgeon
GonarthrosisGonarthrosis ( deforming arthrosis of the knee joint) is a degenerative-dystrophic disease in which the hyaline cartilage covering the condyles of the tibia and femur is affected. In the late stages of gonarthrosis, the whole joint is involved in the process;the underlying part of the bone is compacted and expanded. Gonarthrosis is the first in terms of prevalence among all arthroses. The disease usually occurs in patients over the age of 40 and is more common in women. In some cases( after injuries, in athletes), gonarthrosis can develop at a young age. The main manifestation of gonarthrosis are pains that increase during movement, restriction of movements and synovitis( accumulation of fluid) in the joint. Gonarthrosis develops gradually, for many years. Treatment of gonarthrosis is conservative. Timely preventive maintenance plays an essential role.
Gonarthrosis or deforming arthrosis of the knee joint is a progressive degenerative-dystrophic lesion of intraarticular non-inflammatory cartilage. Gonarthrosis is the most common arthrosis. Usually affects people of middle and old age, women suffer more often. After a trauma or constant intensive loads( for example, in professional sports), gonarthrosis may occur at a younger age. Prevention plays an important role in the prevention of the onset and development of gonarthrosis.
Contrary to popular belief, the cause of the disease is not in the deposition of salts, but in eating disorders and changes in the structure of intraarticular cartilage. When gonarthrosis in the attachment of tendons and ligamentous apparatus can occur foci of deposition of calcium salts, but they are secondary and do not cause the appearance of painful symptoms.
Classification of gonarthrosis
In view of the pathogenesis in traumatology and orthopedics, two types of gonarthrosis are distinguished: primary( idiopathic) and secondary gonorotrosis. Primary gonarthrosis occurs without previous trauma in elderly patients and is usually bilateral. Secondary gonarthrosis develops on the background of pathological changes( diseases, developmental disorders) or knee joint injuries. Can occur at any age, usually one-sided.
Given the severity of pathological changes, three stages of gonarthrosis are distinguished:
- The first stage is the initial manifestations of gonarthrosis. Periodic blunt pains are typical, usually after considerable stress on the joint. Possible small, self-vanishing edema of the joint. Deformation is absent.
- The second stage is the increase in the symptoms of gonarthrosis. The pains become longer and more intense. Often there is a crunch. There is an insignificant or moderate restriction of movements and a slight deformation of the joint.
- The third stage - the clinical manifestations of gonarthrosis reach a maximum. The pain is almost constant, the gait is broken. There is a pronounced restriction of mobility and an appreciable deformation of the joint.
Anatomy and pathological changes in the joint with gonarthrosis
The knee joint is formed by the articular surfaces of two bones: the femur and the tibia. On the front surface of the joint is a patella, which slides along the groove between the condyles of the femur. The fibula in the formation of the knee joint is not involved. Its upper part is located on the side and just below the knee joint and is connected to the tibia by means of an inactive joint.
The articular surfaces of the tibia and femur, as well as the posterior surface of the patella are covered with a smooth, very strong and resilient, dense, elastic hyaline cartilage 5-6 mm thick. The cartilage reduces the frictional forces during movements and performs the damping function under impact loads.
In the first stage of gonarthrosis, blood circulation in small intraosseous vessels feeding hyaline cartilage is disrupted. The surface of the cartilage becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of soft, unobstructed sliding, cartilages "cling" to each other. Due to permanent microtraumas, the cartilaginous tissue becomes thinner and loses its damping properties.
In the second stage of gonarthrosis, compensatory changes occur on the part of the bone structures. The articulation pad is flattened, adapting to the increased loads. The subchondral zone is consolidated( part of the bone located immediately below the cartilage).At the edges of the articular surfaces appear bony growths - osteophytes, which in their appearance on the roentgenogram resemble thorns.
Synovial membrane and joint capsule in gonarthrosis also degenerate, become "wrinkled".The character of the articular fluid changes - it thickens, its viscosity increases, which leads to a deterioration of lubricating and feeding properties. Due to a lack of nutrients, cartilage degeneration accelerates. The cartilage is still thinner and disappears completely in some areas. After the disappearance of the cartilage, the friction between the articular surfaces sharply increases, the degenerative changes rapidly progress, the third stage of gonarthrosis begins.
In the third stage of gonarthrosis, the bones are significantly deformed and seem to be pressed into each other, severely limiting movements in the joint. Cartilaginous tissue is practically absent.
Causes of development of gonarthrosis
In most cases it is impossible to single out any one cause of gonarthrosis. As a rule, the onset of gonarthrosis is due to a combination of several factors.
Approximately 20-30% of cases of gonarthnosis are associated with previous injuries: shin fractures( especially intraarticular), meniscus lesions, tears or ligament ruptures. Usually, gonarthrosis occurs 3-5 years after a traumatic injury, although it is possible that the disease progresses even earlier, 2-3 months after the injury.
Often the manifestation of gonarthrosis is associated with excessive stress on the joint. Age after 40 years is a period when many people understand that regular physical activities are necessary to keep the body in good condition. Starting to engage, they do not take into account age changes and overload the joints, which leads to a rapid development of degenerative-dystrophic changes and the appearance of symptoms of gonarthrosis. Especially dangerous for the knee joints is running and intense quick squats.
Another predisposing factor in the development of gonarthrosis is excess weight. With excessive body weight, the load on the joints increases, both microtrauma and serious damage( meniscus tears or ligament tears) occur more often. Especially hard is gonarthrosis in complete patients with pronounced varicose veins.
The risk of gonarthrosis also increases after the arthritis( psoriatic arthritis, reactive arthritis, rheumatoid arthritis, arthritis with gout or Bekhterev's disease).In addition, among the risk factors for gonarthrosis is the genetically determined weakness of the ligamentous apparatus, metabolic disorders and innervation disorders in certain neurological diseases, craniocerebral trauma and spinal trauma.
Symptoms of gonarthrosis
The disease begins gradually, gradually. Patients are concerned at minor gonarthrosis with minor pain during movement, especially during climbing or descending the stairs. Perhaps a feeling of stiffness in the joint and "tightening" in the popliteal region. A characteristic symptom of gonarthrosis is "starting pain" - painful sensations that arise during the first steps after lifting from the sitting position. When a patient with gonarthrosis "diverges", the pain decreases or disappears, and after a significant load appears again.
Externally the knee is not changed. Sometimes patients with gonarthrosis note a small swelling of the affected area. In some cases, in the first stage of gonarthrosis fluid accumulates in the joint - a synovitis develops, which is characterized by an increase in the volume of the joint( it becomes inflated, spherical), a sense of heaviness and restriction of movements.
