Osteoarthritis of the knee joint: symptoms and treatment

Osteoarthritis is the most common joint disease associated with the destruction (degeneration) of cartilage tissue. The disease is manifested by pain and restriction of movement in the diseased joint, which sharply worsens the quality of life of patients and is a common cause of temporary or permanent disability.1 Clinical symptoms of osteoarthritis are observed in more than 20% of the population.2 More often, osteoarthritis develops in joints that experience heavy loads, in particularly in the knees. According to WHO forecasts, osteoarthritis of the knee joints (gonarthrosis) will become one of the main causes of disability among the population in the next few decades.3

Features of the development of osteoarthritis of the knee joint

Osteoarthritis of the knee joint

is a common pathology that belongs to the category of the most common diseases that have an extremely negative impact on a person’s quality of life.

Degenerative-dystrophic processes most clearly manifest themselves in the form of physical dysfunction of the legs, accompanied by severe pain. Depending on how much the pathological process progresses, further forecasts for the course of the disease are made.

One of the disappointing forecasts is paralysis of the lower limbs. The seriousness of the consequences of pathological processes necessitates seeking qualified medical help.

Causes of knee pain due to osteoarthritis

The knee joint is very strong, and daily supports the weight of the human body, and also endures enormous loads when carrying heavy loads and loads. It can be damaged by a strong blow, but even in the absence of a fracture or dislocation, there is a possibility of long-term pain that increases over time. This is caused by microdamage to the cartilage tissue, which acts as a protective shell for the joint. Over time, this small crack begins to enlarge and grow, causing stronger sensations of discomfort, hindering movement, and over time does not even allow the person to move, leaning on the sore leg.

What causes lead to knee arthrosis?

To identify the causes of arthrosis of the knee joint, it was necessary to conduct a large number of studies. Many years of examinations of patients and a thorough study of the clinical picture of the pathology allowed specialists to come to the conclusion that the influence of a number of negative factors is the root cause of the destruction of joint tissue, causing severe pain and inflammation.

Among the main reasons leading to degenerative-dystrophic processes, it is worth highlighting:

previous injuries - a bruise, dislocation or fracture of the knee automatically classifies a person as a risk group and can cause the development of the disease. Damage to the joint presupposes its fixation, and long-term immobility is a direct path to the formation of arthrosis;
strong physical activity - intense stress on the knees (especially in older people) leads to microtraumas, which also leads to the development of negative pathological processes;
insufficiently strong ligamentous apparatus - abnormal joint mobility also negatively affects their condition, which manifests itself mainly in old age;
excess body weight - extra pounds can cause irreparable damage to the knee joints, because the likelihood of meniscus injuries in this case is incredibly high. If a lot of weight is accompanied by varicose veins, then there is a high probability of developing severe forms of arthrosis of the joints of the lower extremities;
metabolic disorders - a failure in the exchange of nutrients and elements in the body provokes the development of various kinds of diseases, which is caused by insufficient supply of various tissues, in particular bone and cartilage;
increased levels of stress - worries and worries negatively affect not only people’s mood, but also the level of physical well-being.

What factors and in which groups increase the risk of the disease?

Gonarthrosis occurs in people who lead a sedentary lifestyle, suffer from obesity, and subject their knees to excessive stress. Its development is often caused by smoking and alcohol abuse, which impair blood circulation in the legs. Gonarthrosis can be provoked by a deficiency in the diet of microelements, fat- and water-soluble vitamins necessary for the full functioning of hyaline cartilage. The risk group includes people whose work involves constantly being on their feet, as well as professional athletes, especially weightlifters.

Characteristic symptoms of arthrosis of the knee joint

The symptomatic manifestation of the disease allows timely tracking of the onset and development of pathological processes, which gives each patient the opportunity to recover.

Before determining who to turn to for help and how to treat arthrosis of the knee joint, it is important to become familiar with the symptoms of the disease.

