Arthritis of the knee (knee joint disease)

Arthropathy (knee joint disease) is a pathological change in the knee joint that has a chronic course and progresses over time. The disease extends to all components of the knee joint: cartilage, subchondral bone, meniscus, synovium, ligaments, joint capsule and periarticular muscles.The knee joint, which connects the femur and tibia, carries heavy loads throughout life and is often injured. Sometimes minor injuries are ignored immediately but are felt later in life. In this regard, joint injuries are often found in the elderly. However, younger people can also suffer from knee pathology due to sports or an active lifestyle.To maintain maximum mobility and a high standard of living, you should consult a doctor at the first sign of knee problems. An experienced orthopedic traumatologist will diagnose your condition and prescribe the necessary treatment.

Types of arthrosis of the knee joint

Inside a joint, bones are covered with cartilage tissue that absorbs shock, glides smoothly, and prevents bones from rubbing against each other. Cartilage tissue receives nutrients due to the synovial fluid located within the joint and the blood flowing through the blood vessels.Cartilage has a spongy structure, so when at rest it absorbs fluid, and when loaded it displaces fluid. At the same time, cartilage is constantly subject to micro-damage during exercise, which is restored during rest.If the results of mechanical damage exceed the joint's ability to recover, then the cartilage does not receive adequate nutrients and regeneration does not occur. Damage accumulates and changes the structure of cartilage tissue. This is how the articulation of the knee joint begins.Knee arthritis is generally divided into two types based on its cause: primary and secondary.

primary knee arthropathy

The degenerative changes that occur in joints are age-related. The reasons for this are as follows:

• Natural degeneration or degeneration due to slowing of metabolic processes in the body;
• being overweight;
• Sedentary lifestyle;
• malnutrition;
• Genetic susceptibility.

Often, primary knee arthropathy affects both knees at the same time and is called bilateral knee arthropathy.

secondary arthropathy

Secondary arthropathy of the knee can occur at any age as it can be caused by:

• Various injuries - ligament or meniscus bruises, fractures, dislocations, ruptures and sprains;
• Joint diseases: rheumatoid arthritis, osteochondritis dissecans, gout, knee arthritis, etc. ;
• local vascular disease;
• Overloading of the knee joint during exercise or due to the specific circumstances of the job;
• endocrine diseases;
• O-shaped and X-shaped curvature of the legs.

Secondary articulation of the knee most often occurs in only one leg and is called unilateral.In rare cases, idiopathic knee arthritis—a condition that occurs without any apparent cause—is found.

Stages and symptoms of knee arthritis

Regardless of how the articulation of the knee appears, experts distinguish three stages of its development, which are determined by X-ray examination. Each stage is accompanied by characteristic symptoms:

• Stage 1– Mild pain that occurs after prolonged exercise, when climbing stairs, or after strenuous exercise, and disappears after rest. Movement is not restricted, but slight swelling of the joints may sometimes occur. If nothing is done, this condition can continue for years - when the cartilage is just beginning to lose its smoothness due to compromised blood supply. X-rays will show slight narrowing of the joint space and hardening of the bones.
• second stage– Pain can become severe and last for a long time even with slight exertion. A crunching sound may be heard when the joint is flexed and extended. Unable to fully bend the leg due to severe pain. There is slight deformation, muscle atrophy and limited mobility. The pain may be relieved with painkillers or may go away on its own with rest.At this stage, the cartilage layer has become greatly thinned and even disappeared in some places. The synovial fluid becomes thicker and more viscous, which compromises its nutritional and lubricating properties. Osteophytes - bone growth - appear.
• The third phase– The pain increases and is constantly worrying, even at night. Joint deformities become apparent, gait changes, and the lower limbs bend. Reduced range of motion in the knee joint - the leg cannot fully bend or straighten. When walking, you must use a support such as a stick or crutches. Painkillers no longer help.Cartilage is almost completely lost, bones are compacted, and joint space is greatly reduced or eliminated. The presence of numerous osteophytes was noted.

A common symptom of arthritis of the knee can be identified - localized pain of varying intensity along the anterior inner surface of the joint.

diagnosis

If you observe symptoms similar to those of knee joint disease, you should consult your doctor. At the initial appointment, the doctor will take a medical history, check the biomechanical capabilities of the joint, and perform any necessary tests. Be sure to tell him about injuries and illnesses, lifestyle, nutrition, medications and work characteristics.The most informative and easiest way to confirm or refute the diagnosis is a knee X-ray - it allows you to make a differential diagnosis, determine the extent of the arthropathy and monitor the course of treatment.However, radiographic signs appear much later than morphological changes. Therefore, in its early stages, knee arthrosis can be difficult to detect even with X-rays. In this case, the doctor may prescribe arthroscopy—a highly precise method of diagnosing changes in the joints using special endoscopic equipment.Other investigation methods include ultrasound and MRI - these are used when radiographic information is not rich enough.