In the second stage of gonarthrosis, the pains become more intense, occur even under small loads and increase with intense or prolonged walking. As a rule, the pain is localized on the anterior-internal surface of the joint. After a long rest, the pain sensations usually disappear, and when they move, they reappear.
As the progression of gonarthrosis, the volume of movements in the joint gradually decreases, when you try to bend your leg as much as possible, there is a sharp pain. A rough crunch is possible when moving. The configuration of the joint changes, it seems to expand. Synovitis appears more often than in the first stage of gonarthrosis, characterized by more persistent flow and accumulation of more fluid.
In the third stage of gonarthrosis, the pains become practically constant, patients worry not only during walking, but also at rest. In the evenings, patients try to find a comfortable position for a long time to fall asleep. Often the pains appear even at night.
Flexion in the joint is significantly limited. In some cases, not only flexion, but also extension is limited, because of which the patient with gonarthrosis can not completely straighten the leg. The joint is enlarged in volume, deformed. Some patients experience valgus or varus deformity - the legs become X-shaped or O-shaped. Because of the restriction of movement and deformation of the legs, the gait becomes unstable, overbalanced. In severe cases, patients with gonarthrosis can move only with support on a cane or crutches.
When examining a patient with the first stage of gonarthrosis, external changes can not usually be detected. In the second and third stages of gonarthrosis, coarsening of bone contours, deformation of the joint, restriction of movements and curvature of the limb axis are found. When you move the patella in the transverse direction, a crunch is heard. With palpation, a painful patch is revealed from the inside of the patella, at the level of the joint gap, and above and below it.
When synovitis the joint increases in volume, its contours become smoothed. There is a bulging in the anterolateral surfaces of the joint and above the patella. When palpation is determined by fluctuation.
Diagnosis of gonarthrosis
The diagnosis of gonarthrosis is made on the basis of patient complaints, objective examination data and radiographic examination.
Roentgenography of the knee joint is a classical technique that allows you to clarify the diagnosis, establish the severity of pathological changes in gonarthrosis and observe the dynamics of the process, making repeated pictures after a while. Because of its affordability and low cost, it remains the main method to diagnose gonarthrosis to this day. In addition, this method of research makes it possible to exclude other pathological processes( for example, tumors) in the tibial and femur.
At the initial stage of gonarthrosis, changes in radiographs may be absent. In the future, narrowing of the joint gap and compaction of the subchondral zone is determined. The articular ends of the femoral and especially the tibia broaden, the edges of the condyles become pointed.
When studying the radiograph, it should be borne in mind that more or less pronounced changes characteristic of gonarthrosis are observed in most elderly people and are not always accompanied by pathological symptoms. The diagnosis of gonarthrosis is only exhibited when a combination of x-ray and clinical signs of the disease.
At present, along with traditional radiography for diagnosis of gonarthrosis, modern techniques are used, such as computed tomography, which allows detailed study of pathological changes in bone structures and magnetic resonance imaging, used to detect changes in soft tissues.
Treatment of gonarthrosis
Orthopedics treat gonarthrosis. Therapy of gonarthrosis should be started as soon as possible. During a period of exacerbation, a patient with gonarthrosis is recommended to rest for maximum unloading of the joint. The patient is prescribed therapeutic gymnastics, massage, physiotherapy( UHF, electrophoresis with novocaine, phonophoresis with hydrocortisone, diadynamic currents, magneto- and laser therapy) and mud therapy.
Drug therapy for gonarthrosis includes chondroprotectors( drugs that improve metabolic processes in the joint) and drugs that replace synovial fluid. In some cases, gonatrosis shows intra-articular injection of steroid hormones. Later the patient may be referred to a sanatorium-and-spa treatment.
Patients with gonarthrosis may recommend walking with a cane to unload the joint. Sometimes use special orthoses or individual insoles.
To slow the degenerative processes in the joint with gonarthrosis, it is very important to observe certain rules: to exercise, avoiding excessive loads on the joint, to choose comfortable shoes, to follow the weight, to organize the day regimen correctly( alternating load and rest, performing special exercises).
With pronounced destructive changes( at the third stage of gonarthrosis) conservative treatment is ineffective. With severe pain syndrome, joint disruption and disability, especially if gonarthrosis affects a young or middle-aged patient, they resort to a surgical operation to replace the joint( endoprosthetics).In the future, rehabilitation activities are carried out. The period of complete recovery after the operation to replace the joint with gonarthrosis takes from 3 months to 6 months.
How to treat gonarthrosis of the knee joint
Gonarthrosis of the knee joint, that is, damage to its cartilage, is a chronic disease. While there is no medicine that completely heals. However, knowing how to treat gonarthrosis of the knee joint, it is necessary that when using different methods to slow the progression of the disease and reduce painful symptoms.
Therapeutic treatment of gonarthrosis of the knee joint requires the combination of therapeutic measures to solve the following problems:
- pain relief;
- improve articular cartilage nutrition and accelerate its recovery;
- activation of blood circulation in the affected joint;
- reducing pressure on the damaged parts of the joint;
- strengthening the muscles around the aching joint;
- increases the mobility of the joint.
The specified tasks are solved by various methods of treatment.
These include non-steroidal anti-inflammatory drugs( NSAIDs), for example, indomethacin, paracetamol, aceclofenac, diclofenac and others. They are the main analgesics. However, their task ends here.
These drugs are not able to stop the development of the disease and treat joints.
Among patients, uncontrolled ingestion of indomethacin or diclofenac is very common, especially at the onset of the disease.
It should not be forgotten that long-term use of these medicines can lead to serious side effects: the formation of gastritis or stomach ulcers.
This is due to the adverse effects of NSAIDs on the mucosa, especially in the elderly and people prone to gastric diseases. Moreover, it is very important in what dose the medicine is taken. According to the latest medical research, it was found that some doses improve the condition, while others, on the contrary, have a harmful effect on the articular cartilage. That's why it is better to discuss the optimal drug plan with your doctor.
As a rule, treatment with such drugs begins with paracetamol. In the absence of effect, stronger painkillers, up to analgesics of central action, for example, tramadol, are prescribed.
Treatment with anti-inflammatory drugs
Corticosteroids( anti-inflammatory hormones) reduce inflammation of the knee joint. By their action, these are very strong substances. Since they cause many side effects, in recent years, they are almost never prescribed for oral administration. Preparations of the group of corticosteroids - hydrocortisone and kenalog - are administered topically to the knee joint with the help of injections. This procedure is called intra-articular blockade of the knee joint. It reduces inflammation and reduces pain( especially when NSAIDs are not effective).
