Knee joint disease

Knee osteoarthritis (also known as knee joint disease or DOA for short)-Knee joint degenerative dystrophy disease, which is characterized by a chronic, steady course of disease, damage to all structural elements (hyaline cartilage, bone structure around joints, synovium, joint capsule and joint ligaments), resulting in joint deformities and reduced scopeExercise and frequent disability.

The disease begins with changes in articular cartilage, so the articular surfaces of the bones slip. Malnutrition and loss of elasticity lead to malnutrition (thinning) and absorption. At the same time, the bone tissue of the articular surface is exposed, sliding is disturbed, the knee joint space is narrowed, and the biomechanics of the joint changes. The synovial membrane that lines the joints and produces synovial fluid (which nourishes cartilage and acts as a physiological lubricant) is irritated, causing its amount in the joint to increase (synovitis). Under the background of the narrowing of the joint space, the joint volume shrinks, and the synovial fluid protrudes out of the posterior wall of the joint capsule, forming a Becker cyst (large volume, which can cause popliteal pain). The thin and fragile tissue of the joint capsule is replaced by the rough connective tissue, and the jointThe shape changes. Bone tissue around the joint grows, forming osteophytes (pathological bone growth). The blood circulation of the tissues around the joints is impaired, and under-oxidized metabolites that stimulate chemoreceptors accumulate in them, leading to persistent pain syndrome. In the context of changes in the anatomical structure of the joints, the surrounding muscles are invaded, atrophy and spasm, and gait disorder occurs. The range of motion of the joint is continuously limited (contracture), sometimes so obvious that only rocking motion (stiffness) or no motion at all (stiffness) is possible.

Regarding knee joint disease, we can say that this is a fairly common disease: it affects 10% of the population on the planet, and it affects one-third of people over 60.

Causes of knee joint disease

• Damage to bones and joints.
• Joint diseases (rheumatoid, chlamydial arthritis, gout).
• Violation of mineral metabolism in various endocrine diseases (diabetes, parathyroid disease, hemochromatosis).
• Muscle diseases and neuropathy (Charcot disease).

In addition to the main reasons, there are also some unfavorable background factors that are detrimental to the development of knee joint disease, including:

• Overweight (literally putting pressure on the lower limbs);
• Age (mainly elderly people are susceptible to this disease);
• Women (according to statistics, women get sick more often);
• Increase sports and professional sports activities.

Symptoms of knee osteoarthritis

• Pain worsens when walking, and relieves when resting.
• Habitual physical movement of joints is difficult.
• The characteristic "crunch" in the joints.
• Joint enlargement and visible deformity.

Stages of knee joint disease

There are several stages of joint disease:

1. In the first stage, a person will only experience some symptoms, such asSlight discomfortOr the knees are "heavy" and feel uneasy when walking long distances or increasing physical exertion. X-ray examination has very little information: only a slight narrowing of the joint space can be detected, no other changes. At the beginning of the failure of knee joint disease, a person will not turn to a specialist for help instead of paying particular attention to the symptoms that have already appeared.
2. For the second stage of knee arthropathy,Tangible pain, Its severity decreases at rest. There is difficulty in joint movement, and the characteristic "squeaking" sound will be heard when walking (from the patient you can hear a common phrase in daily life-"knee squeaking"). During radiography, it was found that the joint space was significantly narrowed and a single osteophyte was found.
3. As the knee joint disease transitions to the next third stage,Pain symptoms will continue to bother the patient, Including when it is at rest, it violates the configuration of the joint, that is, deforms, and when inflammation is added, it is aggravated by edema. On X-rays, it was confirmed that the joint space was moderately narrowed and multiple osteophytes. In the third stage, many people have sought medical help because the quality of life is significantly affected by pain and difficulty walking normally.
4. The fourth stage of knee joint arthropathy is accompanied byUncontrollable and exhausting pain. . . The smallest attempt to move is a difficult test for a person, joint deformities are visually obvious, and walking is extremely difficult. Radiography showed significant changes: the joint space was almost impossible to detect in the image, showing multiple macroscopic osteophytes, "joint mice" (collapsed bone fragments falling into the joint cavity). Knee joint disease at this stage is almost always accompanied by disability: the result of the disease is usually complete joint fusion, joint instability and the formation of "pseudo-joints".

