Osteoarthritis of the knee joint grade 2 3 treatment. DOA of the knee joints: stages, symptoms and treatment

Hyaluronic acid preparations (sodium hyaluronate, Ostenil, Viscoplus, etc.), when introduced into the joint cavity, replace healthy synovial fluid, lubricate the articular surfaces and nourish the cartilage.

Consequences of the disease

If you start arthrosis and allow it to develop to stage 3, then the disease can progress to the final, stage 4, when the bone is exposed, the cartilage has completely disappeared, and the joint is severely deformed. All these factors lead to the fact that in grade 4 arthrosis causes complete immobilization of the knee joint, which can only be corrected with prosthetics.

In the vast majority of cases, with grade 4 osteoarthritis of the knee, the patient becomes disabled with completely lost functions of the knee joint.

If a patient allows gonoarthrosis to develop to grade 3 or even 4, this only speaks of inattention and neglect of one’s own health, since modern medicine allows one to diagnose and treat arthrosis of the knee, starting from the earliest stages.

If you neglect morning stiffness, swelling and mild aching pain, you may one day notice bowed legs, lameness and a changed gait.

Therefore, it is very important to treat osteoarthritis on time, and not to use ointments available in any pharmacy for the treatment of joints, but by contacting a competent doctor. Moreover, today medicine has a wide range of methods and means for the treatment of gonoarthrosis.

If you do not progress knee arthrosis to grade 3 or 4, there is a good chance of curing the disease completely.

Prevention of arthrosis

Preventing the occurrence of arthrosis of the knee joint is not difficult if you think about it from a young age. How are prevention rules formed? Very simple.

Read the causes of the disease and do everything to avoid them, namely:

• Do not overeat, adhere to a gentle diet and the principles of proper nutrition
• We distribute physical activity wisely
• Don't get too cold
• Treat any diseases in a timely manner
• Avoid injury
• Do gymnastics
• Contact a specialist in a timely manner

During treatment of arthrosis, patients must follow a strict diet.

The diet should be rich in protein, which means it should include the following products:

1. poultry and rabbit meat;
2. fermented milk products and cheeses;
3. legumes;
4. nuts.

Products containing gelatin, such as jelly and jellied meat, have a good effect on sore joints. Jellied meat also contains a large amount of collagen. However, a contraindication to consuming large quantities of jellied meat is a predisposition to excess weight, because this dish is quite high in calories.

It is equally important to maintain a drinking regime. If kidney problems have not previously been identified, it is recommended to drink approximately 2 liters of water per day.

There are also foods that should not be consumed while suffering from arthrosis. These include:

• sweet carbonated drinks;
• spicy dishes, especially with flavor enhancers;
• fat;
• semi-finished products;
• cabbage;
• tomatoes;
• Bell pepper;
• grape;
• bananas.

These are products that contribute to increased salt formation in the body. And therefore they can only make the situation worse
If a patient has grade 3 arthrosis in the ankle joint, the patient may be referred for a surgical procedure, including replacing the affected joint with a prosthesis.

Prosthetics are performed using plastic or metal prostheses. The operation is performed under endotrachial or epidural anesthesia. In rare cases, operations are performed in which partial joint replacement is performed. This is an effective way to restore the former mobility of the joint and return freedom of movement to the patient.

Arthrosis is a disease that is quite easy to diagnose on your own. There is no need to wait until sharp pain occurs in the joints and movement becomes problematic. At the first sign of difficulty in movement, you can start doing physical exercises. And by balancing the diet, patients can easily stop the pathological process.

The diagnosis of DOA is a common one, although, like many others, it has more than one name. Among those used is deforming osteoarthritis. The keyword in the name of the pathology directly speaks of deformation. In the case of DOA, the cartilage tissue of the articular surfaces is affected.

Another word in the name, “osteoarthrosis,” refers to the chronic nature of the joint disease. Moreover, the disease is progressive if nothing is done.

Statistics show the widespread nature of this form of joint damage. It is very important that, along with a deterioration in the quality of life, pathology leads to loss of ability to work and significant financial costs for treatment. For older people, the financial costs of treatment often become prohibitive.

The fact of gender division of pathology by age requires attention. Under the age of 50–55, men are more likely to get sick (in their prime working age!), but older people, the “primacy” goes to women. Hormonal changes leading to excess weight often lead to DOA of the knee joints - look closely on the streets and you will see many older women with a “duck” gait (waddle).

Deforming osteoarthritis is the most common pathology among joint diseases in clinical practice.