Only a specialist competent in this matter can identify the presence and confirm the diagnosis by prescribing treatment for knee arthrosis. However, every patient should know the main symptoms of knee osteoarthritis, among which are usually identified:

pain - discomfort that gradually develops into painful sensations does not appear immediately. Their slight manifestation in the knees can bother a person for many years, but at some point they may become stronger, and they will not stop in a calm state;
crunch – “clicks” when flexing/extending a joint are an alarm bell, which manifests itself already in the second and third stages of the disease;
synovitis is an inflammation of the joint membrane, in which fluid accumulates, which leads to local swelling;
deformation is a characteristic feature that appears in the last stages of the disease, accompanied by pronounced inflammation and swelling.

Symptoms

Osteoarthritis of the 3rd degree of the knee joint is manifested by two main symptoms: pain and dysfunction. Pain at this stage is constant or periodic and intensifies with movement. With rest, the pain usually decreases or subsides completely. The movements may also be accompanied by a crunching sound in the affected knee. This sound is caused by the friction of collapsing articular surfaces.

Dysfunction of the joint is manifested by a feeling of stiffness and a sharp limitation in the range of movements. This leads to changes in daily activities and limitation of the patient's ability to work. At the third and fourth stages of gonarthrosis, curvature of the limb may also be observed due to changes in the configuration of the joint.4

Diagnosis of arthrosis of the knee joint

Diagnosis and treatment of arthrosis of the knee joint is carried out by an orthopedist or rheumatologist. If you wish to undergo a diagnostic examination, each patient can contact a therapist, who will give a referral to a specialist or independently take a voucher to one of them.

The main diagnostic tool of specialists is, of course, an X-ray machine. Thanks to the image taken, you can track not only the presence of pathology, but also the degree of its development.

It is important to note that x-rays can exclude the possibility of the presence of other diseases of the musculoskeletal system.

X-ray examination opens up the opportunity for a specialist to:

track the narrowing of the joint space;
detect compaction in joint tissues.

The combination of clinical symptoms and information obtained from the image provides high-quality diagnosis and diagnosis, with the determination of further treatment for osteoarthritis of the knee joint.

Diagnostic methods

The key methods for diagnosing diseases of the articular apparatus are:

radiography of the knee joints. In this case, it is necessary to determine at what stage the disease is. X-rays of both extremities usually need to be taken;
computed tomography - allows you to determine how worn out the cartilage tissue is, how pronounced the changes in the joint structures are. The diagnosis also determines whether there are ligament injuries and whether there are other pathologies, for example, a Baker’s cyst;
magnetic resonance imaging of the knee joints - with this procedure you can determine the severity of changes in the tissues. MRI helps to assess the condition of vascular structures and determine how much blood circulation has worsened;
sometimes doctors prescribe a procedure such as a topogram;
The collection of anamnestic data is mandatory. The doctor evaluates the patient’s complaints, clinical manifestations of the disease;
Using ultrasound examination of joint tissues, you can determine how worn out the cartilage tissue is. You can find out whether pathological processes are present in the ligamentous, muscular apparatus, in the periarticular space, whether there are changes in the meniscus;
Joint arthroscopy is a diagnostic puncture. After the procedure, the resulting material is sent to the laboratory for further research.

Degrees of osteoarthritis of the knee joint

Modern medicine divides knee arthrosis into several degrees, in accordance with the nature of the development of pathological processes.

To begin with, it is worth noting that according to observations, the disease can have a different nature:

unilateral (right-sided/left-sided);
bilateral.

In addition, the pathological process has three stages of development, each of which has its own clinical picture.

1st degree arthrosis of the knee joint

The initial stage of the development of pathology, the successful diagnosis of which is an incredible success not only for the patient, but also for the attending physician.

The peculiarity of the degree of development of arthrosis at this stage is the absence of clinical signs and clear symptoms. Identification of the disease can be carried out during medical examination or during the study of another disease.

Evidence of grade 1 arthrosis of the knee joint may be:

local discomfort in the knee area during long walking;
mild pain that disappears with rest.

It is important to note the fact that pain can be felt in one or both joints of the lower extremities.

