Treatment of arthrosis of the knee joint

Arthrosis of the knee jointis a degenerative-dystrophic disease of the cartilage tissue, which leads to the exposure of the bone heads and reduced mobility in the joint. The disease is non-inflammatory in nature and progresses slowly - the transition from the initial stage to disability lasts from several years to several decades. Osteoarthritis of the knee is one of the 5 most common causes of disability and disability in the world.

Osteoarthritis of the knee (gonarthrosis) affects more than 20% of people over the age of 55, but the disease is rapidly rejuvenating - more often symptoms appear at the age of 25.

symptoms of knee osteoarthritis

Timely treatment of arthrosis of the knee joint will help to avoid complications and destruction of cartilage tissue.

Signs of knee osteoarthritis

The wear and tear of articular cartilage is accompanied by characteristic signs, the intensity of which depends on the stage of the disease.Most often, patients complain of:

  • morning stiffness and reduced mobility in the joint (warming up after waking up is necessary);
  • pain and discomfort in the knees, which increase after physical exertion (long walking, running or standing) and disappear with rest;
  • in the 2nd phase - the so-calledinitial pain that occurs after a long stay in one position;
  • increased fatigue, which is often attributed to age-related changes;
  • dry, coarse crunching, which is repeated regularly when bending and extending the knee;
  • edema and other symptoms of inflammation that appear in the 2nd stage of the disease due to periarticular tissue trauma;
  • weather sensitivity, increased symptoms in the cold season.

When trying to bend the knee affected by gonarthrosis to a stop, there is a sharp pain and a feeling of a physical obstacle. In the later stages, even with the treatment of arthrosis of the knee joint, patients have a disturbed gait (they start waddling, patients walk on stiff legs), deformity of the lower extremities in the shape of the letter "O" or "X" appears. ".

The insidiousness of the disease is that it can run for years in a latent form, and the first significant symptoms often appear only in the 2nd stage - when complete restoration of the synovial cartilage is no longer possible.
Therefore, it is important to see a doctor at the first signs of discomfort in the knees - for example, weak, dragging pains that occur due to insufficient production of synovial fluid. Remember: knee pain is not normal, regardless of age. Timely examination and treatment of knee arthrosis of the 1st degree can completely protect you from excruciating joint pain in old age.

What happens if osteoarthritis of the knee is not treated?

With self-medication, non-compliance with the doctor's recommendations or without treatment, osteoarthritis of the knee joint progresses on average 3-8 times faster than with complex therapy. If gonarthrosis progresses aggressively, the patient may lose the ability to move normally even before reaching retirement age.

Effective treatment of knee arthrosis in the acute phase is especially important. It can be caused by damp cold, physical or emotional stress, allergies, poisoning, moving to a region with a different climate - in a word, any shock to the body. Aggravation of arthrosis is caused by the destruction of a large number of chondrocytes. In response, the body produces enzymes designed to process and remove dead cells. However, if their concentration is too high, healthy areas of the cartilage also suffer - cell membranes become thinner, foci of erosion appear on the synovial joint surface. This process, if not stopped by the treatment of knee arthrosis with drugs, can last for several weeks, and with chronic stress, lack of sleep or insufficient nutrition, it can be permanent.

Ultimately, without treatment, osteoarthritis of the knee leads to a complete reduction of the lumen of the joint space due to the growth of osteophytes. The gap necessary for normal movement closes, and the patient cannot bend the leg even by 30-45 °. The difficulty is not only climbing the stairs, but also trying to get up from the sofa or moving normally. This condition is accompanied by pain, from which conventional analgesics do not help. In such cases, there is only one option for treating arthrosis of the knee joint - surgical, with complete replacement of the joint architecture with a prosthesis and subsequent long-term rehabilitation. But even in this case, most patients do not manage to return to a completely normal life.

Treatment of knee osteoarthritis

Depending on the stage of the disease and the condition of the joint, conservative or surgical treatment of arthrosis of the knee joint is applied.

Treatment of arthrosis of the knee joint of the 1st degree is always carried out by conservative methods - with a successful combination of circumstances and good self-discipline of the patient, it is possible to achieve a cure of the disease or a stable remission.

As a rule, the treatment of knee joint arthrosis of the 2nd degree is based on the application of all methods of conservative treatment, however, the doctor may also decide on minor surgical interventions on the joint if the disease develops aggressively or with complications.

Treatment for third-degree knee osteoarthritis almost always involves surgery.

