Arthritis (arthrosis) of the knee - symptoms and treatment

Knee osteoarthritis (knee joint disease) is a progressive, chronic disease of the knee joint in which the cartilage portion (articular surfaces of the femur and tibia) is damaged, thinned, and destroyed, as well as damage to the subchondral bone.Studies (arthroscopy and MRI) prove that in addition to damage to the articular cartilage, the meniscus and synovium are also involved.Knee arthropathy is one of the most common orthopedic pathologies.There are synonyms for it - osteoarthritis (OA), osteoarthritis.The disease is an important socioeconomic problem because it is widespread and significantly worsens the quality of life of patients due to persistent pain and, in addition, becomes a cause of high disability.

Until the mid-1980s, there was no unified definition of the disease.It was not until 1995 that the disease was characterized as the result of mechanical and biological factors leading to an imbalance in the degradation and synthesis processes of the extracellular matrix of articular cartilage.As a result, fiber disintegration and degeneration occur, the subchondral bone cortex layer cracks, bone hardening, and compaction occur, and osteophytes grow to form subchondral cysts. 

Many factors contribute to knee joint disease, including:

1. Chronic trauma (violation of physical activity, excess weight);
2. endocrine, inflammatory, metabolic and ischemic diseases;
3. There is a congenital or acquired disorder in the relationship, shape, or structural organization of the joint ends.

Symptoms of knee arthritis

Characteristics of knee osteoarthritis are:

• onset gradually;
• Mild joint pain during activities, especially when going up and down stairs;
• The "tightness," stiffness, and "initial pain" present during the first step, if the patient "dissipates," will decrease or disappear upon recovery after significant physical activity.
• The appearance of the knee remains unchanged.Sometimes there is slight swelling or fluid accumulation in the joint (synovitis occurs).At the same time, the knee increases in size, swells, and becomes flat, and the movement feels restricted and heavy.

As the condition progresses, the pain becomes more severe and can occur with even slight exertion and prolonged walking.Position along the anterior medial surface of the joint.Prolonged rest often helps the pain go away.Joint range of motion may be reduced, a feeling of tightness may occur, and severe pain may occur when the leg is bent to its fullest extent.The shape of the joint changes, as if it is expanding.Synovitis is more common, lasts longer, and involves large amounts of fluid.

What is different in the final stages of knee joint disease is that the pain is almost constant, causing anxiety not only when walking, but also when resting and even at night, when the patient has to find a comfortable sleeping position.Movement is more limited: It is difficult to fully bend and straighten the leg.The joints become deformed and increase in size.Valgus (X-shaped) or varus (O-shaped) deformities of the legs are often observed.The gait becomes unsteady and wobbly.Severe cases require the use of a cane or crutch.

X-rays of 76 percent of older adults complaining of knee pain showed knee arthropathy, researchers said.According to statistics, women are more susceptible to this disease, which is related to hormonal changes after the age of 45.

The pathogenesis of knee arthritis

Osteoarthritis is divided into primary and secondary forms.

Primary arthropathy:

• Articular cartilage is constantly being destroyed and replaced; normally, these processes are balanced.As we age, cartilage turnover slows down and destruction begins to dominate, a process called degeneration or degeneration.The weight of the person plays an important role, because if the weight is 70 kg and 20 steps we are already bearing 700 kg of weight on each leg (70 kg x 10 steps), if the weight is 120 kg we are already bearing 1200 kg on each leg.As a result, fragile cartilage wears away more quickly;
• It is necessary to remember: joints absorb nutrients and recover during exercise; a sedentary lifestyle reduces metabolic processes, and essential elements do not reach the cartilage;
• There is controversy regarding the role of genetics in the development of the disease.If a parent has joint disease, the child is more likely to develop joint disease;
• Occurs due to autoimmune synovial inflammation.

Secondary arthropathy is caused by:

• Injuries (fractures, meniscal and anterior cruciate ligament ruptures).Unfortunately, for anyone, regardless of age, these injuries can cause excessive stress on the cartilage.Fractures of any part of the bone covered by cartilage are accompanied by the formation of unevenness - "steps".In this area, when moving, wear occurs and joints form;
• Rheumatoid arthritis, Koenig's disease (osteochondritis dissecans), consequences of purulent inflammation of joints (knee arthritis), etc.;
• local vascular disease;
• Chronic exudative proliferation and scar adhesion processes in joints.

In joint diseases (osteoarthrosis), in addition to the gradual destruction of cartilage, loss of elasticity and shock-absorbing properties, the bones also gradually participate in this process.Under load, sharp edges (exostoses) appear, which are mistakenly thought to be "salt deposits" - with typical arthropathy, salt deposits do not occur.As arthrosis progresses, it continues to "eat" the cartilage.Then the bones become deformed, cysts form there, all structures of the joint are affected, and the leg becomes bent.

In addition to the inside or outside of the knee, arthrosis can also affect the surface between the patella and the intercondylar groove of the femur.This option is called patellofemoral arthropathy.

The cause is usually subluxation, fracture, or hemilateralization of the patella.

