Osteoarthritis of the knee joint grades 1, 2, 3 - symptoms, treatment, medications

Osteoarthritis of the knee joint. Causes

Osteoarthritis of the knee joint is a chronic disease in which degenerative-dystrophic changes in cartilage lead to complete destruction of the intra-articular lining. Clinical symptoms are pain, limited joint mobility.

More often, gonarthrosis is diagnosed in women 45+, professional athletes, overweight people engaged in heavy, monotonous physical labor.

It is impossible to name a single reason leading to the development of the disease. A number of unfavorable factors weaken cartilage. The onset of the disease is a fatal coincidence of circumstances.

Contribute to the occurrence of the disease:

knee injuries (fractures, dislocations, meniscal injuries), surgical interventions on joints;
aging (with age, cartilage loses its elasticity and cracks easily);
systemic autoimmune diseases (rheumatism, rheumatoid arthritis, lupus erythematosus, etc.);
endocrine pathologies (diabetes mellitus, hypothyroidism), menopause;
genetic factors (vulnerable cartilage tissue, insufficiency of synovial fluid);
excess weight (excessive load on joints);
hypothermia and dehydration;
overload of the knee joints during heavy work and sports;
pathology of the hip joints.

Low physical activity also contributes to the development of arthrosis. With a sedentary lifestyle, the blood supply to the lower extremities decreases, metabolic processes slow down, muscles, ligaments, tendons atrophy, and cartilaginous structures degenerate.

Symptoms of osteoarthritis of the knee joint

The course of the disease is variable and depends on the age and physical condition of the patient, the cause of the pathology, and concomitant diseases. As a rule, pain in the knees during exercise, swelling, burning in the affected joint, numbness after prolonged immobility, dry crunching, clicking when moving are a concern.

The diagnosis of the disease is made by an orthopedic doctor after examination, questioning and additional examinations.

Osteoarthritis of the knee joint 1st degree

The disease is often asymptomatic. Sometimes patients experience slight discomfort, tension, and warmth in the knee joint.

A typical clinical picture of first degree gonarthrosis includes:

pain during movement or at rest after significant loads, at the moment of maximum flexion and extension;
burning, swelling and hyperemia of the knee after exercise (symptoms of inflammation);
X-ray examination reveals single osteophytes and narrowing of the joint space.

Important!
Clinical symptoms typical of the first stage of the disease may be accompanied by significant destruction of cartilage. Timely diagnosis is important, since conservative treatment is more effective at the initial stage of the disease.

Osteoarthritis of the knee joint grade 2

The pain becomes more intense and prolonged, the functionality of the joint is limited (the amplitude of voluntary movements decreases). The knee joint begins to deform due to uneven wear of the cartilage (“flattened”), and pathological bending of the lower limb is possible. Typical signs of grade 2 osteoarthritis:

constant pain during exercise, more pronounced in the morning and evening;
persistent discomfort in the joint even after a long rest;
decreased range of motion;
increase in joint volume, atrophy of periarticular soft tissues;
crunching noise during sudden movements, squats, and sometimes when walking.

X-ray examination reveals osteophytes, narrowing of the joint space is possible up to 30-40%. As a rule, medical help is sought precisely at this stage, when the quality of life is significantly reduced.

Osteoarthritis of the knee joint 3rd degree = deforming osteoarthritis of the knee joint

At the final stage, the disease disables the patient, since the cartilage tissue is almost completely destroyed, the joint space is narrowed to the maximum, and sometimes absent. Multiple osteophytes and deformation of articular segments of bones are determined. It is possible to block the joint due to a fragment of osteophyte getting into the joint space. The leg is not functional and constantly bothers me. Movement is often only possible with the help of a cane, crutches, or walker.

The following symptoms are typical:

constant pain in the joint;
severe deformation of the joint;
immobility of the knee joint;
lameness when walking, there may be shortening of the limb;
swelling of the joint due to excessive accumulation of intra-articular fluid;
numbness of the leg, decreased sensitivity;
significant atrophy of the musculo-ligamentous apparatus of the joint.

