Osteoarthritis of the knee joint: what it is, stages, symptoms and myths about treatment

Osteoarthritis of the knee joint is a complex disease of a degenerative-dystrophic nature that affects the osteochondral part of the knee.The disease most often affects the knee region of the lower extremities.Pathological changes in cartilage and periarticular zones, which in most cases develop against the background of injuries, biological aging of the body and autoimmune disorders, seriously inhibit the musculoskeletal potential of the legs.The joint becomes stiff, loses its stability, its normal motor skills and its shock absorption capabilities.As a result, it gradually deforms, and in the final stages it completely fails.

Degeneration of joint tissues manifests itself not only in the form of physical dysfunction of the lower limbs, but also in severe pain.In severe cases, the pathology leads to disability and, in some cases, paralysis of the legs.Due to such a disappointing prognosis, it is important to identify the disease as early as possible and begin its treatment immediately.

Important information about the disease

Before studying treatment tactics, it is important for patients to familiarize themselves with the material below in order to have complete information about the mechanism of origin and clinical manifestations of pathology.Let us note right away that osteoarthritis and arthritis are closely related, since the disease in question is a consequence of an arthritic disease.But where do the unfortunate diseases that mercilessly destroy the most important bone connection come from?How serious is knee osteoarthritis and by what manifestations can it be recognized?

Causes of osteoarthritis

Degenerative-dystrophic pathogenesis is “triggered” by the following provoking factors:

• previous injuries - shin fractures, knee dislocations, damage to the body of the meniscus, tears and ruptures of ligaments, falls at the knees, all kinds of bruises;
• excessive physical activity;
• sedentary lifestyle;
• high body mass index;
• systemic pathologies such as rheumatoid, gouty, psoriatic, systemic lupus erythematosus;
• genetically hereditary weakness of the ligamento-muscular system or congenital underdevelopment of the structural elements of the joint;
• disorders of metabolism and blood circulation;
• hormonal imbalance, diabetes mellitus and other endocrine pathologies;
• past or chronic infectious and inflammatory diseases.

Very often, people themselves become responsible for the development of incurable joint diseases.Often, after suffering an injury, they ignore contacting a specialist, preferring to make do with the first available painkillers, homemade lotions, etc.And a few years later, due to inadequate treatment carried out in the past, they already come to see a doctor with gonarthrosis, at best - of moderate severity.And here, simple physical prophylaxis and analgesic ointments, as at the very beginning, will not be enough;it is often necessary to act radically, using surgical tactics.

Destruction stages

In orthopedics, this disease is divided into stages, which the specialist then proceeds to when developing a treatment regimen.The degree, nature, localization and nature of the origin of the destruction of the bony knee joint are identified through a number of diagnostic measures, such as x-ray, MRI, CT, ultrasound and various types of blood and urine tests of the patient.

There can be no question of quality treatment without detailed information about the condition of the knee joint and the characteristics of the patient's body, as well as without a visit to the doctor and receiving adequate treatment recommendations from him.Therefore, if you want to improve your quality of life, do not ignore the visit of an experienced specialist;only he can tell you whether you can cope with qualified conservative help or whether only surgical intervention will be effective in solving your problem.

The pathology has several stages of development;according to Kellgren's classification, there are only four.All characterize the severity of morphological changes (presence of osteophytes, reduction in the volume of articular cartilage and its degree of thinning, narrowing of the joint space, etc.) and clinical signs (limited flexion/extension, indicator of loading, nature and intensity of pain, etc.). 

• First stage osteoarthritis It is a disease that is only in its infancy.External symptoms are mild or absent, congruence and shape of the joint are satisfactory.X-rays or MRI photos show small marginal osteophytes along the edges of the joint surfaces, in the subarticular region there is subtle subchondral osteosclerosis and small bone cysts.The joint space is usually normal or altered, but not significantly.
• In case of illness second degree, in addition to the indicators above, the osteosclerotic focus is more pronounced and the narrowing of the interarticular space is clearly visible.The patient begins to experience stronger and more frequent pain when walking, going up/down stairs, standing for a long time, sometimes at night.Lameness develops, joint movements become inferior, especially in flexion.
• Third step characterized by a strong progression of degeneration and irreversible deformation.The configuration of the joint is noticeably deformed, the distance between the articular surfaces is significantly reduced, and the bony outgrowths in the form of spikes are increased in size.The pain becomes prolonged and pronounced, it disturbs the person even at rest, and the lameness worsens.A dependence on support devices and outside help arises. 
• Step fourdegenerative-dystrophic pathogenesis, in the presence of bulky osteophyte growths, the hyaline cartilage is completely destroyed, the joint space disappears or is barely visible, the epiphyses of the articular bones that form the joint are strongly deformed.The knee joint is recognized as a completely non-viable organ of the musculoskeletal system and the person becomes incapacitated. 