With synovitis, anti-inflammatory and analgesic gels and ointments containing both hormonal substances and NSAIDs have a good effect as a topical treatment. This ointment DIPRelif, Diclofenac, Butadion, Bystrumgel and others.
If gonarthrosis occurs without synovitis, it is useful to use warming ointments that improve blood circulation in the joints. These are Menovasin, Espol, Gevkamen, and others.
These are preparations that induce cartilaginous cells( chondrocytes) to synthesize a young cartilaginous tissue instead of a collapsing one. When entering the body, these substances deliver "building material" to the joints for the formation of cartilage. As a result, the condition of the knee joint improves, the destruction of its cartilage slows down, and pains decrease at the same time.
Drugs and chondroprotectors are chondroitin sulfate, hyaluronic acid, glucosamine sulfate. Chemical compounds of this type enter the gel-like part of the cartilage, providing for cushioning in the joint during walking. Such substances in different dosage and ratios are included in the preparations: Don, Arthra, Arthroarin, Arthroactive, etc.
Features of the treatment with chondroprotectors:
These drugs have a delayed action. The effect of them develops within a few months, so you need to wait patiently for the result;
Before treatment is mandatory consultation with a doctor, because the drugs are effective in treating gonarthrosis of the first and second degrees and are useless in the already destroyed cartilage.
If treatment is started in the early stage of gonarthrosis, then, as a rule, long courses of therapy significantly improve the state of cartilage.
Compared with ointments, the means for compresses have a more pronounced therapeutic effect. Popular among them are: dimexide, medical bile and bischofite.
Dimexide is a liquid with a good analgesic and anti-inflammatory effect. Unlike other external drugs, dimexid penetrates through skin barriers, absorbed by the body and relieving inflammation at the site of the disease. In addition, dimexide has a resorptive property, improving the metabolism. Therefore, it is especially useful in gonarthrosis, burdened with synovitis.
Medical bile is a natural bile of pigs and cows. It has a resolving and warming effect. However, bile can not be used if the following conditions exist:
- pustular skin diseases;
- febrile state with high temperature;
- is an inflammation of the lymph nodes.
Bishofit is an oil derivative. It gives a mild anti-inflammatory, analgesic and warming effect.
Physiotherapy of gonarthrosis is a rather quick and effective way to reduce pain and improve joint condition in a short time. With a combination of physiotherapy and drug treatment, it is possible to reduce the dose of pain medications taken.
The best therapeutic effect for gonarthrosis of the knee joint is:
- ultrasound therapy;
- infrared laser therapy;
- rhodonic and hydrogen sulphide baths.
These physiotherapy procedures, in addition to reducing pain, contribute to the overall strengthening of the entire body, reducing stress levels, improving mood.
However, as a rule, procedures are performed only with gonarthrosis of the knee joint of the first and second degrees. And in that period of time when the active joint inflammation is absent in the joint.
Methods of physiotherapy and manual therapy
The use of methods of physical therapy and manual therapy significantly improves the overall condition with knee gonarthrosis.
In the first and second degrees of gonarthrosis, manual therapy often leads to remarkable results. After a few sessions, the patient is noticeably relieved. Manual therapy of knee joints is especially effective in combination with chondroprotective drugs, joint extension and intra-articular injections of Ostenil.
Certain therapeutic exercises and limited physical exertion reduce the excessive tension of the knee joints and relieve the overstrain of ligaments and muscles. You should choose exercises that strengthen the ligaments of the affected joint and the muscles of the diseased limb, but without increased flexion and extension. That is, we need static exercises.
- For example: lie on your back and slightly lift your straight leg, keeping it on the weight. After one or two minutes, fatigue will appear in the muscles of the leg and abdomen, and the joints do not move.
- An example of a slow dynamic exercise is the slow lifting from the floor of a straightened leg and its slow descent. Eight to ten such exercises cause considerable fatigue.
- Thus, the strengthening of muscles and ligaments in gonarthrosis is facilitated by static exercises with fixation of position for a certain time or slow dynamic.
Methods of folk treatment of gonarthrosis
The described methods of treatment can be supplemented with folk remedies, if approved by the attending physician. With the help of various ointments, decoctions, compresses, tinctures, you can reduce pain in the knee and strengthen the entire body.
- Tincture of dandelion eliminates pain in the knee. A bottle of dark glass should be filled with yellow dandelion heads and pour triple cologne. The drug persists for a month. Then drain it. Before going to bed, wipe the aching joints. You can make a similar tincture from the leaf of the ficus.
- When gonarthrosis helps decoction from the leaves of Jerusalem artichoke. One and a half kilograms of stems and Jerusalem artichoke leaves should be chopped and poured with enriched pots of boiling water( 810 liters).Infuse until the temperature becomes tolerant for the skin. The composition should not be allowed to cool. The sick joint should be dipped in this bowl and hold for half an hour. In the following days, repeat ten times.
On the prevention of gonarthrosis
Adherence to preventive measures avoids the development of the disease, and if it has appeared, then improve the condition of the knee joint.
The main "provoker" of gonarthrosis of the knees is overweight. The large mass of the body creates an increased load on the joint. As a result, the regenerative capacity of cartilage is reduced. With the help of diet and other means of reducing weight, you can improve the condition of the body in this disease.
It is very important to reduce the physical stress on the legs( respectively, on the knees).If possible, it is better to sit down and not stand. If the work schedule assumes a high physical load on the legs, you need to think about the question of changing it to a more sparing one.
If the disease has gone far, even when the gait changes, you need to use a cane or other orthopedic drugs that reduce the load on your knees.
With competent combination of medical measures, gonarthrosis will definitely give up its positions, especially at the first stages of the disease development.
Knee joint gonarthrosis treatment, symptoms, causes
For the first time this disease appears after forty years and most often it is diagnosed in women who complain of pain in the knee.
Knee joint gonarthrosis
No one pays special attention to this and everything is written off to the deposition of salts.
But in fact the cause of pain is gonarthrosis of the knee joint. The essence of the development of this disease lies in the dystrophic changes of the hyaline cartilage, which are covered with the tibial condyles, as well as the femur. In the future, gradual destruction of the cartilage takes place and as a result the subchondral surface of the bones forming the knee joint is exposed.
Causes of the appearance of the disease
The causes of this disease are different, it all depends on whether primary or secondary gonarthrosis is diagnosed.
This type of disease appears most often in the elderly, and against a background of complete health. It is suggested that the cause of the disease is a disturbed metabolism, because gonarthrosis is more often diagnosed in patients with obesity and overweight.
