Treatment of gonarthrosis( arthrosis of the knee) 1, 2, 3 degreesWhat is gonarthrosis? Knee joints can rightly be called the most loaded in the human body. The process of walking, as is known, is a fall, which prevents the second leg from setting. Thus, the knee joint( more precisely, the tibia) at every step experiences a load in the form of the weight of the complete human body( except the tibia of the standing leg).
Given the prevalence of obesity, which greatly increases the load on the articular cartilage, the lifting of various weights that also contribute to the gradual destruction of the knee joints, one can understand why the dystrophic degenerative knee injury, called deforming gonarthrosis, is common, especially in adulthood and old age. Disability is often the outcome of gonarthrosis.
Stages of gonarthrosis
Treatment of gonarthrosis should be differentiated, depending on the stage of the disease:
- in the first stage of deformation of cartilage and articular bag does not happen, there is only swelling of soft tissues;
- the second stage develops, usually after a few months. It manifests itself in the intensification of pain after minor loads and movements. It can be said that any movement hurts. To the pain has passed, you need a long rest. Osteoarthritis of the knee joint of the 2nd degree is still reversible with proper and timely treatment.
- Gonarthrosis of the third degree except functional disorders, is manifested by progressive destruction of the cartilaginous tissue. The pain arises even at rest. It is at this stage that the classic aching in the knees "on the weather" begins, there is a significant restriction of movement in the knees. This disease brings considerable suffering, and leads to disability.
How to treat arthrosis of the knee joint
Treatment of all diseases, and gonarthrosis in particular, is only three types:
- etiotropic, that is, aimed at eliminating the cause of the disease;
- pathogenetic, directed to one of the links in the development of the disease;
- is symptomatic, aimed at relieving suffering.
Only all these measures in the complex can give a lasting positive result. Applicable to gonarthrosis, therapeutic effects should be directed to:
- pain relief( improvement of quality of life) - NSAID group;
- improvement of trophism and restoration of the surface of articular cartilages - reparants( chondroprotectors);
- reduction of blood stagnation( ischemia) and improvement of blood circulation in the microcirculatory bed of the periarticular tissues and the joint bag - vitamins, massage, physiotherapy, local treatment;
- improvement of trophism of muscles of the thigh and lower leg - exercise therapy.
In addition, with various arthrosis is quite effective treatment of folk remedies: phytotherapy, deep warming.
The main groups of drugs used in the treatment of knee arthrosis
- NSAIDs are non-steroidal anti-inflammatory drugs. Are non-hormonal. They are used to relieve acute pain. Therefore, they are used in the first place, since only after the withdrawal of the expressed pain syndrome other methods of treatment are possible. However, their administration should not be long, as it is possible to develop side effects, for example, such as NSAID-induced gastropathy.
In addition, removing pain, taking these drugs does not prevent further destruction of the joints, but only improves the quality of life. Representatives of this extensive group of drugs are such as nimesil, tselebrex, movalis, orthophene, voltaren and many others.
Modern NSAIDs( eg, meloxicam) cause few side effects, and are selective, that is, they exhibit selective, more precise action.
- Preparations protecting cartilage surfaces from destruction and helping to restore it - chondroprotectors. Their main active substances are chondroitin sulfate, glucosamine and hyaluronic acid( synviscus, fermatron).Simply put, these drugs contribute to the timely "lubrication" of the joint, the preservation of its biomechanical function, reducing friction and pain syndrome.
These drugs significantly help in the very beginning of the disease, as well as in the 2nd stage. If the cartilage does not already exist, then the best lubricant will be unable to restore the function. In addition, it has been shown to be effective only in intraarticular administration of the drug, only directly into the joint cavity( Don, Hondrolon, Elbon).
All tablets( Artra, Teraflex, etc.), which are so expensive, are in fact not more effective than a cold containing approximately the same compounds. The course of treatment with chondroprotective agents is quite long.
- Local treatment in the form of ointments, creams and applications on the surface of the knees. This is an extremely widespread method of treatment at all stages of the disease. They do not so much heal as they ease the condition and refer to the means of symptomatic therapy. Most often used ointments with a warming effect, able to improve blood circulation in the joint area. There are a lot of them: Nikoflex, Dolgit, Fastum-gel, Kapsikam, Finalgon and many others.
In the event that a synovitis has joined, that is, there is inflammation and effusion, it is impossible to warm. This can increase swelling of the inflammatory fluid in the joint cavity. In the event that there is effusion, it is possible to use intraarticular injections of hormonal preparations of long-term action( Kenalog, Diprospan) and their analogues.