It is interesting to note that left-sided gonarthrosis is often diagnosed in left-handed people, while right-sided gonarthrosis is typical for people involved in various sports.

2nd degree arthrosis of the knee joint

Symptoms of the second degree of development of pathology are accompanied by an expansion of signs, which are usually included:

pronounced pain syndrome;
stiffness and severe discomfort in the knee joint;
atrophy of the muscles located near the knee joint, which is caused by tissue damage;
increased pain;
visually noticeable deformation of the joint;
limitation of mobility.

Expanding the symptoms simplifies the diagnostic process. Changes characteristic of grade 2 arthrosis of the knee joint are easy to track during palpation. When undergoing a clinical examination, a specialist can easily detect an abnormal formation in the knee area.

3rd degree arthrosis of the knee joint

It is almost impossible not to notice the third degree pathology, because the patient faces constant pain. In addition, the progress of the disease reaches a critical point, which is manifested by severe deformation of the joint, in which the limb completely loses the ability to flex/extend.

The lack of proper treatment leads to complete destruction of the cartilage and, as a consequence, the development of ankylosis (fusion of articular bones).

The only solution for the final stage of development of the disease is an expensive surgical intervention, involving the removal of remnants of cartilage tissue or joint replacement.

Specificity 3rd degree

This pathology is one of the most common among all joint diseases. It tends to progress, thereby significantly inhibiting the motor functions of the knee joint. But it is precisely this section of the leg that is responsible for maintaining weight and allowing a person to perform tasks of the most varied complexity, namely walking, jumping, squatting, running, etc. By letting a joint slip, a person, roughly speaking, dooms himself to disability. Late diagnosis and lack of necessary treatment in the early stages do not lead to anything good. The more advanced the clinical picture, the less and less chance there is of avoiding surgery.

If we consider the disease according to the generally accepted European classification of the development of degenerative-dystrophic changes, then stage 3 is the penultimate degree of a moderate illness. In a large number of cases, conservative treatment turns out to be ineffective or ineffective at all, and these are good reasons for undergoing surgery to replace the knee joint with an artificial implant.

This is what the diagnosis looks like on an x-ray.

As for all kinds of non-surgical and minimally invasive tactics, know that even if they produce an effect at a very difficult stage, it will be no more than temporary symptomatic. It is possible to stop the development of gonarthrosis, please note that it is not even possible to cure it entirely, using non-traumatic methods, but only in the first two stages. Therefore, if you give preference to conservative treatment, do not count on a miracle healing: the knee will not straighten out, the cartilage will not be reborn, and, consequently, all motor problems will be with you.

We say all this so that naive people, far from the intricacies of orthopedics and traumatology, do not have illusions regarding the healing capabilities of widely advertised drugs and physical techniques. At this stage of knee arthrosis, they are unproductive.

Stages of gonarthrosis, from absence to the last degree.

Attention! At stage 3 of gonarthrosis, there are no longer living areas of functional importance left for prevention. The maximum benefit you can find for yourself in non-surgical tactics is to slightly reduce the pain syndrome and to some extent prepare the muscles for the upcoming surgery.

How to treat arthrosis of the knee joint?

The level of modern medicine is at a fairly high level, which ensures successful treatment of various types of diseases. Osteoarthritis of the knees is no exception.

Today, there are a large number of methods for treating arthrosis of the knee joint.

At the initial stages of pathology development, predominantly conservative treatment methods are used. Conservative therapy includes:

physiotherapeutic procedures;
physical therapy (physical therapy);
visiting various massages.

Progressive methods of treating osteoarthritis of the knee joint are also actively used. Among the modern effective ways to combat dangerous pathologies are the following:

Ozone therapy is a local effect of ozone on the affected joint tissues. Helps reduce pain and stop inflammatory processes. Improves blood circulation in the problem area;
kinesitherapy is a set of exercises for arthrosis of the knee joint, aimed at increasing its mobility and increasing blood flow.

Treatment of knee arthrosis with physiotherapy

Physiotherapy is one of the most popular methods of treating knee osteoarthritis.

