Any type of joint disease will have degenerative and dystrophic processes in the joint tissues. This disease is always chronic in nature and cannot be completely cured, but can only slow down or prevent its progression.
According to ICD-10, knee arthropathy (knee joint injury) belongs to the group under the code "M17". The focus of treatment is drug therapy, and surgical intervention is only performed when the course of the disease progresses.
What happens to the knee joint with arthropathy?
Arthropathy of the knee joint is accompanied by degenerative and dystrophic processes, and if left untreated, these processes will progress steadily. In this case, except for very few cases, no inflammatory process was observed.
At first, joint degeneration and malnutrition had little effect on the function of the knee joint. Over time, these processes will lead to the destruction of the joint structure, it stops "sliding" and its surface appears bumpy (due to deformation changes).
Reduced blood circulation and deterioration of local metabolism (metabolic processes) will only increase the rate of disease progression. The degeneration process of hyaline cartilage starts very quickly. It thins, delaminates, and then cracks appear on it.
The end result of the disease is the complete destruction (destruction) of hyaline cartilage and exposing adjacent bones. But the problem did not end there: due to the exposure of the bones, the latter began to thicken and skeletal growth (usually in the form of spines) appeared on it.
All of this will also cause the affected limb to deform and then bend. It is for this reason that this disease is also called "proteoarthropathy". Because the limbs already have deformities, the disease cannot be cured without surgery.
Causes of disease development
In most cases, the development of knee joint disease precedes the appearance of several predisposing factors. There is no need to have innate risk factors at all. The disease usually develops with acquired factors (trauma, infection, inflammation).
main reason:
- Severe disorders of metabolism/metabolic processes in the body (any acute or chronic serious disease of the thyroid and adrenal glands).
- The presence of circulatory disturbances and capillary bleeding tendencies (due to their fragility).
- Overweight (obesity stage II-III), the load of the entire musculoskeletal system is severely increased.
- Knee joint injuries (including direct injuries, penetrating injuries, ligament ruptures, meniscal injuries, fractures, dislocations and subluxations, cracks).
- Recently suffered from inflammatory diseases (mainly arthritis or rheumatism).
- Excessive physical activity (risk groups include athletes, gymnasts, people who play tennis, football, and basketball).
- Consequences of long-term improperly treated knee injuries.
- Congenital defects and abnormal joint tissue structure, genetic risk factors (gene mutations).
There is a direct link between the cause and the severity of joint disease. If metabolic disorders or severe damage are the cause, the prognosis is worse than if joint disease occurs in the context of joint overload or age-related dystrophic changes.
Incidence statistics
Statistically speaking, arthropathy of the knee joint is very common; it is one of the predominant forms of arthropathy. Approximately 20% of patients who apply to specialized medical institutions suffer from knee joint disease.
If we consider all diseases of the knee joint, the proportion of arthropathy is about 53%. Recently, the number of cases of knee joint disease in the population has increased, especially in developed countries.
This is related to an increase in average life expectancy (the older a person is, the greater the risk of this form of joint disease), and the predominance of a sedentary lifestyle. This is indeed a problem, because doctors still cannot completely cure knee joint disease.
Why is knee joint disease dangerous?
The main risk of knee joint disease is disability due to the development of complications that cannot be treated conservatively. First of all, this is the deformation of the joints and bones of the affected limb. In the third stage of the disease, disability is possible.
The second danger is the development of chronic severe pain, which can make the patient so disturbed that they cannot fall asleep normally. Constantly waking up due to knee pain is one of the most common knee problems in stage 3-4.
There will be no fatal consequences due to knee joint disease. In theory, a sudden joint jam may cause serious injury. This is the so-called joint block symptom and is most commonly observed in the 3-4 stages of the disease.
The degree of knee joint disease and the difference between them
The disease is divided into four stages, which vary according to the severity of the course, the severity and number of symptoms, and the final prognosis. In addition, each stage of arthropathy is treated in a special way (although the difference in treatment options may seem small to non-doctors).
Degree of arthritis:
- Level 1: The disease actually has no manifestations, and may only have mild discomfort, but overall the patient feels well, so it is very difficult to diagnose the disease in the first stage;
- Level 2: Severe pain, especially after walking or standing for a long time; characteristic tightening during physical activity, the process of quadriceps atrophy may have begun;
- Third degree: The pain is unbearable, constantly plagues the patient, the joint has obvious deformation changes, it feels hot to the touch, and it is unable to walk or even run normally;
- Fourth degree: severely deformed joints, persistent pain, even unable to fall asleep, very difficult; joint dysfunction is so obvious that there may be ankylosis (the affected joint is completely fixed).
The first two degrees of knee joint disease are considered conditional favorable conditions because they do not actually interfere with a person's normal life. The last two stages are very serious and can lead to disability.