Dimexid, penetrating through the skin, and bischofite have a good therapeutic( analgesic and anti-inflammatory) effect. Bishofit is an "oil brine" that accompanies the emergence of oil while drilling wells. It warms well and anesthetizes, if applied in applications and compresses.
- Of great importance are non-medicinal methods: medical gymnastics, physiotherapy, massage. Special exercises, especially in the pool, with reduced load, have a beneficial effect on the restoration of articular cartilage. Using the cane also reduces the load on the affected joint.
- Also an important component of the complex therapy of gonarthrosis is a diet. Food should not be monotonous, it is necessary to exclude refined meat byproducts that can cause urine acid diathesis and the attachment of microcrystalline arthritis, which worsen the course of gonarthrosis.
Glandarthrosis of the knee joint of 2nd degree - treatment
Gonarthrosis - arthrosis of the knee, deforming arthrosis - a disease in which progressive destruction of articular cartilage is observed.Symptoms and stages of gonarthrosis
In the development of the disease, doctors distinguish 3 degrees:
- In gonarthrosis 1 degree of pain occurs only after prolonged physical exertion. In the region of the knee, there may be a slight swelling, which quickly passes by itself. At this stage, it is possible to cope with the problem of traditional medicine methods.
- With gonarthrosis of the knee joints of the 2nd degree, the pains become frequent or constant, arise even in a state of rest and are intensified after exercise. When walking, flexing and unbending the leg in the knee, there may be a crunch and clicks. The knee is swollen almost constantly, its apparent deformation is observed. In addition, there is a joint stiffness, which can decrease throughout the day. At night, there may be pain in the calf muscles. Treatment of gonarthosis of the 2nd degree requires the reception of a number of potent drugs, and folk remedies can only be used as ancillary drugs.
- With grade 3 gonarthrosis, there is a visible significant deformation of the joint, permanent pain, restriction of mobility, even to the impossibility of stepping on the aching leg, pronounced lameness. Conservative treatment at this stage is usually ineffective and surgical intervention is required.
How to treat gonarthrosis of the knee joint of the 2nd degree?
With 2 degrees of knee joint gonarthrosis, treatment with conservative methods is still possible, but it should be performed under strict medical supervision. Treatment of gonarthrosis includes a whole range of measures:
- Drug administration.
- If possible, reduce the load on the affected joint. With unilateral gonarthrosis of the 2nd degree, the use of the cane is a good way to reduce the load, but in the bilateral form of the disease, when both knees are affected, this method is not available and it is necessary to limit oneself to special knee pads.
- Physiotherapy - laser, magnetotherapy, electrophoresis, low frequency vibration. Helps reduce puffiness, pain and inflammation.
- Massages, manual therapy and therapeutic gymnastics. They help improve blood supply, joint development and restoration of normal mobility.
- The diet for gonarthrosis of the knee joint of the 2nd degree is an obligatory component of the treatment and is called upon to normalize the weight( since the fat deposits create additional stress on the joints) and ensure the intake of the necessary vitamins and minerals. The food should be fractional( 4-5 times a day), contain a small amount of fats and as little salt as possible, be rich in plant and animal proteins, B, C and D. Vitamins.
Knee Glandarthrosis Products Standard Schemetreatment of gonarthrosis involves taking medications such groups:
1. Non-steroidal anti-inflammatory drugs:
They are used primarily to relieve the pain syndrome and to a greater extent eliminate symptoms than have a prolonged therapeutic effect.
- Chondroitin sulfate.
These are medicines containing synthetic analogues of the substances that make up the cartilaginous tissue of the joint. Contribute to the restoration of cartilage, but should be taken regularly, long courses. To the same group include preparations of hyaluronic acid, which is an analogue of articular lubrication.
3. Intra-articular injections of corticosteroids. They are used in short courses for acute symptoms and severe pain.
4. Ointments and compresses - used to relieve swelling and reduce pain. Of the ointments, the most effective are preparations based on non-steroidal anti-inflammatory drugs:
For compresses most often used drugs such as Bischofite and Dimexid.
Gonarthrosis( arthrosis of the knee joint) 2nd degree
With pain in the knee, the doctor is consulted when difficulties arise when walking. And this is most likely arthrosis 2 degrees. The first did not cause special troubles - a slight fatigue and discomfort in the joint. With arthrosis of the 2nd degree, a person often loses his ability to work, but there is still the possibility of self-service. This disease occurs so often that it has its name "Gonarthrosis".In translation from the Greek gonato - the knee, artrosy - the joint, the ending os - speaks of the dystrophic origin of the disease.