Symptoms and complaints

The severity of clinical manifestations depends not only on pathomorphological features, but also on the individual factor.In any case, there is not much pleasant about knee osteoarthritis;it is very difficult to bear both in the 2nd and 3-4th stages.The general list of symptoms includes:

• pain syndrome, mainly mechanical type (dull, painful, acute, sudden, periodic and constant);
• the appearance of a crunch when moving;
• joint stiffness;
• limitation of range of movements;
• muscle weakness of the limb;
• hyperthermia of the skin and swelling of the knee area;
• changes in gait, manifested by lame and wobbly legs;
• instability or drawer syndrome;
• “jamming” of the knee, which occurs when movement of the bone joint is suddenly blocked.

Important! Conservative treatment of osteoarthritis of the knee joint will not help if the disease has a complicated course, which in the worst case can already occur at the second stage of development of osteochondral degenerations.Unlike traditional conservative therapy and alternative methods, without exception, surgery for severe gonarthrosis of 2-3-4 degrees is the only way that, for a long period of life, helps to significantly improve the quality of life.

Conservative treatment

Non-surgical treatment methods are appropriate in the initial phase of deforming osteoarthritis.The principle of non-surgical treatment involves:

• systematic implementation of exercise therapy developed by a professional on an individual basis;
• carry out physiotherapy procedures;
• the use of painkillers in the form of ointments, tablets, injections, etc.;
• proper nutrition and compliance with a special diet prescribed by a doctor;
• compliance with a special regime of daily physical activity;
• complete cessation of bad habits;
• unconditional passage of a repeated diagnostic check;
• annual visit to a specialized sanatorium-resort medical institution.

Surgery for osteoarthritis of the knee joint

Now let's get acquainted with surgical methods, which are often necessary, because at an early stage the pathology often goes unnoticed.Basically, we are dealing with osteoarthritis in full bloom, which has largely affected the joint structures and periarticular matter.

• Endoprostheses – helps in more than 95% of cases to restore as completely as possible the lost locomotor and support functions of the knee of the lower limb.The operation is not easy, followed by difficult rehabilitation, but the effect is worth it.Approximately 3 months after the installation of an artificial analogue in place of the native joint, which has undergone irreversible pathological changes, the full range of movements of the leg returns and the pain syndrome is completely eliminated.
• Arthrodesis – an uncommon procedure for “closing” the joint, due to its aggressive effect on biological structures, but which sometimes also takes place, for example if a person is not able to undergo implantation.Its essence lies in the elimination of articular surfaces and the fixed connection of the articulated bones with each other using special fixation devices in an advantageous position.Over time, a natural merging of the listed elements occurs.Artificial ankylosis completely blocks the mobility of the joint, but allows for good load-bearing capacity of the limb and reduces pain.
• Knee osteotomy – is also used in extreme situations, in the same way as arthrodesis, particularly when it is necessary to delay the installation of endoprostheses for several years.During the surgical session, the specialist performs an artificial fracture, filing the bones and placing them at a more correct angle in order to advantageously distribute the load on the cartilaginous elements.  

Irreversible pathogenesis cannot be corrected by physical exercise, you need to understand this.Ointments and even drugs from the chondroprotector series, not to mention grandmother's advice to be treated with gelatin, will also not play a special role.The maximum that they can do to help in an advanced state is to prepare the musculoskeletal system for the upcoming operation.

Modern knee implants can withstand normal daily stress and function perfectly for at least 15 years, and often 20 to 25 years.A person can even play certain sports with a replaced joint.

Stage 3 treatment

At stage 3 of osteoarthritis, surgical intervention is performed.The changes at the joint level are very pronounced;At this stage, the disease significantly reduces the patient's standard of living and performance.Osteochondral lesions have reached a critical point at which the bone junction tissues no longer represent any functional significance.The hyaline cover is almost completely destroyed. 

• Important cartilage does not repair itself, including by non-surgical methods.
• The exposed, flattened surfaces of the interacting bone ends exert abnormal pressure on each other, constantly rubbing against each other, severely injuring neighboring soft tissues, and becoming even more deformed each day.
• The person feels terrible pain, not to mention the loss of the ability to walk normally.Patients experience daily torment, when sleep is not a joy, and during the day there is no rest from pain.Only a few people report a relatively tolerable condition.
• As a rule, anti-inflammatory pain relievers have a mild effect, but more often they do not “work”.It makes no sense to use chondroprotectors, because strengthening and nourishing the rare remains of cartilage does not save the situation.