Symptoms of arthritis in different stages
The clinical manifestations of knee joint disease depend on the stage of the disease. In the first stage, there may be no symptoms, and in the fourth stage, they are very obvious and will not stop disturbing the patient even under strong medication.
First stage symptoms:
- Slight discomfort or pain, severe pressure on the joints.
- There is almost no obvious tightening.
- Subtle increase in joint size.
Stage 2 symptoms:
- Pain of moderate intensity usually occurs with a period of deterioration and relief;
- The joints feel warm to the touch;
- The skin on the affected joints may become red;
- Moderate knee dysfunction (walking and running are still possible, but there are some difficulties);
- The pain worsens in the morning and after standing for a long time.
Stage 3 symptoms:
- Severe pain that plagues patients all day long, but during the worsening period (triggered by each patient's worsening), the pain will aggravate several times;
- Deformation changes can be seen on the knee, and its size increases;
- The affected joint becomes warm when palpated;
- Because the joints are partially fixed, they cannot move normally;
- It may be a bent calf.
Stage 4 symptoms:
- Pain becomes unbearable, do not let patients do daily tasks (including intellectual activities, because pain can impair cognitive function);
- Synovitis due to accumulation of fluid in the cartilage cavity of the knee joint;
- Now the deformation changes are clearly visible not only in the joints, but also in the entire limbs;
- Palpate the volatility of the patella and surrounding tissues;
- The knee joint is almost completely fixed (in this case, only surgery can help restore the function of the limb).
If the pain cannot be eliminated or significantly reduced in the 3-4 stages of arthropathy, the doctor will turn to analgesic blockers, but they cannot block them every day.
diagnosis
The focus of the diagnosis of knee joint disease is imaging technology, and laboratory tests usually have nothing.
Diagnostic methods used:
- The orthopedic surgeon will examine the affected joints, linear measurements of bones, and blood vessel measurements.
- Clinical blood tests (total erythrocyte sedimentation rate and erythrocyte sedimentation rate / ESR) determine the level of fibrinogen in blood and urine, especially urea, and other biochemical parameters.
- Radiography (narrowing of the joint space, deformity, cartilage sclerosis, salt accumulation and even osteophytes).
- Ultrasound examination (only for differential diagnosis).
- Magnetic resonance imaging or computed tomography (the most informative in terms of imaging and diagnostic methods).
Usually, X-rays are sufficient to make a diagnosis, especially if the disease is at an advanced stage. In relatively rare cases, a computer or magnetic resonance imaging is required.
Treatment of knee joint disease: methods
The treatment of knee joint disease is very complicated, because there is no single treatment method isolated from other treatment methods (or even drugs), and the effect is very good. The treatment time is very long, can last for several years, and sometimes it will even be used for the rest of your life.
Treatment methods used:
- Drug therapy-the basis of treatment;
- Physical therapy exercises;
- Diet therapy
- Physiotherapy;
- operation treatment.
The main content of arthropathy treatment is the systematic nature of the process and absolute compliance with the recommendations of the attending physician. Attempts to treat knee joint disease independently, including ignoring a doctor’s prescription, usually end in disability.
Exercise therapy
Physical therapy exercises are most suitable for treating 1-2 stages of knee joint arthropathy. At this stage, this is almost the main treatment method, because sports can slow the progression of the disease and eliminate most of the symptoms.
However, classical sports has no special meaning, and it can also be harmful. Therefore, perform special exercises for the patient and do it separately (because knee joint disease may progress differently in individual patients).
There is no time frame for kinesitherapy treatment-ideally, you need to engage in the prescribed exercise for life, and see a doctor from time to time to monitor the joints dynamically. Combining exercise therapy with exercise in the swimming pool is very useful (where the joint load is much less).
diet
Although nutritional correction is very useful, it is not a mandatory treatment. Only in 40% of cases, diet therapy can produce significant results, and it usually achieves significant results in those who have joint disease attacks due to endocrine diseases.
Instruct patients to abstain from greasy, fried, salty, and smoked foods. The use of alcoholic beverages is prohibited, and smoking is sometimes prohibited. At the same time, it is stipulated that a large amount of vegetables, fruits and meat products are consumed.
In this case, sausages, sausages or Vienna sausages cannot be called meat products. Instruct patients to eat lean meat, boiled chicken is particularly useful (due to relatively low calorie content and high protein content).
physiotherapy
Physical therapy procedures are only useful in relieving the symptoms of joint disease, but do not directly affect the disease. In other words, no matter what some "experts" say, with the help of physical therapy, even the first stage of joint disease cannot be cured.
Physical therapy can help relieve pain, but only if it is gentle. For severe pain (arthropathy stages 3-4), physical therapy and most medications (especially oral medications) are of no avail.
