Osteoarthritis of the knee joint grade 3 is treated conservatively or surgically. In the first case, the patient is prescribed medications, drug blockades, therapeutic exercises and physiotherapy, in the second case, endoprosthetics is performed.
Diagnosis by X-ray.
The presence of grade III deforming arthrosis of at least one large joint is a direct indication for surgical intervention. During the operation, doctors remove the destroyed joint and replace it with an artificial prosthesis.
Many patients with osteoarthritis try to avoid surgery for as long as possible. The reason may be fear of going under the surgeon’s knife, reluctance to undergo long-term rehabilitation, or lack of money for surgery. Such patients hope that a healthy lifestyle, regular medications and simple exercises will help them cope with the disease. Unfortunately, this is a misconception.
To dispel all the myths about the effectiveness of conservative therapy, the American Agency for Healthcare Research and Quality conducted a number of large-scale studies. In 2006-2012, it analyzed and summarized the results of a large number of clinical trials. Let's see what came of it.
How effective is physiotherapy?
In orthopedics, physiotherapeutic procedures are prescribed to stimulate blood circulation and metabolism in joint tissues. This helps slow down degenerative processes in articular cartilage. Together with exercise therapy, which strengthens muscles, physiotherapy significantly improves the functional state of joints. It makes sense to use such treatment only at stages I-II of arthrosis.
The effectiveness of different methods of physiotherapy (Agency data, 2012):
- exercises to increase muscle strength. When performed correctly, they strengthen the leg muscles, relieve pain and improve joint mobility;
- myoneurostimulation. Ineffective in the fight against grade 3 osteoarthritis of the knee joint. Relieves pain for a short period. Soon after the end of the course of treatment, the pain intensifies;
- water gymnastics. Temporarily improves the general well-being of patients and removes some physical restrictions;
- wearing orthopedic devices, cryotherapy, magnetic therapy, diathermy. As it turned out, these methods are ineffective in the treatment of arthrosis.
Physiotherapy methods are not able to restore damaged cartilage and bones. They only relieve unpleasant symptoms and make life a little easier for patients. It is impossible to cure arthrosis with their help (even with conscientious and regular completion of all prescribed procedures).
Diagnosis of knee osteoarthritis
In order to determine the severity of the disease, X-rays of the knee joints are performed using new generation devices. Mandatory radiological signs of knee osteoarthritis include narrowing of the joint space, subchondral osteosclerosis, osteophytes at the edges of the articular surfaces, and optional ones include clearing of bone tissue.
Arthroscopy allows doctors to assess the integrity and tone of the cruciate ligaments, the severity of thickening of the synovial membrane, reveals bone growths, and the presence of fixed or loose bodies in the joint cavity. The study is carried out at an early stage of the disease, before the appearance of characteristic radiological signs. During this procedure, a targeted biopsy is performed followed by microscopy of intra-articular structures.
Using ultrasound, the pathology of soft tissues is identified, the thickness and structure of cartilage, the condition of the synovial membrane, the presence of free fluid in the joint cavity, defects of the articular surfaces and bone growths are determined. Magnetic resonance imaging is the main method for imaging hyaline cartilage. Using the study, you can obtain information about all structures of the knee joint, clarify the integrity of the ligaments, see the pathology of the tendons, and the presence of bone marrow edema as a manifestation of osteitis. There were no changes in laboratory tests specific for osteoarthritis. In some patients, C-reactive protein levels increase slightly. Sometimes rheumatoid factor is detected in a low titer, especially in elderly and senile people. Synovial fluid is sterile, viscous, transparent or slightly turbid, the number of cells does not exceed 2000 per mm3.
Why medications won't help
The development of deforming osteoarthritis is based on the progressive destruction of articular cartilage. This process has not yet been fully studied, and it is very difficult to control. Some drugs can affect the pathogenesis of the disease, but are not able to eliminate its cause. Drug treatment can only slow down degenerative processes in the joint.
This is a “living” joint from the inside at 3rd degree.
Table 1. Basic drugs for the treatment of gonarthrosis
| Drug groups | Representatives | Disadvantages of use for severe gonarthrosis |
| Symptomatic quick-acting remedies | NSAIDs, corticosteroids, local anesthetics | They temporarily relieve pain and inflammation, which is why in the later stages of osteoarthritis they need to be used almost constantly. They have only a symptomatic effect, but do not treat arthrosis itself. With prolonged use, they disrupt metabolic processes in articular cartilage, accelerating their destruction |
| Delayed action modifying agents | Glucosamine and Chondroitin | Chondroprotectors act slowly. To achieve a noticeable effect, you need to spend a lot of time and money on treatment. Ineffective in the treatment of grade 3 osteoarthritis of the knee joint. It is impossible to restore the structure of cartilage that is no longer there |
| Means for intra-articular administration | Hyaluronic acid | Hyaluronic acid injections are expensive. Not everyone can afford 2-3 injections a year. The introduction of medication into the synovial cavity is accompanied by tissue trauma and is associated with certain risks. |
In addition to the negative effect on cartilage, painkillers have a lot of other side effects. Regular use of these medications can be detrimental to your health. Therefore, if you have chronic pain syndrome, do not delay surgery. Know: after endoprosthetics, you can be completely off medications.