There are suggestions that the cause of the disease is a hereditary factor, and this can be influenced by the long reception of hormonal drugs and much more. In this case, do not forget that the presence of anomalies in the structure of the joint tissues, not only cartilaginous, but also bone may be the cause of gonarthrosis. Also, the appearance of the disease can significantly affect the various pathologies of the ligament apparatus.
In this version of the disease, the causes are more obvious:
- injuries of the knee joint - bruises, dislocations and the like;
- surgical operations, which a person suffered after a knee injury, removal of the meniks;
- joint disease - arthritis or swelling and other inflammatory diseases in the joints;
- untimely application for medical aid after the received knee injuries, which leads to the development of gonarthrosis;
- hormonal imbalance. This can be a slow metabolism or a malfunction of metabolic processes in the body;
- excessive intensity of physical exertion on the joint. As a rule, it manifests itself in people engaged in professional sports;
- diseases that adversely affect muscle tone, muscle spasms and clamps, stiffness of muscles.
Symptoms and stages of the disease
Symptoms of gonarthrosis of the knee depends on its stage. There are three main stages of the disease.
Each stage characterizes a certain period of the course of the disease - from the moment of small changes, to serious lesions of cartilaginous tissue and its complete disappearance.
Gonarthrosis 1 degree
In the initial stage, the disease manifests itself stiffness in the knee joint in the morning hours after sleep and a little pain.
Grade 1Gonearthrosis A person notices that pain and stiffness are aggravated by long walking or prolonged stays in a sitting position. However, with the first degree of gonarthrosis, there is no deformation of the cartilage in communication, with which the pain syndrome is not strongly manifested, and the mobility of the joints remains the same. It is for this reason that in many cases the disease remains unnoticed;
Gonarthrosis of 2nd degree
Gradually the pains become stronger and more persistent. They appear not only after sleep, but also with a prolonged load on the knee - for example, if you stand on your feet or climb the stairs for a long time.
Gonarthrosis of 2nd degree
In the recumbent position the pain decreases. The knee deforms and increases in volume, the patient feels a characteristic crunch when flexing the leg. Bony outgrowths - osteophytes - grow on the surface of the joint. Also, there is no full possibility of bending the leg, which leads to a curvature of the vertebra.
Gonarthrosis of 3rd degree
Symptoms are all the same, but they are more pronounced. The pain in the knee is permanent, it tortures a person both during walking and at night, preventing them from falling asleep normally.
Gonarthrosis of 3rd degree
Sharply disrupted joint function - the patient can not bend the leg in the knee even at ninety degrees.
There is lameness, a person falls on an affected leg or is unable to move without help at all.
Deformation of the joint can be seen immediately, a change in its structure is diagnosed on the X-ray. The bone surfaces are so deformed that there is practically no gap between them, which is necessary for movements and the person has to experience continuous cutting pain.
Treatment with medical and folk remedies
Knee joint gonarthrosis is treated for a long time, and treatment requires doctors to be highly professional, and the patient must be patient. But you can not get rid of the disease forever, but it is quite possible to slow its development.
Medication therapy involves the administration of the following drugs:
- for pain relief. To do this, anti-inflammatory non-steroid drugs are prescribed: diclofenac, indomethacin, paracetamol and others. But they are taken according to the doctor's prescription, a long reception of these medicines can cause an exacerbation of gastritis or stomach ulcers. It should be noted that the action of these drugs is aimed at reducing inflammation and the manifestation of a feeling of pain. Therefore, they only hide the unpleasant symptomatology and do not relieve the disease;
- chondroprotectors. These drugs contain chondrocytes, which will restore the structure of the cartilage. The drugs help to increase the mobility of the affected joint and stop the development of the disease. However, chondroprotectors have a positive effect on the initial stages of the development of pathological changes in the knee joint. They are absolutely useless in the complete destruction of cartilage. These medications are very slow acting and need to be systematically used in certain doses for several courses over a period of one to one and a half years;
- anti-inflammatory drugs. These are corticosteroids, which are hormonal drugs with a strong effect. When the cartilage tissue is destroyed, an inflammatory process occurs and a fluid forms in the joint, and corticosteroids are injected into the joint itself. This hydrocortisone, Kenalog and much more. Assign and hormonal gels with ointments - Diclofenac, butadione and others;
- preparations of hyaluronic acid. A film is formed on the damaged joint, which prevents further destruction of the cartilage by reducing the friction between the articular cavities. As a result, the cartilaginous tissue becomes much more elastic and elastic, including its depreciation abilities. The treatment of gonarthrosis with hyaluronic acid preparations is carried out by courses.
Methods of treatment without the use of medications
This is a physiotherapy that can reduce pain in the affected joint and relieve inflammation. In most cases, electrophoresis is used, because with its help, external drugs penetrate much deeper than the usual application to the skin. Also, to improve nutrition and microcirculation of tissues in medicine, magnetic devices, ultrasound, laser radiation are used.
Medical gymnastics together with manual therapy will relieve the overstrain from muscles and joints, improve the condition and mood of the patient. Wellness gymnastics is an indispensable component of successful treatment of gonarthrosis. Exercise helps to strengthen the muscular system of the lower leg and thigh, thereby increasing mobility of the limb and improving the condition of the ligaments.
In some cases, surgical treatment is prescribed. As a rule, it is necessary in cases when pronounced deformity of the knee joint is observed and its complete immobilization arises and at the same time conservative methods of treatment are not effective. This is endoprosthetics and arthroscopic debridement. In the first case, the patient is placed with a ceramic, metal or plastic prosthesis. In the second case, with the help of an arthroscope, the painful, broken parts of the cartilage are removed.
Folk recipes do not lose their relevance. The joint use of "grandmother's recipes" and medications will have a good therapeutic effect.
It is recommended to rub the joint joint with camphor oil, apply a mixture of apple cider vinegar and honey, or apply a compress from the burdock leaves to the affected knee.
Also, the section of traditional medicine advises you to tie a heated shredded horseradish root at night to your knee, and with pain, drink three times a day a glass of broth from onions, which is prepared by calculating two onions per one liter of boiling water. In addition, it is useful to take a bath twice a week with a decoction of grass hay and malt. If there is a pronounced inflammatory process, wipe the knee joint with a lemon wedge.
Prevention of gonarthrosis
The most important thing in the prevention of this complex disease is muscle training and constant support of them in tone. Very often, having heard advice from a doctor to do gymnastics, a person neglects this and very much in vain. Exercises will help to adapt the body to constant loads, because when they are performed, the muscles of the legs are strengthened.