Methods of physical influence, subject to a certain number of conditions, have the most positive effect on the area of localization of pathologies of various types.

Physiotherapy includes procedures such as:

electrophoresis;
ultraphonophoresis;
irradiation with laser/infrared radiation;
pulsed magnetic therapy.

The effectiveness of the procedures is individual and depends on the quality of the patient’s basic treatment plan.

Massage as a treatment for osteoarthritis of the knee joint

Massage is a useful addition to the treatment strategy for knee arthrosis.

Most experts around the world are of the opinion that massage is a mandatory component of the treatment of symptoms of arthrosis of the knee joint, which has a beneficial effect on metabolic processes and helps speed up recovery.

Knee massage can be performed both at home and within the walls of a hospital. The main thing during massage is preliminary high-quality warming up of the joint and compliance with the optimal duration of the process (from 10-15 minutes).

Treatment of osteoarthritis of the knee joint with massage should include techniques such as stroking, rubbing and kneading.

Gymnastics and exercise therapy for arthrosis of the knee joint

Exercises for arthrosis of the knee joint are an effective way to eliminate unpleasant symptoms and treat the disease.

The process of treating knee arthrosis is a rather complex and lengthy process, and physical therapy is an excellent assistant in achieving the desired result.

The type of exercise therapy and exercises for arthrosis of the knee joint are selected by a specialist individually, depending on the degree of development of the pathology and the general state of the patient’s physical fitness.

The main principle of gymnastics for arthrosis of the knee joint sounds like this: no increased loads on the affected joint, only rational, calm actions.

Drug therapy

Conservative therapy is effective if gonarthrosis is in the early stages of development. If the disease is detected at the second or third stage, with the help of medications it is possible to only slightly relieve the inflammatory process and pain.

With the help of drugs you can achieve the following results:

stop the inflammatory process;
pain syndrome, a feeling of stiffness in the joint after a long rest. As the person moves, the pain decreases;
accelerate the regeneration of cartilage tissue;
get rid of severe painful sensations;
restore joint function.

In parallel with the use of medications, it is important to limit the load on the affected limb during treatment. As part of conservative therapy, the following drugs are prescribed:

analgesics, non-steroidal anti-inflammatory drugs, chondroprotectors;
local application of ointments, gels, creams;
Intra-articular injections of drugs are administered. Most often these are hormonal drugs that help get rid of the inflammatory syndrome within a short period of time. They also replenish synovial fluid and promote the restoration of cartilage tissue;
intra-articular injections of the patient's processed plasma are administered;
Regenerative medicine is used - this is the introduction of intra-articular injections of autologous cartilage tissue cells, which are obtained from the lipid structures of the patient’s body.

Drugs for the treatment of osteoarthritis of the knee joint

Drug treatment for arthrosis of the knee joint is used to relieve symptoms such as pain and swelling, as well as to activate regenerative processes.

Drugs for the treatment of arthrosis of the knee joint can come in different forms (ointments/gels, tablets or injections, patches).

IMPORTANT! Any medication must be prescribed by a specialist as part of an existing treatment plan developed taking into account the symptoms of knee arthrosis.

Self-medication is unacceptable and can lead to extremely negative consequences, in particular, paralysis of the lower limbs and disability.

Painkillers for arthrosis of the knee joint

Used to eliminate symptoms of arthrosis of the knee joint.

Painkillers play an important role in the treatment of arthrosis of the knee joint, because their use improves the patient’s well-being and gives him the opportunity to get a good night’s rest.

Relief of pain is achieved through the action of active substances. The most effective tablets for pain in arthrosis of the knee joint are considered to be “Ketanol” and “Nimesulide”.

Antispasmodics for osteoarthritis of the knee

Prescribed as active assistance. A key area of focus is the fight against spasms.

The active substances included in the preparations help relax the muscle frame and provide pain relief.

Among the frequently prescribed ones, it is worth highlighting Mydocalm.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Treatment of arthrosis of the knee joint with drugs of this type not only eliminates pain, but also slows down and completely eliminates the progress of pathological processes.