Sometimes they try to treat the consequences of grade 2-3 osteoarthritis with minimally invasive surgery (arthroscopy), during which marginal osteophytes can be removed, as well as torn osteochondral fragments from the joint cavity.Such manipulations, as the reviews testify, somewhat alleviate the patient's condition and slightly improve motor function, but temporarily.Osteoarthritis of the knee joint remains active and will manifest itself again in the near future. 

Pathogenesis of 3-4 degrees is a very serious problem that can only be solved with much more complex reconstructive and plastic surgical tactics.To date, there is no procedure comparable to stents.Replacing the knee joint with a prosthesis that fully reproduces the mechanical characteristics, configuration of shapes and sizes of a natural organ will allow you to say goodbye to both the unfortunate pathology and the disability that it “assigned” to you.

The disease progresses quickly and can progress from moderate to medium phase to stage 4 within a few months.Surgical intervention should be carried out as early as possible, before degenerative processes penetrate deep into the bone.Severely damaged bones can make it difficult to place a stent.

Many, not fully realizing that the severity of the degenerations that have occurred are incomparable with conservative and unconventional tactics, try by all means to circumvent the operation, swallowing pills in handfuls, applying ointments to the painful area.Someone turns to osteopaths, private doctors who practice all kinds of alternative techniques.Unfortunately, you cannot go against nature, healing will not come after it and you must accept this fact.Therefore, reject foolish ideas and act with caution.

Your fitness is entirely up to you!You may continue to suffer from stiffness and pain throughout your life, unsuccessfully testing "empty" treatment methods: non-standard medications and remedies that have no evidence of effectiveness for the severity of your condition.Or you can undergo surgical treatment and begin living a full life, free from past suffering and support systems.

There is no need to worry about surgery;modern technologies have made great progress and today knee joints are brilliantly replaced abroad with durable implants.After such implantation, carried out in a good clinic, the risk of complications is minimal (1-2%) and restoration of mobility functions occurs in more than 95% of cases.After the arthroplasty, a 3-4 month rehabilitation course will follow, including:

• physical recovery through special therapeutic exercises;
• take medications (antibiotics, antithrombotics, etc.);
• a physiotherapy program including myostimulant, anti-inflammatory, analgesic and healing procedures;
• massage sessions (in the later stages of rehabilitation).

Good to know! At stage 1, the disease can be stopped and prevented conservatively.If you do nothing and trigger osteoarthritis of the knee, allowing it to move from stage 1 to stage 2, drug treatment will be much more problematic, but for a certain category of patients, a non-surgical approach remains appropriate.The last two steps are always an operation.

2 degree treatment

With moderate severity of knee osteoarthritis, quality of life is already significantly impaired.A painful knee worries more, the pain syndrome manifests itself more often and more intensely than it was at the beginning of the disease.The pain is especially pronounced immediately after waking up in the morning, when going up and down the stairs.There is often an unpleasant feeling of numbness that appears after prolonged walking or standing in one position for a long time.Flexion at the knee is reduced, the patient is not able to bend the leg, as required by physiology.A person begins to spare his limb, almost trying not to step on it, which is why progressive muscle atrophy occurs.

We emphasize that treatment necessarily involves a qualified and comprehensive approach.

• If the doctor does not see an urgent need for surgical intervention, the priority is to reduce the load on the problem area.If you are overweight, in order to provide good relief to the joint affected by osteoarthritis, it is imperative to adjust your weight by following the diet that your doctor recommends.
• All patients are prescribed the use of special orthopedic devices when traveling.This, depending on the existing problem, may include knee pads, compression garments, elastic bandages, a cane, crutches or a walker.
• Additionally, the orthopedic traumatologist will prescribe a unique set of exercises that will help strengthen and increase the endurance of the muscles of the affected limb.
• In addition, osteoarthritis in its moderate to moderate manifestations involves the use of drugs containing substances present in the cartilaginous tissues of the knee.These include formulations based on chondroitin sulfate, hyaluronic acid injections and preparations based on glucosamine.They cannot restore cartilage, but saturate it with nutritional components in order to achieve remission of the disease.
• Physiotherapy procedures are also recommended, but they are used only after all signs of inflammation have disappeared.Physical sessions, for example laser, magnet or ultrasound, must take place within the medical facility.Thanks to physiotherapy, the nutrition and metabolism of bone, muscle and cartilage tissues improve.If you purchased a vibroacoustic device for home use, first find out from a specialist about the possibility of using it for your diagnosis and the operating characteristics of the device.