Osteoarthritis affects joint bone tissue, increasing the risk of fractures. At this stage, only surgical treatment is effective. Conservative methods help reduce pain, slightly increase range of motion, and temporarily improve quality of life.

Endoprosthetics

Advanced arthrosis sooner or later requires joint replacement. This is the main treatment method for such patients. Millions of such operations are performed annually around the world. They are becoming more and more effective and safe.

The essence of the operation is that the person’s own joint is removed. An artificial endoprosthesis is installed in its place. It has sufficient functionality for a person to lead a physically active lifestyle. Even operations carried out over decades were mostly successful. Today their effectiveness is even higher because:

Signs of osteoarthritis of the knee joint

The main clinical symptoms of the disease: knee pain, limited mobility, joint deformity, aseptic inflammation of the synovium (synovitis).

Knee pain

Pain in the joint can vary from severe, limiting joint mobility, to barely noticeable with certain movements. In the initial stages of OAC, the pain is insignificant and occurs with prolonged sitting in an uncomfortable position, long walking, or lifting heavy objects. They go away quickly after rest and get worse in cold and damp weather.

The cause of severe pain in the knee is reactive inflammation of the joint (synovitis) or periarticular soft tissues (muscles, tendons, bursae). When periarticular soft tissues are involved in the inflammatory process, the pain intensifies with certain movements, and “starting” pain is characteristic (pain and stiffness after a period of rest).

Limitation of joint mobility

Due to the destruction of cartilage, the proliferation of osteophytes, and a deficiency of synovial fluid, the biomechanics of the joint is disrupted, which leads to a limited range of movements up to complete immobility in the last stage.

Knee deformity

Due to the uneven destruction of cartilage and subchondral bone tissue, the joint loses its usual shape (deforms). The muscles, tendons, and ligaments that form the joint atrophy.

Synovitis

Synovitis is a reactive inflammation of the inner lining of the joint. Aseptic (microbial-free) inflammation inside the joint occurs due to irritation and damage to the synovial membrane with pieces of destroyed cartilage. The inflammatory pain is intense, intensifies with movement, the knee increases in volume. The process subsides on its own, but can resume under unfavorable conditions.

Pathogenesis of arthrosis of the knee joints

Morphologically, arthrosis is wear and tear of the cartilage lining of the joint, leading to disruption of the normal anatomical structure of the articular surfaces. The joint is formed by the articular surfaces of the tibia and femur, covered with cartilage tissue. During movements, cartilage acts as a shock absorber. Cartilage consists of connective tissue fibers loosely located in a jelly-like substance (matrix). Due to the matrix, cartilage is nourished and regenerated.

Cartilage tissue is like a sponge: at rest it absorbs fluid, and when loaded, squeezes it into the joint cavity, allowing the bones to glide. Under load, some of the fibers are worn out and destroyed. Normally, they are replaced by newly synthesized ones. Osteoarthritis occurs when there is an imbalance between the synthesis of cartilage and its destruction.

Damaged, less complete cartilage structure absorbs less fluid, drier and more brittle cartilage easily splits under stress. The structure of the underlying bone changes - osteophytes grow along the edges of the joint, compensating for the loss of cartilage by the growth of articular surfaces.

Not only the cartilaginous covering of the joint suffers; meniscal tears, cruciate ligament injuries are periodically diagnosed with DOA, and sometimes loose intra-articular bodies are detected. Due to partial or complete destruction of the cartilage and subchondral plate, the contact surfaces are displaced, causing the joint to become deformed.

Deforming osteoarthritis of the knee joint is arthrosis of the last stage.

Primary arthrosis of the knee joint

Primary ACS is considered if the immediate causes of the disease have not been identified (there were no injuries, no concomitant diseases, no professional history).