Regular use of medications allows you to observe a constant concentration of active components, which guarantees a positive effect.

Artradol is considered to be the most effective NSAID.

Chondroprotectors for arthrosis of the knee joint

The main assistants in the treatment of arthrosis of the knee joint are chonroprotectors.

The active effect of chondroprotectors for arthrosis of the knee joint is aimed at restoring motor ability, which is due to the microelements included in the composition, which are an integral component in the process of building cartilage tissue.

The peculiarity of the principle of action of drugs involves a rather long, but at the same time effective process of getting rid of osteoarthritis of the knee joint.

Among the most effective and affordable drugs, it is worth highlighting Artracam, Structum and Chondroxide.

Surgery for stage 4

Some people definitely want to become disabled in order to be guaranteed to receive financial assistance from the state every month. And there are good reasons for this, because a person with such orthopedic disorders is not only able to go to work, but is simply unable to take care of himself at the everyday level. We have already found out whether it is possible to obtain a document in Russia and Ukraine confirming the status of “disabled person” with deforming arthrosis of the knee of 3-4 degrees. Yes, of course, you can count on a positive decision from the local medical and social examination authorities. These are the two most difficult degrees of severity by the standards of a person’s physical condition.

But still, as observations show, no benefits and benefits can replace the patient’s desire to get rid of persistent chronic impairment of static-dynamic functions, hellish pain and, of course, disability status. Everyone dreams of returning to a normal lifestyle. And if an old woman of 85 years old may still come to terms with her condition, but not people who still have time to live. No one would like to be disabled, suffering from their inferiority and feeling defective for the rest of their life, while giving up worldly joys. There is a way out, despite the incurability of a serious disease! And we talked about it several times in this article. Yes, this solution is endoprosthetics. And, fortunately, it copes well with the three most important tasks, and these are:

relief from deformities and pain;
restoration of healthy knee mobility;
return of a person to a working state.

No operation other than endoprosthetics will relieve you of disability. And replacing a knee joint with an endoprosthesis will put even the most seemingly hopeless person back on his feet. And he will not only provide, but also open all the doors to a normal existence, the same as that of healthy people. A unique artificial joint transplant is a real chance to become a full-fledged person who does not evoke pity and sympathy from strangers.

On the left is partial endoprosthetics, on the right is total.

With a new knee joint, you will be able to walk independently without depending on aids, do physical exercise, travel, realize yourself in a professional field, calmly do housework, and much more. In a word, such treatment for stage 3-4 gonarthrosis, such as endoprosthetics, will relieve disability. Successful restoration of function is observed in approximately 98% of cases.

Knee replacement process

For anesthesia, specialists mainly use epidural anesthesia - the introduction of a special anesthetic drug through a catheter into the epidural space of the spine. This type of anesthesia blocks nerve impulses in the spinal cord, making the lower body completely insensitive to pain. The person remains conscious and tolerates all surgical procedures on the lower limb well. After the administration of the anesthetic, the surgical process begins, which, with such a severe diagnosis, mainly involves the complete replacement of the problematic knee joint with a total prosthesis.

On the front side of the knee, the surgeon makes a small incision in the soft tissue structures, its length is approximately 10 cm. The non-viable joint is carefully resected, after which the doctor makes several sawdusts on the femur bone and tibial component. In turn, the tibia is subjected to perforation, that is, a special depression is made in order to tightly immerse the leg of an artificial metal platform (the tibial component of the endoprosthesis) into it.

When the bones are prepared, the installation of the prosthesis begins. The specialist first installs a test endoprosthetic system to be sure that the corrected axis is correct and the corresponding section is stabilized. Next, the prepared ends of the femur and tibia are covered with permanent functional components of the prosthetic structure. Their strong fixation is carried out using medical cement or by hammering. Then the knee cavity is thoroughly washed with saline, drainage is placed on the wound, and the surgical incision is sutured in layers. The limb is immobilized using orthopedic devices.

What will happen after the operation?