Prevention of gonarthrosis
Excess weight is also a risk factor for the onset of gonarthrosis. This same gymnastics will help him to fight, because the fat people are constantly stressed by joints due to weight.
One of the causes of the disease is trauma. Therefore, while skating, skiing should be cautious and if you do not imagine your life without it, then take care of good protective equipment and use quality knee pads.
Vitamins are especially useful for prevention. This vitamin E, D and C, so you need to periodically use vitamin complexes.
About calcium fortress calcium will take care, a high amount of calcium is found in eggs, sesame and celery.
The right diet will help the joints. The food should be balanced and correct, for the prevention of gonarthrosis you need to consume a lot of fresh vegetables, cakes and sweets replace with fruits. In winter it is useful to eat cranberries with honey. Homemade cottage cheese, milk and cheese will also help to strengthen joints with bones.
Effective methods of treatment of knee joint gonarthrosis abroad
Gonarthrosis is one of the most common diseases of the musculoskeletal system, which mostly affects middle-aged and elderly women.
The first descriptions of the disease are found in medical treatises of a hundred years ago. But, despite the fact that modern doctors are well acquainted with this disease and methods of diagnosis, there are no 100% effective methods for its treatment to this day.
What is knee joint gonarthrosis?
Gonarthrosis refers to the pathological lesion of the knee joint, when the cartilage tissue is destroyed, gradually involving all parts of the joint in this process. As a result, it deforms, which leads to a partial or complete restriction of mobility of the limb.The causes of gonarthrosis are still not accurately determined.
To date, the causes of the onset of the disease have not been accurately determined. In some cases, the primary gonarthrosis occurs for no apparent reason, while the appearance of secondary gonarthrosis can result in a chronic infectious disease of the knee joint or trauma.
Is it possible to treat leg joints? Which methods are used in this case.
All about rehabilitation after arthroscopy of the knee joint here.
Treatment of gonarthrosis of the knee joint of the 2nd degree
To date, all existing treatments for gonarthrosis do not guarantee a complete recovery and are aimed mainly at reducing pain and restoring the functionality of the joint.
Treatment of gonarthrosis begins with medical examination and diagnosis. First of all, the patient is assigned an X-ray, which helps to establish the diagnosis accurately and determine at what stage the disease is located.
Depending on the dynamics of the disease and the general condition of the body, certain types of therapy are prescribed. As practice shows, the best results can be achieved with a comprehensive approach to treatment.
In most cases, a well-chosen treatment regimen allows you to slow down the degenerative processes in the cartilaginous tissue of the joint, respectively, for a longer time there is no need for surgery.All conservative methods of treatment are justified only at I - II severity of the disease. In advanced cases, only the surgical intervention can improve the patient's condition.
Drug medication for gonarthrosis
Conservative treatment involves the use of medications and physiotherapy procedures aimed at strengthening and reducing the burden on the affected joint. The patient is prescribed:
- anti-inflammatory drugs - to reduce pain,
- hormonal preparations - to restore cartilaginous tissue.
In order for the healing effect to be maximum, the patient's joint should be provided with complete rest. For this, a patient with gonarthrosis in the acute stage is recommended to use a cane or orthopedic insoles. Very well in this case, the orthoses proved to be their own - special fixing mechanisms that allow redistributing the load to different parts of the joint.
In a complex with medical treatment all European clinics specializing in the treatment of gonarthrosis offer physiotherapeutic procedures:
- electrophoresis with novocaine;
- phonophoresis with hydrocortisone( ultrasound therapy);
- ultraviolet irradiation;
- oxygen therapy;
- therapeutic exercise.
Phonophoresis with hydrocortisone is a method of influencing the painful part of the body with ultrasonic waves. In Russia, for the treatment of gonarthrosis of the knee joint ultrasound device UZT 1.01 F( EMA) is used.
Oxygenotherapy is an innovative technique, in some cases allowing to refuse hormonal therapy. During the procedure, medical oxygen is introduced into the joint cavity, which is in a gaseous state. It provides an opportunity to remove puffiness, remove pain syndrome and promote the treatment of injuries.
Therapeutic physical training - is of great importance in the treatment of gonarthrosis of the knee joint of the 1st degree. This kind of physiotherapy allows you to strengthen the joint, improve blood circulation in it and prevent the emergence of contractures.
Arthroscopy of the knee joint
Often, patients with the initial stages of gonarthrosis are offered arthroscopy instead of medical treatment, a minimally invasive operation, when the damaged parts of the cartilaginous tissue and meniscus are removed through a small incision.
Arthroscopy is most often recommended for those patients who, by age or other considerations, are too early to make endoprosthetics. Usually arthroscopic surgery after a while requires a repetition, but, one way or another, it allows you to prolong the life of the joint and improve its functionality.Today, for arthroscopy, most often go to clinics in Israel and Germany, where in almost 80% of cases it is possible to achieve lasting improvement in the course of the disease.
Treatment of knee joint gonarthrosis with stem cells
Some German clinics offer another effective method of treating gonarthrosis - the use of stem cells. Cell transplantation enables early stages of the disease to stop the destruction of cartilage and other pathological processes in the joint. The observation data confirm that after the application of this method the need for radical treatment is postponed for ten years or more.
However, to date, the stem cell method is used by only a few of the largest orthopedic centers in Germany.
3-degree knee joint In cases where conservative treatment methods are not effective, doctors can offer a surgical method for solving the problem:
- leg repair surgery,
Endoprosthetics are offered in cases where it is no longer worthwhile to save a damaged joint or it can lead to additional complications. In all other cases, an operation to correct the axis of the leg is prescribed.Operative intervention entails postoperative rehabilitation.
Based on the x-ray, the orthopedist determines the angle of curvature, and then removes the "interfering" bone fragment. This allows you to reduce the load on the damaged joints, slowing down its destruction. Such surgical intervention subsequently requires rehabilitation and postoperative recovery.
If, despite ongoing treatment, there is no relief, and an X-ray shows deformity of the joint surface, endoprosthetics is recommended. In this case, all damaged bone tissue is removed, and in its place is installed a plastic prosthesis made of biocompatible materials.
About effective treatment of coxarthrosis of the hip joint folk remedies here. Suitable for the initial stage of the disease.
All about the treatment of intervertebral hernia lumbar http: //mdtur.com/lechenie/orthopedy/ lechenie-gryzhi-poyasnichnogo-otdela-pozvonochnika.html on our site mdtur.com.
Endoprosthetics of the knee joint abroad
Today, the list of services of many domestic clinics includes knee replacement, but if this is the case, should go to Israel or Germany for treatment.