Secondary arthrosis of the knee joint

Secondary AKS is degenerative-dystrophic changes in the knee joint due to metabolic diseases (diabetes mellitus, gout), rheumatoid diseases (rheumatoid arthritis), vascular pathology (vasculitis, atherosclerosis) or in the presence of a professional history (sports, heavy physical labor) .

Prognosis and complications

If deforming osteoarthritis is diagnosed at the initial stage of development, then with the help of conservative treatment it is possible to completely normalize the functioning of the joint. The prognosis is less favorable for already developed complications - hallux valgus or varus deformity, secondary reactive synovitis, spontaneous hemarthrosis, ankylosis, external subluxation of the patella.

Diagnostics

To verify the diagnosis, special examination methods are prescribed. The most informative are: X-ray, magnetic resonance imaging and arthroscopy. X-rays reveal narrowing of the joint space and deformation of the articular surfaces. The degree of damage to cartilage, menisci, and ligaments can be assessed using an MRI examination.

Diagnostic arthroscopy is an examination of articular cartilage using endoscopic equipment. Softening and degeneration of the articular lining (chondromalacia) of varying severity are detected.

1st degree. Superficial damage to articular cartilage. The cover is uneven, degeneratively changed.

2nd degree. Deep destruction - fiber disintegration, cracking.

3rd degree. Profound changes, pronounced thinning of cartilage.

4th degree. Through defects of cartilage with exposure of underlying bones.

Osteochondral mosaic plastic surgery

the presence of a limited defect of articular cartilage no more than 4 square centimeters;
good quality of the cartilage surrounding the articular defect (pathological changes no more than grade II according to Outerbridge);
the defect is located in the loaded area of the femoral condyle;
There is donor material in sufficient quality and quantity.

For extensive defects of the cartilage surface, surgery is not performed. It is also not performed if it is impossible to obtain sufficient quantities of high-quality cartilage tissue from donor areas of the body.

Abrasive chondroplasty

This is a palliative operation. It reduces pain but does not prevent further wear and tear of the cartilage. During surgery, the hyaline cartilage is “polished.” Damaged fragments are removed. The thickness of the removed layer is 1-3 mm. After the procedure, a blood clot forms and cartilage-like tissue forms to cover the defect. The technique gives good early but poor delayed results. The operation does not have a drastic effect on the outcome of arthrosis.

Classification of ACS

According to the Kosinski classification of ACS, three stages of the disease are distinguished according to radiological and clinical manifestations. They focus on the degree of narrowing and unevenness of the joint space, deformation of the articular surfaces, changes in the subchondral bone (osteosclerosis).

First stage of gonarthrosis

The changes are almost invisible. The joint space is normal or slightly narrowed, with isolated tiny osteophytes at the edge of the articular surfaces.

Clinically - mild short-term pain after significant fatigue, minimal impairment of knee function. Most do not perceive these symptoms as a pathology and do not seek medical help.

Second stage of gonarthrosis

The joint space is unevenly narrowed by 2-3 times. Maximum narrowing in places of maximum load (usually the inside of the joint). Along the edges of the articular surfaces there are large osteophytes, sclerosis of the endplate, and subchonar bone cysts. Moderate deformation of the bone epiphyses, disruption of the congruence of the articular surfaces.

Clinically - dysfunction of the knee in the form of limited movements, crunching, limping. Often there is slight local swelling and atrophy of the periarticular soft tissues.

Third stage of gonarthrosis

The intraarticular gap is barely noticeable or has disappeared. Many sharp massive osteophytes completely surround the articular surfaces. Gross deformation of the articulating surfaces (expansion and flattening), osteosclerosis of the epiphyses of the bones forming the joint, the presence of cysts. The joint is deviated from the vertical axis.

Clinically - visual deformation of the knee (thickening), forced position, immobility. Atrophy of all muscles of the lower limb, especially the quadriceps. Lameness, movement with the help of crutches, canes, walkers, constant excruciating pain. Patient's disability.

Therapeutic gymnastics and its role

The main objectives of therapeutic exercises are to eliminate all symptoms of pathology and prevent its spread to healthy tissue. To achieve this, patients are recommended to perform daily exercises to strengthen the muscles of the knee joint.