What contributes to the development of arthrosis
The knee joint experiences the greatest loads, therefore it wears out earlier than others.
The causes of gonarthrosis are different:
- age after 50 years;
- female gender;
- previous joint diseases( inflammatory, endocrine);
To a greater extent, this disease affects obese women after 50 years. It is not uncommon for knee joint arthrosis in athletes. Lacerations of ligaments, tendons, intraarticular fractures, often cause anatomical changes and impaired blood circulation in the organ.
With arthrosis, not only cartilage but also bones, tendons, ligaments that make up the joint are destroyed. The cartilage loses elasticity, strength and is gradually erased, exposing unprotected bone surfaces.
Symptoms for arthrosis of the knee joint are the same as in other localizations:
- "crunch" when moving;
- limitation of mobility in the joint.
The inability to move freely aggravates the condition of the patient.
Pain in the knee joint with arthrosis of the second degree occurs with any movement, but it subsides in a supine position. It is especially difficult to take the first steps after waking up or staying in a stationary state for a long time. This is the so-called "starting pain".
Due to constant friction, the bone surfaces of the joint become denser, forming osteophytes, which further aggravate morbidity during movements. There are night pains, lameness progresses.
Restriction of mobility in the joint
Not only pain and overgrown osteophytes prevent bending and unbending the knee. The muscles of the thigh and lower leg, protecting the leg from painful movements, are in constant tension, which is expressed by the pain and fatigue of the limb.
Another reason is synovitis. To dystrophic phenomena is added inflammation. The fluid accumulates in the joint, it is enlarged in size and painful to the touch. Movement limbs are even more limited. The inability to unbend the joint forces the person to walk slowly, on the knees bent at the knees. The slightest roughness on the road becomes a serious obstacle. Moving without support becomes more difficult.
Treatment of gonarthrosis
Every person suffering from arthrosis of the knee joint should remember that treatment will help if it is received continuously, despite the improvement of well-being. The order of medication, physiotherapy and physical exercises will be determined by the doctor.We recommend reading the article:
LFK for arthrosis of the knee joint
Gonarthrosis( arthrosis of the knee joint) is treated with conservative and surgical methods.
Conservative methods include:
- therapeutic exercise;
- relieving the load from the knee joint.
Drug therapy begins with the appointment of chondroprotectors, drugs that slow down the destruction of cartilage and contribute to its recovery. Anesthetic effect after their use is retained for half a year. Chondroprotectors are not effective in single or non-regular administration. They are assigned courses for 3-6 months, which are repeated periodically.
Chondroitin sulfate( contained in the preparations Chondroitin, Structum) and glucosamine, which is a part of Elbon and Don, have this effect. A number of preparations contain both these substances: Teraflex, Arthra. They have no complications and very rarely cause side effects.
Paracetamol( Panadol, Denol, Efferalgan) is used as an anesthetic for arthrosis. A more pronounced effect is possessed by NSAIDs( non-steroidal anti-inflammatory drugs).But they have a big drawback - they irritate the gastric mucosa and adversely affect the cardiovascular system.
NSAIDs are indispensable for gonarthrosis
The last few years have created drugs with minor side effects. Arkoxia, Celebrex, Movalis and Nimesulide are prescribed to patients with concomitant diseases of the stomach and elderly people.
Synovitis, due to inflammation and severe pain, can interfere with medical treatment. In this case, arthrosis of the knee joint is initially performed intra-articular injections of corticosteroids( kenalog, hydrocortisone), which have a strong anti-inflammatory effect. Then, physiotherapy and exercise therapy are performed.
Hyaluronic acid effectively acts as a natural lubricant. This natural substance not only permanently removes pain, but also significantly increases mobility in the joint. Mortars, Cinoceros, Fermotron containing hyaluronic acid are injected into the joint cavity.
In recent years, Gialgel is produced, containing not only hyaluronic acid, but also chondroitin sulfate. It is applied to the skin, has a large penetrating ability, reduces pain and swelling of the joint, delays the destruction of cartilage.
For arthrosis, anti-inflammatory ointments
are used. For local treatment, warming ointments, Menovazine, Gevkamen are used. They are indicated for arthrosis of the knee joint with no signs of inflammation. If the joint is edematous, hot to the touch and movements are sharply painful, it is better to use anti-inflammatory ointments( Dolgit, Fastum-gel or Voltaren).