Important. The essence of the pathological process of DOA is the insufficiency of the compensatory ability of cartilage tissue, which leads to inflammatory and degenerative changes, and subsequently the development of osteophytes. At the last stage of development of the disease, persistent deformation of the diseased joints occurs with disruption of their function.

Among middle-aged and older people, deforming osteoarthritis is a common cause of disability and disability. The development of the disease reduces the quality of life due to constant acute pain and limited mobility.

Anatomy

Human joints are the active part of the musculoskeletal system, which allows movement.

Joint anatomy

Joints are parts of the body that connect the surfaces of bones with the possibility of their movement in one, two or three planes.

The articulation of the bones is covered by an articular capsule, which holds the bones in the desired position. The cavity of the joint capsule contains synovial fluid, which is necessary to minimize friction between the articular surfaces of the bones.

For reference. Bone joints are covered with hyaline cartilage, which allows sliding of the contacting surfaces of the cartilage.

Histology of cartilage tissue

One of the most important components of the joint is hyaline cartilage, which ensures the integrity of the epiphyses of the bones and smooth movement.

Important. The structural features of cartilage tissue include the absence of blood vessels and nerve endings. Nutrition of cartilage cells occurs through osmosis of nutrients.

Features also include a relatively low metabolism, a tendency to constant growth and a combination of strength with
elasticity.

Histologically, three zones are distinguished:

• Perichondrium. Consists of flattened, low-specialized chondrocytes. This is the only section of cartilage that has its own blood vessels and nerve endings. Thus, one of the tasks of this layer is the transport of nutrients. Due to the abundance of nerve endings during injury or degeneration of the perichondrium, a severe pain syndrome of increasing nature appears.
• Zone of young cartilage (or intermediate). Here are larger chondrocytes that are active as metabolites.
• Zone of mature cartilage (basal). This layer of cells ensures growth. Depending on the location, there is a non-calcifying layer and a calcifying layer directed towards the bone.

Molecular structure

Chondrocytes produce a number of substances that provide the characteristics of cartilage tissue: a combination of strength and elasticity.

For reference. The bulk of the tissue is a hydrated gel, which is formed by proteoglycans and glycoproteins. It contains collagen fibers, mostly type 2, less types 9,10,11.

Collagen is a polypeptide molecule that has a helical shape. It is collagen that provides the elasticity and strength of cartilage tissue.

Localization of the lesion

Deforming arthrosis affects the joints:

• Hands,
• Feet and metatarsals,
• Atlantovertebral joint,
• Hip (coxarthrosis),
• Knees,
• Ankle,
• Shoulder (oarthrosis).

One joint may be affected (monoarthrosis), two (oligoosteoarthrosis), three or more (polyarthrosis).

Etiology

Causes of the disease

The causes of deforming osteoarthritis can be divided into two groups:

• Primary. The development of the disease begins spontaneously without any apparent reason. Experts give preference to the genetically determined genesis of deforming arthrosis in this case.
• Secondary. These are the reasons against which deforming osteoarthritis develops as a secondary disease. These include post-traumatic arthrosis, which occurs as a result of injuries or congenital defects of the articular apparatus.

Risk factors

There are a number of factors that can increase the risk of deforming arthrosis. These include:

• Advanced age;
• Osteoporosis;
• Obesity;
• Hormonal disorders;
• Climax;
• Female;
• Metabolic changes;
• Impaired vascularization of cartilage tissue;
• Congenital and acquired pathologies of the musculoskeletal system;
• Surgical intervention;
• Genetic predisposition;
• Increased lysosomal activity;
• Chronic arthritis;
• Haemorrhoids;
• Arterial hypertension;
• Diabetes;
• Lack of microelements in the body;
• Toxic lesions;
• Hard physical labor;
• Professional sports with high loads.

Symptoms

The disease is chronic and symptoms develop slowly. The intensity of symptoms increases gradually over several years.

For reference. The main symptom is pain of varying intensity.

When collecting anamnesis, the most common complaints are:

• For joint pain, the intensity of which increases after physical activity. The pain can also be acute, which is caused by blocking of the joint by a free intra-articular inclusion. The intensity of pain increases towards the end of the day and subsides or is completely absent at rest.
• Crepitus (specific crunching sound).
• Change in joint shape due to the formation of osteophytes.
• Periodic inflammatory pathologies: sanovitis, tendovaginitis, arthritis.
• Limited mobility.