After 2-3 months of regular training, blood supply to tissues significantly improves and range of motion increases.

Treatment of arthrosis of the knee joint

Treatment of arthrosis of the knee joint is complex, including drug therapy, physiotherapy, surgical interventions, therapeutic exercises, and diet therapy. The range of therapeutic measures depends on the degree of cartilage destruction and clinical manifestations.

Conservative treatment gives a positive result in the first, partly in the second stage of the disease, while most of the cartilage is not yet destroyed.

Drug treatment

Non-steroidal anti-inflammatory drugs (diclofenac, ketoprofen, indomethacin, meloxicam, etc.) are used to relieve pain and inflammation. It is not recommended to take them for a long time, as they negatively affect the synthesis of proteoglycans, which causes dehydration and accelerated cartilage destruction. In addition, they have unwanted side effects from the gastrointestinal tract.

Chondroprotectors (glucosamine and chondroitin sulfate) nourish cartilage tissue, promote regeneration, improve the production of intra-articular fluid, and normalize lubricating properties. Chondroprotectors are ineffective in the third stage of gonarthrosis, when the cartilage is practically destroyed. To obtain a real treatment result, 2-4 courses of treatment are needed (lasting up to one and a half years).

Glucocorticosteroids (diprospan, hydrocortisone, celeston) quickly and effectively relieve pain and inflammation during synovitis, but arthrosis itself is not treated. The first injection of GCS relieves symptoms more effectively than all subsequent ones. They have many side effects and, with frequent use, negatively affect cartilage tissue. Moreover, glucocorticoids are dangerous for diabetes mellitus, arterial hypertension, renal failure, and peptic ulcer disease.

Hyaluronic acid preparations are a modern and safe way to treat arthrosis. Act in the joint as a natural synovial fluid. Sodium hyaluronate covers damaged cartilage with a protective film, preventing further destruction and improves gliding. Penetrates deep into the cartilaginous lining, improving firmness and elasticity, restoring shock-absorbing properties. They start the process of producing their own hyaluronic acid. As a result, the biomechanics of the joint is normalized, pain is relieved, and mobility is restored.

Important!
HA drugs are destroyed in the inflamed joint. Therefore, you first need to stop the symptoms of synovitis with the help of GCS and NSAIDs.

HA preparations:

HYAL-SIN - 1% high molecular weight hyaluronic acid. The course of treatment includes three injections with an interval of 7-10 days.

HYAL-SIN PROLONG - 2% high molecular weight hyaluronic acid. The high concentration of hyaluronic acid makes it possible to reduce the course of treatment to two injections, while simultaneously enhancing the intra-articular effect of the drug and prolonging the effect.

GYAL-SYN PROLONG PLUS -2% long-acting high molecular weight HA (12-24 months) for single use. Intermolecular cross-linking of the HA chains of this drug is carried out for a longer effect and resistance to destruction. One injection per course of treatment. Applicable only to the knee joint.

The most effective is an integrated approach: when all methods of conservative therapy are used.

Surgery

For advanced forms of KLA, the method of choice is knee replacement. This is the replacement of the knee joint with a functional endoprosthesis. Implants made of high-tech alloys (titanium, cobol-chromium, etc.) are strong, rigid, elastic, and biocompatible with human tissue.

Endoscopic arthroscopy with minimally invasive manipulations is performed if the course of the disease is complicated by ruptures of the ligaments, meniscus, or the entry of a bone fragment into the joint capsule.

Physiotherapy

Complex treatment of stages 1-2 of OAC includes shock wave therapy, ultrasound, manual techniques, iontophoresis, mechanical traction of the joint, laser therapy, thermal treatment, cryotherapy (local cooling). A good effect is obtained by combining manual therapy with traction.