The most preferred treatments for arthropathy are magnetic therapy, quantum therapy, mud therapy, acupuncture and leech therapy (leech therapy). Due to the threat of additional joint damage, shock physical therapy techniques are banned.
Operation
When conservative methods are no longer needed, surgical intervention is only needed in the 3-4 stages of the disease. Different types of surgery can be used: joint cavity drainage, osteophyte removal, joint replacement (prosthesis).
In order to restore the function of the joint, it is best to transplant, but the problem is that this is a very expensive process. Therefore, only 10-15% of patients can afford such surgery. But even with the necessary funds, it is not always possible to replace the connector.
The fact is that this type of surgery is not suitable for severely ill patients or patients over 65-70 years of age. Remember that any knee surgery has its own risk of complications (even fatal complications are possible, but they are very rare).
drug
Together with physical therapy exercises, it is the foundation and mandatory part of therapy. If other operations cannot be used, then the combination of medication and exercise therapy is indispensable (traditional medicine cannot replace medication).
Give the patient analgesics (severe pain-blockers), decongestants, muscle relaxants, and antihistamines. It is possible to prescribe chondroprotective agents frequently and to inject hyaluronic acid (instead of the physiological lubrication of the joints).
Medications can only really affect the disease in the 1-2 stages of joint disease. In the 3-4 stages of the disease, drug treatment only plays a role in treating symptoms, and only surgery can affect the disease.
The nuances of treatment during acute exacerbation and remission
The treatment of knee joint disease during the period of deterioration and remission is somewhat different. In the worsening stage, active treatment is used to restore joint function and eliminate symptoms as soon as possible.
The pain reaches its peak just in the worsening stage of the disease, so in this case, drug blockers can be prescribed.
Non-steroidal anti-inflammatory drugs can be prescribed. Although arthropathy usually progresses without inflammation, it may occur in the acute phase. The patient was ordered to rest in bed, exert minimal pressure on the affected joints and avoid overheating of the limbs.
In contrast, during the relief phase, physical exercise is prescribed, and increased physical exercise is usually prescribed. The reason is that you can walk normally in the remission period, because the joint function improves, and the pain is usually of moderate intensity.
It is necessary to use relief skillfully-this is the period of class in the swimming pool, class with a rehabilitation therapist and trying to restore joint function. You can't live without medicine at this stage.
In most cases, chondroprotectants and oral pain relievers are prescribed (at the patient's discretion, because if the pain is barely noticeable, there is no need to take it). Ointments, gels and creams can be prescribed, including ointments with a warming effect (it is best not to use them during periods of deterioration).
In addition, massage can be prescribed, including manual therapy (only when the disease is in stage 1-2). Special gymnastics techniques can be used with the permission of the doctor.
The remission period is the ideal time for physical therapy, but the choice of specific physical therapy should be handled by the doctor, not the patient. Finally, if necessary, during the remission period, a hyaluronic acid preparation can be injected.
As arthropathy worsens, no prescription for hyaluronic acid is prescribed, because in the context of inflammation, such injections can cause serious consequences. Please note: injections can only be performed by appropriately qualified personnel.
Ordinary doctors, especially mid-level medical staff (nursing staff, nurses), are not allowed to perform such injections. Self-injection into the joint will not only cause disability, but also death (an anaphylactic shock or blood clot can result if the needle accidentally enters the blood vessel).
Treatment prognosis
The prognosis of treating knee joint disease varies according to the stage of the disease and the general health of the patient. If this is stage 1-2 and treatment is started immediately, the prognosis is very good, especially in people of working age.
For stage 3-4 arthropathy, the prognosis is extremely poor for both young and elderly patients. Although it has been noted that young people are more likely to tolerate joint disease at these stages, but it still inevitably leads to disability.
However, suffering from arthropathy stages 3-4 is not the same as a sentence. In fact, with the help of surgical intervention, you can try to restore, if not all knee function, then most. The implantation of artificial joints can produce excellent results.
Prevent knee joint arthropathy
Arthropathy is a group of diseases that can be completely prevented by taking fairly simple preventive measures. Of course, such measures do not guarantee 100% protection, but they can reduce the risk of disease (especially for people at risk).
Precaution:
- It is necessary to avoid unnecessary stress on the joints (such loads include occupational sports).
- Reasonable nutrition, mainly fruits and vegetables in the daily diet.
- Maintain a good body shape and do gymnastics regularly.
- Prevent or eliminate obesity (more weight-more pressure on body joints).
- Use chondroprotective agents for preventive treatment after reaching 45 years of age (only after consulting a doctor).
- Adequate daily fluid intake (approximately 1. 5 liters of water per day), and minimize salt intake.
The most important thing is not to over-exercise, because it is only useful in moderation (if the musculoskeletal system is not worn). Sports are useful, sports are not, especially for the joints and cardiovascular system.