- If in Russia such operations have been carried out relatively recently, in European countries the endoprosthesis installation is one of the ordinary operations, which increases the chances of a successful outcome of treatment and reduces the risk of possible complications.
- Another factor in favor of gonarthrosis treatment abroad is the fact that foreign orthopedists pay more attention to postoperative rehabilitation of their patients, which additionally improves clinical results.
Treatment of knee joint gonarthrosis with folk remedies
With gonarthrosis, folk remedies - ointments, infusions, decoctions, herbs - can only be used as ancillary rather than basic methods of treatment. However, the patient is quite able to alleviate his condition.
To do this, it is recommended to change the diet, excluding from the diet:
- fatty and salty dishes,
- to reduce weight,
- to regularly engage in exercise therapy.
Despite the fact that gonarthrosis does not refer to diseases with rapid current and can develop over the years, early diagnosis and timely initiation of treatment often allow prolonging the life of the joint.
Like the article? Watch for new content on VKontakte, Classmates, Twitter, Facebook or Google Plus.
- 12/13/2013 at 09:57
I have arthrosis of the knee joint for about five years. I paid no attention to his first signs. After all, basically my knee began to hurt with heavy loads and I wrote off everything for fatigue. Then the pain began to recur more often and I was helped only by a long rest. But it was not always possible to have a rest, because there are enough cares both at work and at home. When I went to the doctor, he diagnosed me with gonarthrosis - arthrosis of the knee joint. I am only 55 years old, but my problem is that I am still overweight. I knew that sooner or later it would affect my health. The doctor prescribed me a lot of any medications that were ineffective. I tried not only a lot of means against arthrosis, but also visited many doctors. Then I found on the Internet information about products from microspheres and silver ions. I bought it, carried it for about two weeks and gradually life became easier, because my knee was worried less and less. Now I'm back to life without pain, regularly wear a SilverStep product and, of course, watch my weight, try to lead a more correct way of life. Forget healthy!
How to treat knee joint gonarthrosis
The invention relates to medicine, in particular to physiotherapy exercises. To do this, therapeutic gymnastics is organized, consisting of three parts: the introductory part, the main part, the final part. At the same time, in the introductory part, breathing exercises and walking exercises are also performed in an amount of 5-6 times. The main part consists of a set of exercises in the starting position sitting on a chair;lying on his back, arms along the trunk;lying on his side and exercises near the gymnastic wall. And each of the exercises are performed 6-8 times, starting with a slow pace with acceleration to average. The final part includes exercises in the starting position standing at the chair, practicing on the stationary bike at a slow and medium pace for 2-3 minutes, ending with breathing exercises. The method allows to reduce pain in the knee joints, stiffness, decreases the tension of periarticular muscles, improves blood circulation in them, and also avoids a sharp rise in contact pressure in the joint.
Before going directly to the recommended medical training, I would like to make some recommendations:
Vigorous movements with arthroses are strictly contraindicated, in connection with which, all exercises must be performed slowly and smoothly, gradually increasing the amplitude of movements. Physical exercises are performed in a sitting or lying position. In the case of pains, it is necessary to stop occupations. Training should be conducted regularly, several times during the day, but, at the same time, the duration of each exercise should last no more than a few minutes.
And now we will consider the most effective physical exercises for arthrosis of the knee joint:
exercise 1. Exercise is performed lying on the back. The legs are stretched, the heels are forward, the socks are pulled back. Such movements very well relieve muscle tension and improve metabolic processes in almost all joints of the lower extremities.
exercise 2. This exercise is called "vertical scissors".It is performed lying on the back, alternately raising and lowering the legs in the hip joints.
exercise 3. Flexion and extension movements in the knee joint in the supine position.
exercise 4. Lie on your back. The legs are bent at the knees and simultaneously in the hip joints. We perform flexion movements of the legs in the knee joint.
exercise 5. "Horizontal scissors".This exercise is also performed by lying on the back. The legs are bent in the hip joints, alternately they are reduced and divorced.
exercise 6. "Bike" - flexion and extension of the legs in the knees and thigh in the supine position.
Exercise 7. Raising and lowering the knees straightened in the knee in the prone position on the side.
exercise 8. Lying on the abdomen, flexion and extension movements are made in each knee alternately.
exercise 9. Raising and lowering the straight leg lying on the abdomen. The sock is not pulled off.
exercise 10. Rocking the legs in a sitting position( on a high chair).Exercise is done with a small amplitude, without effort.
Reasons for reactive synovitis of the knee joint are described here.
Is it possible to play sports with arthrosis of the knee joint http: //sustavprof.ru/lk/ fiziolechenie-pri-artroze-kolennogo-sustava.html.
Who really needs an operation on the knee
With arthrosis of knee joints, there are situations when one can not do without surgical intervention.
This happens in the following cases:
at the third degree of osteoarthritis of the knee joint, when the cartilaginous tissue is already completely destroyed, painkillers do not work or give insufficient effect, and most importantly, that the pains are not even in motion, but at rest and at night, due to what surgical intervention - the only way out in this situation;with arthrosis of the knee of the second degree: in this situation it makes sense to go through surgery, which does not solve the problem of the disease completely, but can significantly reduce pain in the knees for a fairly long period( on average from six months to 3 years).
There are several types of surgical interventions on the knee joints with osteoarthritis, which can vary quite widely among themselves.
The essence of this procedure is that the foot is fixed in the most suitable functional state, and then immobilized in the knee, removing the remains of the cartilaginous tissue.
The femur, the tibia and the patella grow together, and thereafter no movements occur in the region of the knee, that is, so-called ankylosis is formed.
When creating an arthrodesis, the approach to the treatment of arthrosis of the knee joint is very radical: if the patient is concerned about pain in the joints while moving, then if the joint is completely removed with the remains of the cartilaginous tissue, then there will simply be nothing to hurt.
However, a very strong disadvantage of such an operation is that a person with his help loses the joint, although almost non-working before. Since now there are other, more progressive and subtle methods of surgical treatment of arthrosis, in which a person can continue to own his joint, now such surgical interventions are not very frequent( although it is used, for example, in the surgical treatment of ankle arthrosis).
When there is a choice, usually both doctors and patients choose to perform endoprosthetics, which is discussed below.
Unlike the previous procedure, arthroscopic debridement is a "temporary measure": with her intervention in the joint is minimal, but it has a temporary, but still long enough effect.
Usually this arthroscopic operation on the knee joint is performed in the second stage of gonarthrosis, when the cartilaginous tissue is still more or less preserved, and pains in the joint are only in motion, and they are related to the fact that small dying particles of cartilage freely float in the joint cavity, injureit, and this and cause painful sensations.