Diet therapy

Age-related osteoarthritis is associated with the loss of calcium salts, which provokes microcracks in bones and fragility of osteophytes. Patients with OAC are advised to follow a non-strict diet, which includes:

consumption of lean meat, fish, seafood;
introduction of high-protein ingredients (nuts, legumes, wheat germ) into the diet;
dishes that include plant and animal collagen (jelly, aspic, jellied meat);
dairy products;
ban on fatty, salty, spicy foods.

People who are overweight are prescribed a more strict diet to lose weight.

Physiotherapy

Therapeutic gymnastics strengthens muscles and activates blood circulation in the joint. Use exercises without maximum flexion and extension. Instead of the usual dynamic exercises, static ones are used. For example, lying on your back, raise your outstretched leg and keep it suspended for some time.

Important!
To strengthen muscles and ligaments, do static or slow dynamic exercises. If the exercise causes sharp pain, then it is contraindicated or performed incorrectly.

Intra-articular injections

well tolerated by the patient;
improve metabolism in cartilage tissue;
stimulate cartilage repair;
relieve pain;
have a long-term effect even with advanced arthrosis.

We use hyaluronate and platelet-rich plasma. The treatment method is absolutely safe. The results of the course of injections last for 6-12 months.

Hyaluronic acid is a joint lubricant. It reduces friction of articular surfaces. Therefore, pain decreases and cartilage destruction slows down. While platelet-rich plasma stimulates regenerative processes due to growth factors that are released by platelets. We prepare plasma from the patient’s blood immediately before the injection into the joint.

Narcotic analgesics

For severe pain that cannot be relieved by other methods, one has to resort to narcotic analgesics. Doctors really don't like to use them because the use of opiates is strictly regulated by administrative regulations. The slightest violation of instructions entails serious liability, even criminal.

Whenever possible, doctors prescribe tramadol. This drug is a weak opiate. Its turnover is not so tightly controlled. To potentiate the effect of this drug, NSAIDs, chondroprotectors, physiotherapy, and intra-articular injections of drugs are used.

Only in extreme cases are strong narcotic analgesics such as morphine or fentanyl used. In Russia, their appointment is carried out on average 10 times less frequently than in Western countries. However, it is possible. Order No. 110 allows the use of narcotic analgesics by the attending physician by decision of the medical commission in the case of severe pain syndrome of non-tumor origin.

The prescription of opiates for advanced arthrosis requires serious justification. They are used if:

other therapeutic methods do not provide sufficient analgesic effect;
there is no high risk of complications and addiction.

In most cases, such treatment is not considered lifelong. It is prescribed while the patient is awaiting surgery.

Forecast. Prevention

Osteoarthritis of the knee joint is difficult to treat and is one of the ten main causes of disability in the Russian Federation and Belarus. However, in the early stages, the progression of the disease can be significantly slowed down. If there are risk factors for the purpose of prevention, it is recommended to:

balanced loads on joints (optimal training and work regimen);
swimming;
massage of thigh and calf muscles;
maintain optimal weight;
rejection of bad habits;
regular physical therapy exercises;
wear comfortable shoes, do not get too cold, do not overwork;
diet therapy;
treatment of concomitant diseases.

Long-acting hyaluronic acid preparations GIAL-SIN, GIAL-SIN PROLONG, GIAL-SIN PROLONG PLUS will improve trophism and slow down the degeneration of the cartilage lining of the knee. Course treatment is the key to achieving a positive effect. The duration of therapeutic and preventive action is 12-24 months.

Endoprosthetics

computer navigation systems are used that perfectly calculate all angles, distances and biomechanical axes when installing an endoprosthesis;
new, increasingly high-quality artificial joints are appearing, almost completely areactogenic (not rejected by the body), very functional (providing a high range of motion), capable of serving for decades;
Minimally invasive techniques for installing artificial joints are used with minimal damage to soft tissue, which shortens the rehabilitation period and reduces the risk of complications.

Already on the first day after endoprosthetics, a person is recommended to put weight on the operated leg. Rehabilitation lasts several months. After six months or a little more, the person is allowed to bear full weight on the operated leg.