Who treats knee arthritis?

Therapists, rheumatologists and general practitioners (family doctors) can provide qualified knee joint disease medical services to patients, but these specialists are responsible for the treatment of uncomplicated knee joint disease.

When synovitis occurs or the treatment prescribed by the therapist does not achieve the expected results, the help of an orthopedic surgeon is indispensable. In cases where surgical treatment is required, patients with knee joint arthropathy will be referred to specialized orthopedics and traumatology.

How and how to treat knee arthropathy?

The currently known methods for treating patients with knee joint disease are divided into non-drug conservative, drug and surgery.

Non-pharmacological methods

Many patients ask themselves the question: "How to treat knee joint disease without taking medicine? " To answer this question, we have to regret to say that knee joint disease is a chronic disease and it is impossible to eliminate it forever. However, there are many non-pharmacological (ie, no drugs) methods for the treatment of this disease that can significantly slow down its progression and improve the patient's quality of life, especially when used in the early stages of the disease.

Seeing a doctor in time, the patient has enough motivation to heal, sometimes enough to eliminate negative factors. For example, it has been shown that reducing excess weight can reduce the manifestations of the main symptoms of the disease.

Eliminate pathological physical activity, on the contrary,Therapeutic gymnasticsBy using reasonable physical procedures, they can reduce the intensity of pain. The effect of exercise to strengthen quadriceps has been proven to be equivalent to that of anti-inflammatory drugs.

If we treat knee joint disease, then we must fight forProper nutrition：Improve the elasticity of joint cartilage, help to contain a lot of animal collagen (meat and fish diet) and cartilage components (shrimp, crab, krill), fresh vegetables and fruits rich in plant collagen and antioxidantsThe products, and on the contrary, the passion for bacon, marinades, preservatives, sweet and savoury dishes will aggravate the disturbance of the metabolic process in the body and the accumulation of excess weight until obesity.

Reflecting on the most effective treatment of knee joint disease, it is worth remembering such an effective treatment and prevention method, such asOrthotics: Fixed knee pads, orthotics, elastic bandages and orthopedic insoles can reduce and correctly distribute the load on the joints, thereby reducing the intensity of joint pain. It is also recommended to use a walking stick as an effective way to relieve the knee joint. It should be in the hand opposite the affected limb.

Comprehensive treatment of knee joint arthropathy also means that appointments are very effective, even in advanced forms of the diseasephysiotherapy. . . is widely used in different types of patients with any degree of joint disease, and has proven its effectivenessMagnetic therapy: After several operations, the intensity of pain decreases and the degree of joint mobility increases due to the improvement of blood circulation, reduction of edema and elimination of muscle spasms. With the development of joint active inflammation, the effect of magnetic therapy is particularly obvious: the severity of edema is significantly reduced, and the symptoms of synovitis subside. Not so popular, but equally effective in the treatment of knee joint disease is physical therapy, such asLaser therapywithCryotherapy(Exposure to cold), has obvious analgesic effect.

medical treatement

In the effective treatment of knee arthropathy, the following drugs are used.

Non-steroidal anti-inflammatory drugs (NSAIDs)They are produced in the form of external use (various gels, ointments) and systemic use (tablets, suppositories, solutions), which have long proven their effectiveness in treating osteoarthritis and are widely used by doctors. By blocking inflammation at the enzyme level, they can eliminate joint pain and swelling and slow the progression of the disease. With the early manifestations of the disease, topical use of these drugs combined with non-drug methods (therapeutic exercise, magnetic therapy) is effective. But for advanced osteoarthritis of the knee joint, pills and sometimes injections of non-steroidal anti-inflammatory drugs are essential. It must be remembered that long-term systemic intake of non-steroidal anti-inflammatory drugs can lead to the development and deterioration of the gastrointestinal ulcer process. In addition, it can also negatively affect the function of the kidneys and liver. Therefore, patients who take long-term non-steroidal anti-inflammatory drugs should also prescribe drugs to protect the gastric mucosa, and regularly monitor the laboratory performance of internal organs.