After surgery, the patient remains in the hospital for several days, usually until the stitches are removed. The medical institution must carry out intensive prevention of all possible complications (from vein thrombosis, against infections, pneumonia, etc.) through medication and physical therapy, and prescribe physiotherapeutic procedures. From the next day until the end of rehabilitation, therapeutic exercises are indicated. Already 24 hours after the implantation, the patient begins to master the first skills of walking with the use of crutches, a little later they will be allowed to switch to a cane, and by the end of the recovery, at a certain period, the attending physician will allow full use of the leg without supporting devices.

After discharge from the hospital, the patient must continue high-quality rehabilitation in a specialized medical institution under the supervision of competent specialists! This is a very important condition that affects the final result of treatment. To restore limb mobility, correct musculoskeletal disorders and adapt to a new joint, successful implantation alone is not enough! Only a flawlessly completed entire course of a rehabilitation program compiled at a professional level will guarantee you a full recovery and protection from unwanted consequences. The duration of recovery treatment after surgery averages 2.5-3 months.

If all medical recommendations are followed, the non-native analogue joint will last quite a long time, from 15 years or more. In clinical practice, there were cases when patients required reinstallation of the prosthesis only after 30 years. Stunning prospects should help people who have suffered for many years from ill-fated gonarthrosis to understand that disability is not always a final and irrevocable sentence, and you yourself can cancel it at any second. It’s enough just to overcome your fear of surgery and go to a good clinic to undergo a prosthetic procedure.

Today, this type of intervention can be completed within your own state, and completely free of charge, under a special quota. Therefore, we advise you to carefully choose the medical center where you will be operated on, and preferably from among the best foreign clinics.

Diet and general nutritional recommendations for arthrosis of the knee joint

A diet for arthrosis of the knee joint is necessary for patients with excess body weight. A low calorie diet and a wealth of nutrients will ensure weight loss and accelerate the recovery process of affected joints.

Nutrition for arthrosis of the knee joint should first of all be balanced. The daily diet should contain dishes enriched with beneficial vitamins and microelements necessary for the regeneration of joint tissues and maintaining the balance of the entire body.

It is recommended to give up not only bad habits (alcohol abuse and smoking), but also such dishes as:

store-bought semi-finished products;
fatty, spicy and overly salty foods;
sweet carbonated drinks.

For convenience and competent planning of the diet, when treating knee arthrosis, it is recommended to keep a food diary, which disciplines and helps facilitate the process of restructuring the usual lifestyle.

Auxiliary treatment

Physiotherapy. Special therapeutic exercises are mandatory for those people who strive to maintain motor function of the joints for as long as possible. With the help of therapeutic exercises, muscle strength and endurance increase, and coordination improves. With regular exercise, synovial fluid is actively produced, which is a natural lubricant between the joint. Thanks to it, joint friction is reduced.
Special food. This is a must for those people who are obese. If you are overweight, your knee joints experience regular heavy loads. Therefore, doctors strongly recommend monitoring your diet in order to reduce body weight and reduce stress.

Additional methods also include physiotherapeutic procedures:

UHF;
magnetic therapy;
massage
balneotherapy
cryotherapy
electrophoresis
current therapy;
manual therapy;
acupuncture
hirudotherapy
mud baths;
ozone therapy
galvanotherapy

If the listed methods for treating grade 3 gonarthrosis are ineffective, the doctor prescribes the following procedures:

Arthroscopy is not only a diagnostic procedure. With the help of arthroscopy, surgery is performed on the meniscus, cartilage tissue, joint effusions and fluid accumulation in the joint are removed;;
endoprosthetics - this procedure is prescribed for complete destruction of cartilaginous structures. It involves replacing a joint or one of its parts with an implant that is not rejected by the body;;
osteotomy – involves surgery on the bone. The main task is to restore the integrity of bones, as a result of which the destruction of cartilage tissue slows down.

Doctors also recommend wearing special orthoses. With their help you can reduce the load on the joint. Orthoses and bandages will be especially useful for those people who play professional sports or for patients who regularly exercise their joints.