Comprehensive conservative treatment of arthrosis of the knee joint includes removing pain and inflammation, restoring cartilage tissue and increasing the range of motion in the joint. For this, the patient is prescribed an orthopedic regimen of exercise and rest, drugs of systemic and local action (hormonal and non-hormonal anti-inflammatory drugs, analgesics, chondroprotectors and others). Innovative biological methods are also gaining popularity - injections of drugs for the treatment of arthrosis of the knee joint directly into the joint bag. In this case, PRP injections (plasma rich in platelets) are used, as well as injections of stem cells obtained from the patient's own fat tissue. Auxiliary and rehabilitation methods are connected in parallel - physiotherapy, massage, manual therapy, therapeutic exercises.

Surgical treatment of osteoarthritis of the knee joint is carried out in cases where drugs are ineffective.With this pathology, the doctor can prescribe the following interventions:

  • Arthroscopy of the knee. Collective name for a group of minimally invasive operations whose goal is to remove a broken piece of joint tissue or osteophyte, i. e. partial excision of the joint membrane. It allows you to postpone or turn off prosthetics, as well as to eliminate discomfort in the early stages of the disease. It is used primarily for the treatment of knee arthrosis in patients under 60 years of age.
  • Osteotomy. Surgery to cut part of the bone and correct the load axis on the affected knee, which allows you to slow down degenerative changes. It is usually performed in the treatment of knee joint arthrosis of the 2nd degree.
  • Endoprosthetics. Partial or complete replacement of the knee joint with a titanium implant, which lasts 15-20 years. This technique is a last resort because it carries certain risks. It is recommended for patients older than 55 years.

All these operations require a recovery period and have a number of contraindications, so the best option is prevention (physical therapy, chondroprotectors) and treatment of knee arthrosis in the early stages.

Along with the main methods of treatment, diet therapy and other methods of reducing body weight are used. Bandages and other orthoses (sticks, orthopedic insoles, etc. ) are used to relieve the diseased joint.

Treatment of knee arthrosis is prescribed by a rheumatologist or orthopedist. At the first examination, he palpates the joint, performs motor tests, and then refers the patient to tomography or radiography.

Therapeutic exercises for knee arthrosis

Therapeutic exercise for the limbs of the lower girdle is considered the most effective method for pain reduction and treatment of arthrosis of the knee joint of the 1st degree. The first results of therapeutic exercises come after 2-4 weeks of continuous training. Continuity in the treatment of arthrosis of the knee joint is one of the main factors affecting the effectiveness of exercise therapy. A full lesson is held 1 time a day every day, and at least 3-4 training sessions during the day are recommended.

therapeutic exercises for arthrosis

Therapeutic exercises for knee arthrosis during the period of remission will help relieve pain.

The main task of physical exercises in the treatment of osteoarthritis of the knee joint is to strengthen the muscles of the upper leg and lower leg, maintain the elasticity of ligaments and tendons, as well as suppress the muscle atrophy that is characteristic of osteoarthritis. This allows you to transfer the load from the joint to the periarticular structures - and thus slow down the mechanical abrasion of the cartilage, reduce inflammation.

Exercises for the treatment of knee arthrosis are performed for both legs! If there is sharp pain, the session should be stopped or continued at a slower pace.

  1. Starting position - lying on your back. One leg is stretched out on the floor, the other is raised and bent at an angle of 90° (lower leg parallel to the floor). Movements are performed with the lower leg up and down, as much as the range of motion in the joint allows.
  2. Starting position - lying on your back. Let's do the bike exercise.
  3. Starting position - lying on the stomach. We swing our legs alternately, trying to bring the heels as close to the buttocks as possible.
  4. Starting position - lying on the side, the arm is bent under the head or extended above the head in line with the body. The other hand rests at the side. We swing with a straight leg. We switch sides.
  5. Starting position - lying on your back. We pull our feet along the floor forward with the heel (away from you), the socks look "at ourselves".
  6. Starting position - lying on the stomach. We do the "boat" exercise. If physical fitness does not allow, we put our palms on both sides of the chest and return the legs alternately, experiencing tension in the back of the thigh and lower leg.
  7. Starting position - lying on your back. We alternately rotate our feet, trying to describe a full circle with our socks.
  8. Starting position - standing against the wall. Squat slowly and smoothly, without lifting your back from the wall, in order to distribute the load. When the legs are bent at the knees by 90 °, we begin a smooth upward movement.
  9. Starting position - standing. We alternately swing our legs forward, backward and sideways.