We have reviewed the basic principles on which the official treatment of osteoarthritis is based, meeting the standards of orthopedics.Since many people suffering from stage 2 osteoarthritis are very interested in alternative methods, seeking their salvation in them, we suggest you familiarize yourself with the most popular of them.And let's find out if they are as unique as they are presented to us on the Internet.

Stem cells for knee treatment

We will talk about the autotransplantation of mesinchemic stem cells in a patient with gonarthrosis of the knee, taken from the pelvic crest or femur.Cell therapy, according to interested sources, will make it possible to achieve quasi-self-renewal of the entire joint by activating regenerative self-healing processes in the damaged segment.Thanks to this technology, it is theoretically possible to improve the constituent units of the osteochondral organ.However, in practice, there is not yet a single “living” x-ray evidence that would confirm that after the introduction of stem cells into the affected area, the joint became healthy.

The positive effect of stem cells on joints and bones has not been proven and is very doubtful, since this technique is not yet recognized in orthopedics.Scientists just study and experiment with it.In addition, there is information regarding the dangerous effect of stem cells on the human body, which, according to highly competent specialists, can cause cancer.What about people who paid for the procedure and were happy with the result?Here we can only say one thing: many patients will believe in eternal life for this kind of money, but the placebo effect does not last long, don't forget that either.

Sludge treatment

Therapeutic mud sources containing unique components (magnesium, chromium, iodine, bromine, calcium nitrate, etc.) help reduce painful symptoms, increase blood flow to diseased areas and stimulate metabolism.They are particularly useful for people with a mild stage of the disease or patients who have already undergone leg surgery.It is also allowed to carry out mud therapy at level 2 if the doctor believes that a natural remedy in combination with the main treatment program will reduce the aggressiveness of pathological phenomena (stop progression) and improve the overall clinical picture.Mud therapy is practiced in special health resort-type medical institutions.Natural healing muds based on peloids are used in the form of applications and in combination with the galvanization method (electrophoresis).

Uses of gelatin

Natural gelatin is a safe product that helps maintain joint structures in good condition.It is recommended to consume the gelatinous substrate, diluted in water, internally.According to reviews of some doctors, gelatin will have a faster and more productive effect on bone, cartilaginous and musculo-ligament elements.Experts emphasize that this method does not have medicinal properties, it only helps prevent osteoarthritis.Therefore, in the case of already established pathogenesis, gelatin treatment in the absence of pathology or in the early stages can be considered only as a measure aimed at preventing the appearance or progression of degenerative-dystrophic changes.When the disease is moderate or severe, this approach will not work for preventative purposes.

Ayurveda for joints

Modern alternative medicine is known for many extraordinary trends, including Ayurvedic treatment of various parts of the musculoskeletal system.According to this unofficial theory, joint damage is associated with excess toxins accumulated in the body due to energetic disharmony.The damaging mechanism of energy imbalance (Vata) is above all the weakening of Agni, or digestive fire, which leads to the accumulation of undigested food residues (Ama) in the intestines.They secrete toxins that the blood carries to the joint, where harmful substances are deposited and inhibit metabolic processes.

According to Ayurveda, osteoarthritis is classified into several types, and each type has its own treatment system, the basis of each of them is diet, herbal medicine, taking Ayurvedic tablets and powders, yoga and breathing exercises, unconventional massage, self-training for healing, etc.Of course, all this sounds tempting, but if osteoarthritis cannot be reversed even through high scientific technologies, how can you believe that herbal willpower powders, thought therapy and other Ayurvedic tactics cure irreversible deformities?!

Salt compresses

Salt is used to prepare a saturated saline solution, which is used to impregnate compresses applied to the sore spot for several hours.Such therapy should not be considered as an independent remedy, much less as a panacea for knee osteoarthritis.Salt can temporarily soothe pain, relieve swelling of the soft tissues covering the bone structure, without harming biological structures.But this will not cure the disease or put the patient back on his feet!Its effect is purely symptomatic.The solution is prepared at the rate of 100 g of salt per 1 liter of water at room temperature.

It's worth the detour! Sometimes salt is used in dry, heated form, placed in a bag, and local heating of the knee is carried out.Sometimes in the form of moist but warm dressings.Hot procedures are dangerous in case of purulent-inflammatory processes in the joint cavity;they will only worsen the clinical picture.Therefore, do not use such recipes without being sure that the lesion is not accompanied by a similar process.