Glucocorticoid (GCS)-Hormonal drugs with obvious anti-inflammatory effects. When the non-steroidal anti-inflammatory drugs previously prescribed for the patient cannot eliminate the inflammatory manifestations, they are recommended. As a powerful anti-inflammatory agent, GCS has certain contraindications in the treatment of arthropathy, because they can cause many significant side effects. In the systemic form of knee joint disease, they are actually not prescribed. In general, in order to effectively treat joint disease, GCS injection into the pain points around the joint means that this will increase the intensity of the fight against inflammation and minimize the risk of adverse drug side effects. This operation can be performed by a rheumatologist or trauma specialist. For concomitant synovitis or rheumatoid arthritis, these drugs are injected directly into the joints. With a single use of GCS, the effect of this treatment can last up to 1 month. According to the national guidelines for the treatment of osteoarthritis, do not inject drugs into the same joint more than 3 times a year.

For advanced "neglected" osteoarthritis, when a person experiences unbearable pain, it does not subside even at rest, disturbs normal sleep, and cannot be eliminated by NSAID, GCS, and non-medicinal methods. prescriptionOpioid analgesics. . . These drugs can only be used under a doctor's prescription, and the doctor will consider the appropriateness of their appointment in each case.

Chondroprotective agent(Literally translated as "protect cartilage"). The name is understood as a variety of drugs, combined by one attribute-a structural modification, the ability to slow down the degenerative changes of cartilage and the narrowing of the joint space. They are produced in the form of being taken orally and introduced into the joint cavity. Of course, these drugs will not produce miracles, nor will they "grow" new cartilage, but they can prevent its destruction. In order to achieve lasting results, they must be applied for a long time, with regular courses several times a year.

Surgical treatment of knee joint arthropathy

It is often the case that despite sufficiently complicated treatments, the disease is still developing and continuously reducing the quality of human life. In this case, the patient began to ask questions: "What if prescription drugs do not help knee joint arthritis? " "Does the knee joint need surgery? " To answer these questions, it is necessary to be clear that knee joint osteoarthritisThe indications for surgical treatment are intractable pain syndrome and obvious joint dysfunction, which cannot be eliminated by complex conservative treatment, and finally, the fourth degree of the disease.

The most popular types of surgical care for third and fourth degree arthropathy areEndoprosthesis, IE. Remove your own joint and install a replacement metal prosthesis at the same time. Its design is similar to the anatomy of a human knee joint. In this case, the prerequisites for this surgical treatment are: the joints have no obvious deformities, the formation of "false joints", muscle contractures and severe muscle atrophy. In the case of severe osteoporosis (significant decrease in bone mineral density), endoprosthesis is also not applicable: "sugar" bone will not be able to withstand the introduction of metal needles, and the rapid absorption (absorption) of bone tissue will be in itsFrom the installation site, pathological fractures may occur. Therefore, it seems very important to decide whether to install an endoprosthesis in a timely manner-the decision should be made when the age and general condition of the human body still allow surgery. According to the results of long-term studies, the duration of the role of endoprosthesis in patients with advanced joint disease, that is, the temporary duration of no obvious movement limitation and maintaining a decent quality of life is about ten years. The best results of surgical treatment have been observed in people 45-75 years old, lighter weight (less than 70 kg), and higher living standards.

Although knee replacement surgery is widely used, the results of this type of surgery are often unsatisfactory and the incidence of complications is high. This is due to the design features of the endoprosthesis and the complexity of the surgical intervention itself (technically speaking, it is much easier to replace the hip joint). This determines the need for organ preservation (joint preservation). These include joint medullary bypass surgery and corrective osteotomy.

Articular Medullary Bypass-Use a shunt to connect the femoral medullary tube to the knee joint cavity-Hollow metal tube. This allows the fat marrow from the lower third of the femur to enter the knee joint, nourish and lubricate the cartilage, thereby significantly reducing pain.

When changing the axis of the lower limbs (but in the case of slightly limited range of motion), effectiveCorrective osteotomy-Transect the tibia and correct its axis, then fix it in the desired position with steel plates and screws. Two goals were achieved at the same time-the normalization of biomechanics due to the restoration of the limb axis, and the activation of blood circulation and metabolism during bone fusion.

In summary, I would like to point out that the treatment of knee joint disease is a complex social task. Although today's medicine cannot provide a drug or other method to completely cure this disease that can permanently get rid of this disease, a healthy lifestyle, timely seeking medical help and following the doctor's advice can prevent its progress.