Note: therapeutic exercises after joint surgery have their own specifics and vary depending on how many days have passed since the surgery. It is prescribed by a doctor - a surgeon or a rehabilitation specialist.

Massage for knee osteoarthritis

Therapeutic massage for knee arthrosis is performed on both legs. In the beginning, at least 10-12 sessions are usually required with a masseur-rehabilitator or with the help of hydromassage equipment, however, a simple restorative massage can be performed at home. It includes the following types of movements:

  • superficial stroking and rubbing (up and down, clockwise and counterclockwise);
  • fingertip probing and stretching of deeper tissues;
  • pinching and tapping the skin.
massage for knee osteoarthritis

Massage for knee arthrosis should be performed by a specialist who does not harm the affected joint

Self-massage can be combined with the treatment of arthrosis of the knee joint with drugs: it will not be superfluous to apply heated ointment or balm before or during the session. You can also take a warm bath before the procedure.

Important: massage is contraindicated in patients with symptoms of inflammation (osteoarthritis or exacerbation of arthrosis). In this case, acute phase therapy is required.

Diet therapy for arthritis

A standard nutritional protocol for the treatment of osteoarthritis of the knee requires:

  • limit foods and dishes rich in simple carbohydrates (white bread, sweets, snacks, sweets, potatoes, sugar);
  • exclude processed (ready-to-eat) and salt-rich foods - fast food, semi-finished products, sausages;
  • avoid alcohol, decaffeinated coffee and fatty meat.

Instead, include in the menu:

  • sprouted and whole grain dishes;
  • fatty fish from the northern seas and dietary poultry meat;
  • cartilage (ears, snouts, legs and other parts of domestic animals rich in collagen), aspic and jelly;
  • fruits and vegetables rich in vitamins and antioxidants (especially vitamins A, B12, C, E);
  • nuts and other sources of omega fatty acids and valuable minerals.
knee arthritis diet

The knee osteoarthritis diet provides a balanced diet that helps repair cartilage.

It is also recommended to treat osteoarthritis of the knee joint with drugs - vitamin-mineral complexes (2 courses per year).

Physiotherapy for the treatment of knee osteoarthritis

The following physiotherapy procedures are used to effectively treat knee arthrosis and enhance the effect of drugs:

  • magnetotherapy;
  • laser therapy;
  • UHF;
  • ultrasound therapy;
  • amplipulse;
  • electrophoresis (including medical - with analgin, novocaine or chymotrypsin);
  • applications of ozokerite and paraffin;
  • thermotherapy (cryotherapy, inductothermy);
  • phonophoresis (especially with hydrocortisone);
  • balneological therapy (sulphur, hydrogen sulphide baths).

As a rule, acupuncture is not used in the treatment of arthrosis of the knee joint of the 2nd degree.

Before visiting the procedures, it is necessary to consult with your doctor - many types of physiotherapy are contraindicated in case of worsening of the disease.

Medicines for the treatment of arthrosis of the knee joint

Treatment of osteoarthritis of the knee joint with drugs is carried out symptomatically and taking into account the patient's individual response to the selected drugs. Drug therapy - injections, ointments or tablets for the treatment of knee arthrosis - is usually prescribed in courses or as needed.

treatment of arthrosis with drugs

In order to choose the right drugs for the treatment of arthrosis of the knee joint, consult a doctor who will select the necessary drugs after research.

There are several directions in the treatment of arthrosis of the knee joint with drugs: making life easier for the patient, improving cartilage nutrition, regenerating cartilage tissue and maintaining a normal musculoskeletal system.

Nonsteroidal anti-inflammatory drugs

To relieve exacerbations, NSAIDs in tablets or capsules are taken in courses (about 12 days) or as needed, depending on the intensity of the pain syndrome. Uncontrolled intake of NSAIDs in violation of instructions or doctor's recommendations is fraught with stomach or intestinal ulcers. They should be taken with great caution in combination with glucocorticosteroids and drugs that affect blood clotting. Additional risk factors are age over 65, smoking, alcohol consumption during the course. In these cases, doctors usually recommend injecting drugs, bypassing the gastrointestinal tract. Together with NSAIDs, it is advisable to take gastroprotectors.

The maximum effect can be achieved by a combination of systemic NSAIDs (for internal use) and external ones - in the form of ointments, creams or gels. The second option provides a spot effect on the affected joint and at the same time minimally affects digestion.