Physiotherapy and exercise therapy
Physical exercises should be a constant companion of treatment for any degree of arthrosis. Gymnastics prevents the development of contractures, preserve muscle tone. Movement is the prevention of any arthrosis.
Physiotherapy methods quickly reduce pain, inflammation and increase the amount of motion in the knee joint. Magneto-laser and UHF-therapy, phonophoresis with hydrocortisone, massage, baths are applied. All procedures have indications, contraindications and are prescribed by a doctor.
Knee braces are used to fix the knee joint and rigid functional orthoses. To reduce the load on the joint, it is recommended to use a walking stick or crutches.
Surgical treatment of
In case of pronounced impaired knee function, inefficiency of conservative treatment and complete destruction of cartilage, surgical methods are indicated:
- Endoprosthetics - replacing a damaged joint with an artificial joint.
- Osteotomy - removal of bone deformities or restoration of the limb axis.
- Arthroscopic manipulations are performed by optical instruments inserted through skin punctures in the knee. With the help of this low-traumatic method, fragments of the destroyed cartilage are removed from the joint cavity, medications are introduced.
Knee osteoarthritis is a common disease prone to progression and leading to disability and disability. Complex therapeutic measures, carried out continuously, allow for a long time to delay the destruction of the cartilaginous tissue of the joint and reduce the severity of the symptoms.
Genuine scourge of the twenty-first century is gonarthrosis of the knee joint. If several years ago only elderly people were at risk, now the disease does not spare the youth.
In most cases, gonarthrosis develops against the background of injuries sustained by athletes in training and competition.
Knee joint destruction occurs gradually: first, against a background of mechanical damage, microtraumatic cartilage arises, then the process of its degeneration occurs.
This disease is characterized by a change in the tissue of the cartilage of metabolism, the essence of which is that the saturation of the cartilage with chondroitin sulfate is markedly reduced.
The causes of progression of gonarthrosis are:
- arthrosis, formed against the background of Paget's disease;
- bone tumors of benign or malignant nature;
- fractures of the bones of the knee joint;
- ankylosing spondylitis( arthritis affecting the joints of the sacrum and spine);
- rheumatoid arthritis.
Modern physicians distinguish 3 degrees( or stages) of gonarthrosis.
Unfortunately, this stage of gonarthrosis is often ignored by most people. Pain syndrome occurs only after a load, and the deformation of the knee joint to notice with the naked eye is almost impossible.
Symptoms of the disease become more specific. Thus, the duration and intensity of painful sensations localized in the joint increases, and often a characteristic crunch is formed during flexion.
Gonarthrosis, developed to 3 degrees, is characterized by quite strong painful sensations, arising both during movement and when a person is standing or sitting. In addition, the affected joint "reacts" to the weather change. Mobility of the knee joint is limited, there are changes in the gait( lameness).
Medicine is known for two types of disease: primary( idiopathic) and secondary.
The disease occurs and develops due to intensive loads of the knee joint. The risk group includes middle-aged and elderly women, as well as athletes and people with obesity.
The pathological process extends both to one joint and to both. When there is a simultaneous destruction of both joints, doctors diagnose bilateral gonarthrosis.
The provoking factors of gonarthrosis secondary are:
Knee joint gonarthrosis of 1, 2 and 3 degrees: treatment, causes, symptomsWhat is it - gonarthrosis is a non-inflammatory disease of the knee that disrupts the blood supply of cartilage, covering the articular surfaces of the femoral and / or tibia. As a result, the cartilage is destroyed, the parts of the bones begin to rub against each other, as a result of which they become denser and expand. This is often accompanied by inflammatory phenomena. Symptoms of the disease are due only to the above processes;calcium salts, if they are deposited in the joints, the cause of the pathology is not. Pathology most often develops in individuals 40 years and older, mainly women and people who are engaged in professional sports or having knee injuries. Articular cartilage does not regenerate, so the disease must be detected and treated early in the early stages.
Causes of gonarthrosisThe disease develops with a combination of several causes:
- fractures of the bones of the lower leg involving the knee joint;
- trauma of cartilage interlayers of the joint - meniscus;
- tears of knee joints;
- increased load on the joint - running, squatting, lifting weights from the vertical position of the body - after 40 years of age, especially if a person does not exercise regularly;
- excess weight
- joint inflammation( arthritis), which has a different - psoriatic, gouty, rheumatoid or reactive - etiology;
- genetically determined weakness of the ligamentous-capsular apparatus of the joint, because of which its loosening occurs;
- pathology of joint innervation, characteristic of craniocerebral and spinal cord injuries;
- metabolic disease.