When diagnosing DOA, a specialist is based on the following clinical criteria:

• Pain syndrome that occurs at the end of the day/during exercise.
• Change in the normal shape of the joint.
• X-ray picture.
• Reducing joint space.
• Osteosclerosis.
• Osteophytosis.

Diagnosis of DOA of the knee joint

The most common form of DOA diagnosis is deforming osteoarthritis of the knee joint. The main provoking factors for the development of arthrosis of the knee joint are:

• old age,
• gender predisposition (occurs twice as often in women),
• heavy physical exertion or hard work,
• staying in one position for a long time,
• excess weight,
• diabetes,
• injuries.

Attention. If you do not consult a doctor in a timely manner, deforming osteoarthritis of the knee joint leads to the closure of the joint space and complete destruction of the articular cartilage.

In such a situation, the only solution would be prosthetics because Drug treatment for DOA of the knee joint will not be effective.

For drug treatment of DOA of the knee joint, non-steroidal anti-inflammatory, analgesic, hormonal, vitamin agents and chondroprotectors are used.

Pathogenesis of DOA development

The first stage in the development of deforming arthrosis is a violation of the water balance of cartilage tissue (hypohydration). Under the influence of etiological factors, rapid destruction of articular cartilage occurs.

Tissue metabolism is disrupted; due to lack of nutrition, the quaternary form of proteoglycans is deformed with their depolymerization. Also, some chondrocytes die, while others change in phenotype. Which subsequently leads to the synthesis of altered proteoglycans and collagen.

In the absence of shock-absorbing ability, articular cartilage under pressure (heavy physical activity) enters the compensation stage, during which the formation of marginal osteophytes is observed.

In this case, during the operation of the affected joint, a gradual fragmentation of the surface layer occurs, and then a slow destruction of the entire hyaline cartilage down to the underlying bone. During the destruction process, flattening or deformation of the articular surfaces occurs.

For reference. If there are fragments of damaged cartilage tissue in the cavity, the body fights them by phagocytosis of leukocytes. However, in the process of dissolving fragments of articular cartilage by leukocytes, a large number of lysosomal enzymes are released.

Because Since enzymes do not have strict specificity, surrounding tissues are subject to fermentation. This leads to chronic synovitis, arthritis, and tendovaginitis. The synovium and capsule, being in a state of constant inflammation, undergo fibrous degeneration.

Thus, today the immune dependence of the development of deforming arthrosis has been scientifically proven, which acts in many ways:

• increased production of T-helper cells (strengthen autoimmune reactions),
• synthesis of chondrospecific autoantigens (changes in proteoglycans),
• the formation of antibodies and immune complexes (damage cartilage cells).

Classification of deforming osteoarthritis

According to the severity of the pathological process, three degrees of DOA are distinguished.

DOA 1st degree

It is asymptomatic. At this stage of the disease, the patient still has no complaints. During this period, the pathological process is caused by hypohydration, impaired metabolism of cartilage tissue, a decrease in the population of chondrocytes, the synthesis of altered proteoglycans and collagen fibers, and the formation of an immune response.

Thus, the pathological process occurs only at the cellular and molecular level, and is extremely difficult to diagnose even with the use of radiography and computed tomography.

DOA 2 degrees

DOA grade 2 is characterized by processes occurring at the tissue level. Articular cartilage is destroyed due to loss of elasticity. As a compensatory action of the body, the formation of osteophytes begins. At this stage, symptoms appear: pain, joint deformation.

DOA 3 degrees

With deforming osteoarthritis of the 3rd degree, complete destruction of elastic tissues occurs, bone surfaces are subject to deformation, which leads to a change in the axis of the limbs.

Diagnosis of DOA – complications

Most problems arise due to a disregard for the symptoms of DOA.

We think that it will “resolve.” The bustle of life (often real) makes you brush aside the pain that has arisen. Indeed, at the initial stage, when it is realistic to cope with the emerging pathology, most people think that they simply pulled a muscle.

With untimely treatment and long-term progression of deforming osteoarthritis, the following may develop:

• secondary synovitis,
• spontaneous hemarthrosis,
• ankylosis,
• osteonecrosis.

Attention. In the case of development of deforming osteoarthritis of the knee joint, the pathology may be complicated by external subluxation of the talus.

Diagnostics

Diagnosis of deforming arthrosis begins with a consultation with a rheumatologist, as well as with a clinical examination of the degree of functional ability of the joints, which is assessed according to characteristic clinical criteria. The basis for diagnosis is x-ray examination.