Classification and development stages of knee joint disease

Regardless of the cause, the disease has three stages:

• Phase One – Initial Performance.It is characterized by major changes in hyaline cartilage.Bone structure is not affected.The blood supply of intraosseous vessels and capillaries is disrupted.The surface of the cartilage becomes dry and loses its smoothness.If the disease is accompanied by persistent severe synovitis, cysts may form.After the joints are under great pressure, dull pain will occur.There may be slight swelling that will go away with rest.No deformation.
• Stage 2 - The cartilage layer thins dramatically and in some places disappears completely.Osteophytes appear on the edges of joint surfaces.The qualitative and quantitative characteristics of joint synovial fluid change - it becomes thicker and more viscous, resulting in a deterioration of its nutritional and lubricating properties.The pain is long-lasting and severe, and there is often a crunching sound when moving.There is slight or moderate limitation of movement and slight deformation of joints.Taking painkillers can help relieve pain.
• Stage III - Most affected areas lack cartilage, severe hardening (sclerosis) of the bone, numerous osteophytes, and sharp narrowing or loss of joint spaces.The pain is almost constant and gait is impaired.The ability to move is severely limited and the joints are deformed significantly.NSAIDs, physical therapy, and other standard treatments are ineffective. 

Unilateral and bilateral knee arthrosis can be distinguished based on the number of joints affected.

Complications of knee arthritis

The most common complication in stages II and III is tenosynovitis of the adductor muscles of the thigh.This manifests as pain on the inner surface of the joint that worsens with movement.The reason is muscle imbalance and deformation.Contractures can occur with a chronic reduction in range of motion.In addition, synovitis often occurs.Advanced knee arthrosis affects the entire musculoskeletal system, disrupting the biomechanics of the spine and other large joints in the lower limbs.This can lead to herniated discs and arthritis in other joints.The second knee joint is overloaded (if the disease is unilateral) because the patient retains the sore leg and shifts the weight to the other healthy leg.

Diagnosis of knee arthritis

The diagnosis is made by an orthopedic traumatologist, and in the vast majority of cases, two projection (direct and lateral) examinations and X-rays of the knee joint are sufficient.Clinical data and images help determine the stage of the disease.

In the early stages of the disease, bone tissue changes are small, and X-ray examination is of little value.At this stage, knee arthropathy can be diagnosed through arthroscopy.The method is extremely accurate; only its invasiveness and price prevent it.

Ultrasound cannot clearly observe changes in articular cartilage and intra-articular structures.Using MRI, you can detect changes in the bone, cartilage and soft tissue structure of the joint, as well as the subchondral bone, with 85% accuracy.Scintigraphy can assess the metabolic activity of bone tissue around joints.

Increased phosphorus and calcium content in dehydrated synovial fluid is evidence of destruction of joint osteochondral tissue and accumulation of degradation products.Blood is also examined - general analysis and erythrocyte sedimentation rate (ESR); levels of fibrinogen, urea and other biochemical parameters in blood and urine are determined.

Treatment of knee arthritis

Conservative treatment - anti-inflammatory drugs, analgesics, muscle relaxants, vascular, chondroprotective agents, compresses, sports tape, physical therapy, physical therapy, orthotics.

Minimally invasive - paraarticular block (novocaine + medication to relieve pain and inflammation), artificial lubricant is injected into the joint itself, plasma is raised.

Surgery - Arthroscopy (a low-invasive method of treating intra-articular lesions and removing damaged structures), endoprostheses.

A conservative approach is most effective in the initial stages of the disease.They help relieve pain and temporarily slow cartilage destruction.In the second phase, more efficient methods are needed.Hyaluronic acid preparations are introduced into the joint cavity to reduce friction and trauma to cartilage.There is no clear evidence that it can restore cartilage, but it can help lubricate surfaces."PRP therapy" (Plasma Boost) involves injecting platelet-rich plasma, obtained from the patient's own blood by centrifugation, into the knee joint.It nourishes cartilage and promotes its repair, as autologous platelets contain a large number of growth factors and cytokines that promote the regeneration of damaged tissue.

Endoprosthetic replacement is a common and effective surgical treatment for severe knee joint disease, allowing you to maintain mobility in your limb and subsequently your ability to live a fulfilling life.This is a high-tech surgery that lasts about an hour and a half.The postoperative period requires long-term rehabilitation and development of the joints.After 25-30 years, when the artificial joint wears out, it needs to be replaced again.

forecast.prevention

You need to understand that if a joint begins to appear, it must be treated immediately.If you are at risk of developing this disease, you can delay the onset of the disease, for which it is recommended to:

• Reduce pressure on knee joints;
• Swim – Water relieves stress;
• Massage your calf and thigh muscles yourself;
• Avoid hypothermia and overexertion;
• Maintain a normal weight;
• Quit smoking and drinking;
• Women wear comfortable, low-heeled shoes;
• do physical therapy

You should definitely consult your doctor before starting therapeutic exercises.Practice at a slow pace.If pain or discomfort occurs during gymnastics, the practice should be stopped.

Only effective medications must be used.Folk methods such as rubbing and applying are ineffective; they do not act on the cause of the disease but only help distract from the pain.Avoid injury and overload - jumping, carrying heavy objects, standing for long periods of time or sitting in uncomfortable positions.This accelerates the progression of the disease.

Prompt diagnosis and treatment of rheumatoid arthritis, gout, and systemic diseases are also required.

Prognosis depends on the stage at presentation and the correct treatment.The sooner appropriate treatment is started, the higher the chance of avoiding surgery.