- 1) Primary. It occurs against the background of full joint health( without pre-injury or inflammation).It is based on metabolic diseases, long-term use of hormonal drugs, genetic predisposition of articular cartilage. The process is usually two-sided( although it can begin as one-sided).It develops more often in the elderly.
- 2) Secondary. Develops due to injuries, inflammations, tumors transferred to the joint operations. Can develop at any age. The process is usually one-sided.
Symptoms of knee joint graft diseaseHow the disease manifests itself will depend on how far the degenerative process has progressed. Depending on this, three stages of the disease are distinguished, each of which has its own symptomatology. As a rule, the first degree of gonarthrosis of the knee joint is manifested by certain symptoms, which should be noted:
- a feeling of tightening under the knee;
- stiffness in the knee, which manifests itself after sleep, prolonged sitting or prolonged immobility of the joint;
- joint pain:
- arising during prolonged walking, squats, walking on stairs;
- aggravated after standing or physical exertion
- joint swelling may occur for a short time, passes by itself.
- joint pain becomes more intense, lasts longer. It disappears after rest.
- pain is felt inside the joint or on the inside of the knee.
- there is a crunching in the knee when walking.
- in the morning it is impossible to unbend the knee.
- closer to night and at night there are pains in calves.
- does not fully extend the leg.
- joint swells, acquires signs of initial deformation.
- 1) Joint pain constantly worries, regardless of physical activity of a person.
- 2) Pain syndrome increases with changing weather.
- 3) The mobility of the joint is limited, due to which the person limps.
- 4) The knee is enlarged in size and deformed. When the process progresses, the joint becomes an X-shaped or O-shaped.
Diagnosis of gonarthrosisThe presence of gonarthrosis of the knee in a patient can be suspected even on the basis of his complaints and objective examination data. The diagnosis is confirmed with the help of such instrumental studies:
- 1) Radiography. This method may be uninformative at the first stage of the disease, but subsequently it visualizes the narrowing of the joint gap, the compaction of the bone zone below the articular cartilage, and the sharpening of the edges of the condyles.
- 2) Computed tomography of the joint. This is more expensive, but more informative( even at stage I) method based on x-ray radiation. Visualizes the joint itself and surrounding tissues in more detail and layer by layer.
- 3) Magnetic Resonance Tomography - a method based on a non-radiological, considered harmless radiation, which can be used for contraindications to CT.Also layer-by-layer displays the picture in the joint, but is more informative regarding the surrounding soft tissues.
- 4) Arthroscopy is an invasive technique for joint research when a fiber optic device is inserted into a hole made under local anesthesia, allowing a specialist to examine the joint from the inside.
- 5) Knee ultrasound is informative for the diagnosis of such complication of gonarthrosis as synovitis.
Treatment of gonarthrosis of the knee jointThe doctor involved in the treatment of this disease is an orthopedist. Medical treatment of the disease includes the following groups of drugs:
- 1) Non-steroidal anti-inflammatory and pain medications: Voltaren, Celebrex, Rofika, Nimesil, Movalis.
- 2) Chondroprotectors: "Artra", "Arthron", "Dona", "Teraflex", "Chondroitin complex".These drugs are taken for at least six months in the dosage prescribed by the doctor.
- 3) Inside the joint with pronounced inflammatory phenomena, enter "Hydrocortisone" or "Kenalog" no more than 3 times.
- 4) The preparations of hyaluronic acid are shown, which must be inserted into the joint when the inflammatory phenomena in it subsided: "Hyalurum", "Ostenil", "Sinocrom".These medications show a very good effect, they are administered only a few times, while having a fairly high cost.
- 5) Heating compresses with "Dimexid", "Bischofite", medical bile to improve the blood supply of the joint, increase the production of "lubricating" liquid in it.
- 6) The preparation on the basis of drawing from soya and avocado plants - "Piascladin" - has also established itself as an effective tool in the treatment of gonarthrosis of the knee joint. At the same time, the treatment course is not less than six months.
Physiotherapy for gonarthrosisIn an acute period a person needs to provide complete rest for a diseased knee. Then proceed to the gradual introduction into his regime of the day of physical exertion. Exercises are carried out in the position of the patient lying on his back, they consist mainly in lifting the straightened legs, keeping them in the raised position. It is important to perform exercises smoothly, carefully, so that they do not cause pain. Begin with 10 minutes, gradually, 2 minutes a day, increasing the duration of classes. Increase and the amplitude of movements, which should be selected by specialists individually for each.