What is the essence of this procedure? With the help of a special device - an arthroscope - the surgeon extracts from the joint cavity necrotic cartilage particles that cause pain. Despite the fact that this procedure does not help with arthrosis once and for all, nevertheless, the effect of such procedure in the form of disappearance or significant reduction of pain continues for 1-2 years, which is also very good.
Like the creation of arthrodesis, at present, this surgical intervention is practically not applied. This is due to the fact that it is technically difficult enough, but the most important thing is that the rehabilitation of patients after it takes a very long time( up to 4-6 months), and the effect of this operation is only temporary.
The essence of this surgical intervention is that the bones participating in the knee are definitely filed and reassembled, but at a slightly different angle. Due to this, the load falling on the joint is redistributed, and the pains caused by increased loads disappear, because the weight is taken over by other parts of the bones.
Endoprosthetics is one of the most common operations on joints. During such an operation, the knee joint that has stopped working is removed, and in its place is placed a high-quality joint prosthesis made of metal, high-tech plastic or ceramics.
Undoubted plus of this procedure is its cardinality, so the question of knee arthrosis can be closed for a very long time. Thanks to modern achievements in prosthetics, the artificial joint replacement can work up to 20-25 years or more. Knee endoprosthesis is performed as follows:
The price of such an operation is from 40,000 to 100,000 rubles and above, depending on the clinic where it is performed.
Consult a doctor about the type of knee surgery you need( if needed), taking into account the severity of your illness, the rate of its progression and other factors.
General recommendations for massage
The massage session with gonatrosis is best performed after special exercises of therapeutic gymnastics. Also a good "prelude" for the manual therapy session will be a hot shower or some time spent in the steam room or sauna. Then the muscles get warm enough, and the massage manipulations have a deeper effect. In addition, it is often practiced to massage in water at a temperature of about 37 degrees.
To achieve a lasting result, you need to complete a full course of massage. The massage is best entrusted to a specialist - a manual therapist, but today there are many instructions for self-massage.
During the procedure, you can use both ordinary massage oils and creams, and ointments, specially designed for rubbing with arthrosis of the knee joints. All movement should be directed strictly along the lymphatic vessels. Massage should not cause pain and any other discomfort, especially in the joint area.
In addition to manual local massage for arthrosis of the knee joints, vibratory mechanical massage is also used. It is also recommended to perform vibrating movements with a sponge and a nozzle with spikes.
Techniques and Methods
For today in manual therapy of gonarthrosis use four known massage systems, namely Finnish, Swedish, Russian and Oriental. They all have their own characteristics. The Russian massage method includes rubbing and stroking. The founder of this system advised to combine these techniques with hydrotherapy and gymnastics.
The task of the eastern system is the release of massaged muscles from venous blood and the improvement of the motor function of the joint. The most powerful effect in gonarthrosis is the application of the Swedish technique. In it, stroking and rubbing are combined with the movement of the joint. Thanks to this approach, muscles, neurovascular connections are well stretched, seals in tissues are rubbed.
The Finnish system is very close to Swedish, however, there is one difference - kneading is carried out only by bundles of thumbs.
For the massage there are several basic techniques, the combination of which is a standard massage movements. So, for example, almost any massage begins with stroking and ends with it. The strokes are carried out with the whole palm and pursue the goal of relaxing the muscles, improving blood flow, relieving tension, stimulating the outflow of lymph.
Rubbing is one of the main techniques for knee joint massage. It reveals a deep action: stretches and relaxes muscles and ligaments, accelerates blood flow and lymph flow. When grinding occurs, resorption and the removal of deposits from the joint, improving the mobility of the joints.
Mening is the main procedure for massage of patients with knee arthrosis, in practice it looks like a slight pushing on the skin. By stretching a specific area on the foot, the masseur gets to the deepest layers of the skin, affects the trophism of the tissues and muscle tone, making them stronger and more elastic.
Vibration is a kind of shaking of the skin and muscles, which thanks to the amplitude transmits its vibrations to tissues that are located more deeply.
The entire massage session is divided into three parts: introductory, basic and final. During the introductory and final stages of the movement is characterized by light pressure, slow pace. But the most intensive manipulations are carried out in the middle of the session, when tissues and muscles are already well prepared for such actions. Rules for the massage
When gonatrozee massage not only the knee, but also other parts of the body. Begin the massage from the area of the lower segment of the spine. Then the muscles of the thigh of the diseased leg are kneaded. At the same time, the following techniques are used: combined stroking, squeezing the fist crests and the edge of the palm. All these manipulations are carried out 3-4 times. Then shaking and stroking( 2-3 times) are done, the muscles are again kneaded and shaken and stroked again.
After the muscles of the thigh are developed, you can proceed to direct massage of the affected joint. It begins with circular strokes on the sides, and then uses several types of rubbing. After that, you need to repeat the thigh massage again, but already reducing the number of repetitions. In this order of knee massage for arthrosis, and also, the hip is performed several times. Then the masseur conducts careful bending and extension of the knee joint, and rotation of the shin.
After such active actions and another massage procedure in the hip area, you can repeat kneading. To stroking this time, rubbing with fingertips and phalanges is added. Complete the procedure with shaking and easy stroking in the area of the patient joint
Patients with gonarthrosis must adhere to the diet. You should change the diet and eat every 4 hours, taking the bulk of the food at lunch time. It is also necessary to limit the use of table salt and abandon semi-finished products, salted fish, chips and mayonnaise. During cooking, it is better to use unrefined oil.
Often in patients with gonarthrosis is overweight, so you should use a diet that would help lose weight, but at the same time provided the body with all the necessary substances. To maximize the correct menu, it is worth consulting with a nutritionist who will take into account the features of arthrosis and other associated pathologies.
To prevent excessive weight gain, it is recommended to eat a lot of fruits and vegetables, as they contain complex carbohydrates, which are slowly absorbed and not deposited as fat. From sweet and good food is better to refuse.
To control body weight, it is necessary to remember:
any alcoholic beverages stimulate appetite;there should be small portions, thoroughly chewing food;you need to monitor the emptying of the intestine - the chair should be daily.
For proper metabolism, the body should receive a sufficient amount of vitamins and minerals. When gonarthrosis is recommended to use a lot of protein, because it is proteins used to build new tissues and to repair cartilage. Especially useful are dairy products, low-fat varieties of fish and meat, buckwheat porridge and lentils. For better assimilation of proteins, it is recommended to eat boiled, stewed dishes or steamed foods.