The X-ray image determines:

• the presence or absence of narrowing of the joint space,
• the presence and degree of formation of osteophytes,
• expansion and unevenness of the border plates,
• Usuration (erosion) of the articular surface,
• the presence of cysts,
• disproportion of articulation of articular surfaces of bones,
• the presence of intra-articular bodies,
• deformations of the epiphyses.

Important. For a more specific study, ultrasound, CT, and MRI are additionally used. In rare cases, puncture and arthroscopy are justified.

Differential diagnosis

For the average patient, the principle of diagnosis does not matter. However, it is important to understand that differential diagnosis is necessary in those cases (and there are quite a few of them) when the symptoms of, for example, a dozen diseases are approximately similar, but the approach to treatment is different.

It is the differential diagnosis of the alleged diagnosis of DOA that must confirm or refute it. Because an initially incorrect diagnosis, in this case, will only prolong the time that the disease uses to further deteriorate the condition of the joints.

With the expected diagnosis of deforming osteoarthritis, differential diagnosis is carried out for a number of rheumatological diseases:

• spongyloidosis,
• intervertebral osteochondrosis,
• Bekhterev's disease.

They are differentiated by the presence of fever, acceleration of ROE and C-reactive protein, as well as a characteristic x-ray picture.

DOA differs from rheumatic arthritis in:

• absence of fever and heart damage,
• hypergammaglobulinemia,
• acceleration of ROE.

For gout:

• absence of gouty nodules,
• absence of hyperuricemia,
• urate deposition,
• effectiveness of colchicine use.

For reference. Infectious arthritis is excluded based on medical history, clinical and immunobacteriological evidence.

Treatment of DOA

Treatment of deforming arthrosis is long-term and complex. Therapy has several goals:

• elimination of the etiological factor,
• relief of symptoms,
• pain relief,
• restoration of joint function.

For reference. It is very important in the treatment of DOA to normalize the metabolism of cartilage tissue.

Load control is mandatory in the treatment of deforming arthrosis. Which, in turn, should be reduced to a certain minimum. If joint compression increases due to stress, this can lead to exacerbation of synovitis and arthritis.

Important. To reduce joint compression, you need to get rid of excess weight, which will also have a positive effect on your metabolism.

Drug therapy

When DOA is diagnosed, a number of chemotherapy drugs are prescribed. To relieve pain, nonsteroidal anti-inflammatory drugs (drugs containing salicylic acid, pyrazolone derivatives, indomethacin, etc.) and analgesics are prescribed. When using anti-inflammatory drugs, an analgesic effect is achieved by eliminating swelling.

For immune-related synovitis, immunocorrective drugs are used. Intra-articular administration of hydrocortisone has worked well.

Attention. The use of corticosteroid drugs is carried out carefully, only if the benefit from the drug is significantly higher than the possible side effects, which in turn are manifested by immunosuppression and an increase in the rate of degeneration of cartilage tissue.

If the diagnosis of DOA is supplemented by concomitant recurrent synovitis and tendovaginitis, then continuous use of aminocholine drugs is indicated. These may be the following medications:

• delagil,
• Plaquenil,
• chloroquine,
• hingamin.

For reference. Their mechanism of action is due to their weak immunosuppressive properties, which prevents autoimmune destruction of cartilage tissue. Stabilizes lysosomal membranes, which reduces the degree of damage by proteolytic enzymes.

The choice of drug is carried out only by a rheumatologist, taking into account individual characteristics, concomitant diseases, and level of immunity.

Because with deforming osteoarthritis, joint deformation and a change in the axis of the limb can occur, which leads to a redistribution of the load on the muscles. This phenomenon may be accompanied by muscle pain and spasms. To relieve muscle pain, muscle relaxants (for example, scutamil-C, mydocalm) are used in the treatment regimen.

Pathogenetic therapy

These treatment methods are aimed at stopping pathogenetic mechanisms. Pathogenetic therapy of DOA includes normalization of local and general metabolism.

For this purpose, chondroprotectors are prescribed. For example, Runalon, which stimulates the production of chondroitin sulfate by chondrocytes. In combination, to enhance the effect, biostimulants of various effects can be prescribed: aloe, peat and others.

Local pathogenetic therapy of joint arthrosis is carried out using a group of drugs, which include:

• arteparone,
• Trasylol,
• polyvinylpyrrolidone.

For reference. The use of intra-articular polyvinylpyrrolidone together with hyaluronic acid has a significant therapeutic effect. This combination of drugs acts as an intra-articular fluid.