Treatment of knee arthritis

After diagnosis, doctors choose the best treatment based on the stage of the disease and personal characteristics. This solves three problems:

• relief the pain;
• Prevent pathological progression;
• Restore joint function.

Experts choose a comprehensive solution that can be adjusted during treatment.In modern medicine, there are many ways to treat joint diseases. They can be divided into three types: conservative, minimally invasive, and surgical.

Conservative treatment of knee joint disease

Typically used in stages 1-2 of knee arthritis. Treatment begins with reducing joint load - patients should avoid excessive vertical loads on the joints: jumping, running, etc. If necessary, it is recommended to lose excess weight. The doctor will recommend a diet and choose a gentle set of exercises to reduce axial impact and improve the nutrition of the cartilage tissue.To improve blood circulation in the joint area, increase range of motion, and enhance the effect of medications, physiotherapy is prescribed:

• Shock wave therapy – the use of low-frequency, significant amplitude sound pulses to produce short-term effects on bone and connective tissue;
• Electrotherapy – exposure of affected areas to electrical current, magnetic or electromagnetic fields;
• Laser therapy – exposure to light radiation produced by a laser;
• Phonophoresis – irradiating the affected area with ultrasound waves and applying medication to the skin;
• Electrophoresis - Exposing the affected area to an electric current.

Massage, compression, wearing orthotics, and myo-tape have also been shown to be effective in treating joint disease.Additionally, well-selected medication can help relieve pain, stop inflammation, and slow the process of cartilage tissue destruction. For this purpose, anti-inflammatory, hormonal, antispasmodic and chondroprotective agents are used. Depending on the situation, they can be in tablet, injectable or topical form.

Minimally Invasive Methods for Treating Knee Arthropathy

If the above methods don't work, your doctor may prescribe intra-articular injections:

• Hyaluronic Acid – Acts as a replacement for synovial fluid to improve friction, reduce pain, and improve knee joint function. The average duration of action of the drug is 3-6 months;
• Platelet-rich autologous plasma - for nutrition and repair of cartilage tissue;
• Corticosteroids – Reduce inflammation.

Surgical methods for treating knee joint disease

If conservative treatments don't work, or if you first seek help from a stage III knee specialist, your doctor may perform surgical intervention:

• Arthrodesis – Artificial immobilization of affected joints in physiological positions to eliminate pain;
• Arthroscopic debridement – the use of an arthroscope to clean the joint;
• Corrective osteotomy – the elimination of skeletal deformities through artificial fractures;
• Endoprosthesis – Replacing a worn joint with an artificial implant made from biocompatible materials.

The type of surgery is selected by the doctor based on the characteristics of the knee arthropathy. But endoprosthesis is considered the gold standard because it allows you to fully return to your normal lifestyle. At the same time, good implants do not need to be replaced for 15-30 years. Full recovery after surgery requires a 3-4 month rehabilitation process.

complication

Knee arthritis develops rather slowly, but it can be detected in time and the necessary treatment can be initiated. Ignoring this disease and its symptoms can have serious consequences:

• Persistent pain that cannot be relieved by medication;
• Affected joints are completely immobile;
• Unable to rely on injured limb;
• The leg joints are severely deformed and bent;
• Damage to other parts of the musculoskeletal system;
• The legs are shortened.

In particularly difficult cases, if not treated promptly, arthropathy can lead to disability and worsening of motor activity, or even immobility.It is important to remember that joint disease cannot be completely cured. But it is possible to halt the progression of the disease and improve quality of life.

prevention

There is no preventive treatment for knee joint disease. But people at risk are advised to follow certain rules:

• Make sure your weight is within age limits;
• Don’t engage in sports that put excessive pressure on your knee joints;
• If possible, cure infectious diseases completely without causing complications;
• Don’t become too cold or overtired;
• Avoid joint injuries and overload;
• avoid stressful situations;
• Don’t forget to take breaks;
• Perform exercise therapy;
• Wear orthopedic shoes.

High-risk groups include the elderly, athletes and dancers. You can also add here those who lead a sedentary lifestyle, stand or lift a lot at work, and are overweight.Any changes in the normal biomechanics of the lower limb axis or joints, dysplasia, loss of size and strength of the leg muscles, or trauma may also lead to arthropathy.Check regularly and take preventive measures.

FAQ

1. What is the difference between knee arthritis and knee arthrosis?Arthritis is a general term for joint inflammation, and arthrosis is a degenerative dystrophic process.
2. Which doctor treats joint disease?Traumatologist - Orthopedic surgeon or rheumatologist.
3. Can I still participate in sports if I have arthritis in my knees?The joints should be protected from prolonged heavy loads and axial impacts. But you shouldn't completely cut exercise out of your life - your joints are better "nourished" and restored when you move. It is important to observe the measurements and follow the recommendations of your doctor, who will choose the type and mode of exercise.