Patients with joint damage are useful to include in their diet a cold based on bone broth. It contains a lot of collagen, which is necessary for building cartilage. In addition, food gelatin is useful. It promotes the restoration of cartilaginous tissue, since it contains substances with chondroprotective properties.
It should be noted that even a carefully formulated diet is not able to cure gonarthrosis of the knee joint, but with the observance of the main recommendations, it contributes to overall improvement and improvement of joints.
In the diet of a patient with arthrosis, doctors recommend including low-fat fish or meat, bread with bran and vegetables. It will be useful to add jelly or jelly, cooked on bone broth. It contains collagen, which is necessary for the construction of bone and cartilaginous tissue, ligaments and muscles.
Correct metabolism in the body is not possible without vitamins and mineral components. Particularly useful are vitamins of group B. Folic acid( the so-called vitamin B12) is found in lentils, bananas, cabbage. Vitamin B6 - in potatoes, bananas, nuts, chicken meat, vitamin B1 - in baked potatoes, beans, peas, whole-grain bread.
Dairy products are rich in vitamin B2 and calcium, necessary for strengthening bone tissue. To restore and build a new cartilaginous tissue that covers the articular surfaces of bones, proteins are required - milk, vegetable and animal. Vegetable protein is found in lentils, buckwheat porridge and beans, animal - in fish and low-fat meat. For better digestibility of proteins, the diet should include stewed or boiled dishes.
Full nutrition with arthrosis is impossible without moderate consumption of fats, which are necessary for the normal course of metabolic processes. However, the consumption of animal fats should be reduced, replacing them with vegetable and butter. How to eat right?
To maintain the health of your joints and prevent the destruction of cartilaginous tissue, proper nutrition with a slight predominance of carbohydrates, a sufficient amount of fruits and vegetables, and a limited intake of protein will help. Naturally, cure arthrosis with a single diet is almost impossible. However, adherence to simple recommendations for food intake in conjunction with the prescribed therapeutic measures will help to reduce weight, improve the joints and the general condition of the body.
There are several tips for reducing hunger and providing adequate nutrition:
Eat from a small plate, so the portion will seem bigger Never overeat Take small pauses during meals Chew each piece of food thoroughly Do not eat after 18 hours After eatingalways go for a walk. Constantly watch your weight
The diet for arthrosis has its own specifics, but it is consistent with standard dietetic techniques aimed at the mindNecessity and sufficiency in nutrition. It is, in principle, unchanged in the defeat of different parts of the body, ie, for example, a diet for arthrosis of the knee joint, as a rule, does not differ from the recommendations on nutrition for arthrosis of the hip or shoulder joints.
The medical treatment of gonarthrosis( arthrosis of the knee joint), despite its widespread application, has a very modest role. The effectiveness of drug therapy is significantly inferior to non-pharmacological treatment methods. And if you are concerned about pain in the joints before you start taking medicine, you should try non-drug treatment methods. And only then when non-drug treatment methods are not effective enough, you can add medications.
One can not disagree with the thesis that treatment of patients with degenerative joint diseases should be early, pathogenetic complex and stage. In this regard, modern approaches to treatment are aimed at reducing pathological symptoms using various methods:
non-pharmacological treatment( eg, educational programs, physical exercises, lifestyle changes);pharmacological treatment( eg, paracetamol, non-steroidal anti-inflammatory drugs - NSAIDs, topical treatment);invasive methods of treatment( for example, intraarticular injections, lavage, arthroplasty).
Medical treatment of gonarthrosis is aimed at reducing pain( analgesic effect) and inflammation( anti-inflammatory effect), as well as slowing down cartilage degradation( structural-modifying effect).It is recommended to begin conservative treatment with NSAIDs, more precisely, with their topical application to the affected joints in the form of ointment, cream, gel. When there is stiffness in the joint or a clear sweating systemic( oral) application of NSAIDs is indicated.
Conservative treatment of deforming arthrosis of the knee joint: In the initial stages of the disease it is recommended to limit the load on the joint, prescribe drugs of the oxicam group( ksefokam, piroxicam), ketorolac. Locally apply ointments with anti-inflammatory drugs( nimulide, voltaren).
In the event that joint damage occurs without significant symptoms, the patient may be prescribed ointments for arthrosis with a warming effect, the main purpose of which is to improve local circulation in the affected area.
As examples of such ointments you can bring Menovazine and Nikoflex - cream, which usually do not provoke the occurrence of allergic reactions and manifestations of side effects. Patients only note a pleasant sensation of warmth and even comfort, which in no way interferes with them.
Very popular is the administration of ointments based on bee venom, for example, Apizatron and Ungapiven, as well as snake venom such as Viprosal. The main principle of their effectiveness is a distracting and irritating effect, but, in addition, due to the contained in them in small amounts of poisons, when absorbed through the skin they increase the elasticity of muscles and ligaments.
Nevertheless, some doctors are wary of prescribing such drugs because of the high risk of an allergic reaction, as well as the possible inflammation in the application sites. In addition, the use of such drugs is strictly contraindicated in children and women during critical days.
In the event that the course of the disease is complicated by manifestations of synovitis, it is appropriate to administer non-steroidal anti-inflammatory drugs, including Voltaren-gel, Fastum-gel, Dolgit and many other ointments. Unfortunately, the effectiveness of these drugs is not as high as we would like, since a certain amount of the drug is delayed on the skin, which is quite enough for the drug to not be able to act at full strength.
Therapeutic ointments and creams, although they can not in any way heal arthrosis, can alleviate the condition of the patient with gonarthrosis.
For arthrosis of the knee joint, which occurs without the symptoms of synovitis, I recommend warming ointments to my patients in order to improve blood circulation in the joint.
For this use menovazine, gevkamen, espol, nicoflex cream, etc. The above ointments usually cause the patient a feeling of pleasant warmth and comfort. They rarely give any side effects.
Ointments based on bee venom( apizatron, ungapiven) and venom of snakes( viprosal) have an irritating and distracting effect, but, in addition, absorbed in a small amount through the skin, improve the elasticity of ligaments and muscles, as well as microcirculation. However, side effects from their use are more: such ointments quite often cause allergy and inflammation of the skin in places of their application. You should also know that they are contraindicated for women in critical days and children.
Ointments based on non-steroidal anti-inflammatory substances( indomethacin, butadion, dolgite, voltaren-gel, fastem) are used in cases where the course of gonarthrosis is aggravated by synovitis. Unfortunately, they do not work as effectively as we would like - after all, the skin misses no more than 5-7% of the active substance, and this is clearly not enough to develop a full-fledged anti-inflammatory effect.