Corticosteroids (steroid drugs used to treat osteoarthritis of the knee)

Hormonal drugs (HA) are usually used for the so-calledsteroid blockade of the knee in cases where NSAIDs are not sufficient to relieve pain and inflammation.

Glucocorticoid injections are considered a last resort in the medical treatment of osteoarthritis of the knee. They provide relief as early as 20 minutes after application, but can lead to hormonal imbalance and cartilage damage if taken incorrectly. Because of the side effects, many orthopedists prefer knee surgery to long-term HA therapy.

Chondroprotectors in the treatment of arthrosis of the knee joint

Chondroprotectors based on extracts from veins and cartilage of cattle, marine fish and shellfish contribute to the restoration of synovial cartilage, and are therefore indispensable for the effective treatment of knee arthrosis. Chondroprotectors contain a large number of glycosaminoglycans - natural polymers from which cartilage tissue is built. Therefore, they make chondrocytes (cartilage cells) more stable, promote their growth, and enrich the synovial fluid.

Unlike anti-inflammatory drugs, chondroprotectors have practically no contraindications. They provide a cumulative, prolonged effect - the first improvements appear after 1-3 months of admission, and the duration of the course is 3-6 months.

Skin irritants

External preparations for the treatment of knee arthrosis with a local irritating effect improve blood circulation and nutrition of the joint, and also distract the patient from pain. For this purpose, ointments, gels, creams and balms based on natural ingredients are used - bee venom, hot pepper extract.

In case of an allergic reaction (persistent redness and pain on the skin, rash), during pregnancy and breastfeeding, as well as in case of other contraindications, it is better to avoid warming ointments for the treatment of arthrosis of the knee joint. and limit yourself to warm baths, applications and external anti-inflammatory agents.

Prostheses for synovial fluid

If there is too little synovial fluid in the joint, the gliding of the joint surfaces is disturbed. And most importantly, it begins to starve the cartilage, because the joint fluid that nourishes it like a sponge normally supplies nutrients for the growth and maintenance of cartilage tissue. In order to prevent cell destruction and mechanical abrasion of the knee cartilage, the doctor may prescribe injections of high molecular weight hyaluronan derivatives. Medicine injections in the treatment of arthrosis of the knee joint (viscosupplementation) are injected directly into the joint capsule, which leads to rapid relief, which lasts from 3 to 12 months after the end of the course. However, with the introduction of prostheses, the risk of necrotic changes or infection in the joint remains.

Antispasmodics, analgesics, muscle relaxants

In cases where spasms and muscle tension prevent the patient from falling asleep, cause pain during movement, the doctor prescribes antispasmodics and muscle relaxants.

Simple analgesics are not used in the treatment of arthrosis of the knee joint, because they mask the pain, but do not relieve the inflammation. You can use them or available NSAIDs without a doctor's prescription for up to 10 days, after which an examination is necessary.

The form of release of drugs for the treatment of arthrosis of the knee joint

For the convenience of patients, drugs for the treatment of arthrosis of the knee joint are produced in various forms. Is there a difference between them and which should I choose?

injections for knee osteoarthritis

Preparations for the treatment of knee arthrosis have several forms of release: bags, injections, ointments, tablets. Choose what suits you best.

Capsules, bags and tablets for the treatment of knee arthrosis

Nonsteroidal anti-inflammatory drugs, corticosteroids, chondroprotectors, and muscle relaxants are available in oral forms. In this case, it is easy to dose them, admission is possible without the participation of a medical worker, it is easy to control which part of the course has already been completed. When taken orally, chondroprotectors and NSAIDs have a fairly high bioavailability (especially in the form of a bag).

Solutions for injections

In the form of injections, you can take the already mentioned NSAIDs, HA, chondroprotectors and muscle relaxants, as well as prostheses for synovial fluid. This method of treating osteoarthritis of the knee joint with drugs shows maximum bioavailability.

This method of treating arthrosis of the knee with drugs is safe for digestion, but it is preferable that the injections (intravenous, intramuscular in the joint area or intra-articular) are given by qualified medical personnel. Intramuscular injections in the buttocks or thigh can be done independently.

Products for external use

Locally irritating, anti-inflammatory and chondroprotective ointments are applied externally for the treatment of arthrosis of the knee joint. The advantage of such drug administration is the direct effect on the affected tissue. However, the skin barrier hinders the action of active substances - unfortunately, often only 5% of the active ingredients reach the desired tissue layers.