Diagnostics
The diagnosis is made based on the patient’s complaints (joint pain, limited mobility) and instrumental examination data. The simplest and most accessible method of instrumental diagnostics is radiography. With its help, you can evaluate the anatomical changes in the joint (narrowing of the gap, bone spurs and their number) and determine the degree of the disease.
Computer and magnetic resonance imaging have higher information content. The MRI method is one of the most modern studies that allows you to visualize all joint structures and surrounding soft tissues.2
Innovative treatment methods
Scientists in America and European countries are developing innovative methods for effective restoration of cartilage tissue. The main direction of their activity is the creation of cell-engineered structures that can be injected into the joint cavity. Some drugs are already used in clinical practice (BioSeed-C, Cartigel, Chondrolon, DeNovo-NT), but they are effective only at stages I-II of gonarthrosis.
The idea of creating artificial cartilage that could be surgically implanted looks quite promising. Most likely, they could completely replace destroyed cartilage tissue. However, to “grow” such cartilage, mechanical stimulation is needed. Scientists have not yet been able to create the necessary conditions for this.
In the CIS countries, the listed treatment methods are not yet used. To create cell-engineered structures, we need special conditions that we do not have.
Treatment
Treatment of grade 3 gonarthrosis can be carried out using conservative methods, which include the following:
- reducing the load on the sore joint;
- physical therapy;
- taking medications;
- physiotherapy.
If all the above methods do not give the desired results, our specialists resort to surgical intervention. For this purpose the following is used:
- Arthroscopy, which is a diagnostic and therapeutic procedure. This is a gentle method that eliminates the presence of a scar and allows the patient to quickly recover;
- Endoprosthetics, which is used when there is complete destruction of cartilage tissue. The procedure consists of replacing a joint or its parts with artificial ones made from materials that take root well in the human body.
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What you need to know about endoprosthetics
Today, surgery is the most effective method of treating grade 3 osteoarthritis of the knee joint. With its help, you can completely get rid of chronic pain and restore normal knee mobility. A properly installed modern implant can last at least 15-20 years.
The success of endoprosthetics depends on the skill of the surgeon and the quality of the endoprosthesis. The implant must suit the patient according to a number of criteria. Negligent attitude of doctors towards the selection and installation of a prosthesis can lead to unpleasant consequences. Poor quality rehabilitation or its complete absence can also cause harm.
Deforming osteoarthritis of the knee joint: what is it, causes
Osteoarthritis of the knee is a chronic and progressive degenerative process that affects the cartilage tissue, subchondral bones and adjacent muscles and ligaments. Normally, cartilage lines the surface of the joint, protecting the heads of the femur and tibia and performing a shock-absorbing function. It is protected from friction by the joint fluid, which acts as a lubricant. In the presence of a pathological process, the cartilage lining is dehydrated, cracks, and then wears off, exposing the bone, and nerve fibers are also damaged. This leads to unpleasant sensations when flexing and extending the legs, an inflammatory process in the tissues and limited mobility in the joint.
The disease is common in both sexes. Moreover, gonarthrosis most often affects women over the age of 45, as well as athletes, obese people and people involved in repetitive physical work. The provoking factors of the disease are:
- leg fractures, knee dislocations, tears and other damage to the meniscus, as well as related surgical interventions;
- inflammatory and systemic autoimmune diseases (rheumatism, gout, rheumatoid arthritis, ankylosing spondylitis);
- metabolic and endocrine disorders (diabetes, atherosclerosis, hemophilia, excess iron, somatotropin);
- congenital hypermobility of the knee joint or a genetic predisposition to arthrosis (usually associated with the characteristics of cartilage tissue or insufficient cartilage lubrication);
- elderly age;
- excess weight (each extra kilogram creates a load on the joint comparable to 3-4 kg);
- hypothermia, dehydration;
- menopausal and postmenopausal periods;
- long-term stress on the joints associated with performing household or professional duties.
The disease can manifest itself at any age - even at 18 years old. Arthritis, an acute inflammation of the joint, is often observed in the early stages of the disease. However, it should not be confused with arthrosis - chronic destruction of cartilage and bone tissue.