Thanks to such injections, the friction of the articular surfaces is reduced, tissue degeneration is slowed down, the intensity of pain is significantly reduced, and the function of joint mobility is improved.

Complex therapy

Complex treatment methods are aimed at normalizing general metabolism and the immune system. This complex includes preparations of vitamins, microelements, ATP, and anabolic steroids.

Attention. In case of complications of deforming osteoarthritis with an infectious origin, antibiotics (of various groups depending on the sensitivity of microorganisms) are included in the treatment regimen.

Physiotherapy

Physiotherapy does not claim to be the main one, however, as a concomitant treatment, it occupies an important place and should not be ignored. For joint pathologies, the following procedures have proven themselves to be effective:

• Wrapping, mud therapy;
• Massage;
• Applications of ozokerite and paraffin;
• Electrophoresis;
• Application of diadynamic currents;
• Ultrasound therapy.

Surgery

In the absence of results from conservative therapy, as well as a significant decrease in quality of life, experts recommend surgical treatment for the diagnosis of DOA. Surgical intervention can be organ-preserving in nature, i.e. During the operation, the patient's diseased joint is left untouched, and pathological areas of ossification are removed.

Important. Endoprosthetics can also be performed - this is a surgical intervention to completely replace a diseased joint, indicated in the case of severe deformity with a complete lack of movement.

Regime and diet

If the diagnosis of DOA has already been made, then it is advisable to organize a strict work and rest schedule. This event is aimed at preventing unnecessary stress.

Attention. During exacerbations, it is recommended to maintain bed rest and completely abandon physical activity, as well as use additional support when moving - you need to protect the joints from further deformation.

The diet for arthrosis is not specialized. A balanced diet, if necessary, supplemented with complexes of vitamins and microelements is necessary. It will be useful to introduce dishes containing gelatin and cartilage into the diet.

Prevention

Important. To reduce the risk of developing the disease, you should monitor your weight and, if necessary, wear orthopedic shoes.

It also minimizes the possibility of injury and overload of the joints. Consider risk factors for developing DOA. If DOA has already been diagnosed, loads should be normalized. Approach the issue of employment rationally.

Osteoarthritis of the knee joint grade 3 is treated conservatively or surgically. In the first case, the patient is prescribed medications, drug blockades, and, in the second, they are performed.

Diagnosis by X-ray.

The presence of grade III deforming arthrosis of at least one large joint is a direct indication for surgical intervention. During the operation, doctors remove the destroyed joint and replace it with an artificial prosthesis.

The effectiveness of different methods of physiotherapy (Agency data, 2012):

• exercises to increase muscle strength. When performed correctly, they strengthen the leg muscles, relieve pain and improve joint mobility;
• myoneurostimulation. Ineffective in the fight against grade 3 osteoarthritis of the knee joint. Relieves pain for a short period. Soon after the end of the course of treatment, the pain intensifies;
• water gymnastics. Temporarily improves the general well-being of patients and removes some physical restrictions;
• wearing orthopedic devices, magnetic therapy, diathermy. As it turned out, these methods are ineffective in the treatment of arthrosis.

Physiotherapy methods are not able to restore damaged cartilage and bones. They only relieve unpleasant symptoms and make life a little easier for patients. It is impossible to cure arthrosis with their help (even with conscientious and regular completion of all prescribed procedures).

Why medications won't help

In addition to the negative effect on cartilage, they have a lot of other side effects. Taking these medications regularly can harm your health. Therefore, if you have chronic pain syndrome, do not delay surgery. Know: after endoprosthetics, you can be completely off medications.

Innovative treatment methods

Scientists in America and European countries are developing innovative methods for effective. The main direction of their activity is the creation of cell-engineered structures that can... Some drugs are already used in clinical practice (BioSeed-C, Cartigel, Chondrolon, DeNovo-NT), but they are only effective.

The idea of ​​creating artificial cartilage that could be surgically implanted looks quite promising. Most likely, they could completely replace destroyed cartilage tissue. However, to “grow” such cartilage, mechanical stimulation is needed. Scientists have not yet been able to create the necessary conditions for this.

In the CIS countries, the listed treatment methods are not yet used. To create cell-engineered structures, we need special conditions that we do not have.

What you need to know about endoprosthetics

Today, surgery is the most effective method of treating grade 3 osteoarthritis of the knee joint. With its help, you can completely get rid of chronic pain and restore normal knee mobility. A properly installed modern implant can last at least 15-20 years.