knee joint disease

knee joint diseaseIt is a deformed joint of the knee joint. It is accompanied by damage to the hyaline cartilage of the tibial and femoral articular surfaces and has a chronic progressive course. Clinical signs include pain that worsens with movement, limited movement, and synovitis (fluid accumulation) in the joints. In later stages, leg support is compromised and significant restriction of movement is observed. Pathology is diagnosed based on history, chief complaint, physical examination, and x-rays of joints. Treatment is mainly conservative: drug therapy, physical therapy, and exercise therapy. If the joint is severely damaged, an endoprosthesis will be needed.

General information

Arthropathy of the knee (from Latin articulatio genus - knee joint) or deforming arthropathy of the knee is a progressive, degenerative dystrophic lesion of the intraarticular cartilage that is non-inflammatory. Knee arthritis is the most common joint disease. It usually affects middle-aged and older adults, with women more likely to be affected. Knee arthritis may develop at a younger age after an injury or sustained exposure to severe stress (for example, in professional sports). Prevention plays the most important role in preventing the occurrence and development of knee joint disease.Contrary to popular belief, the disease occurs not because of salt deposition, but due to malnutrition and changes in the cartilage structure within the joints. In knee arthropathy, calcium salt deposits may appear at tendon attachments and ligamentous devices, but they are secondary and do not cause painful symptoms.

Causes of knee joint disease

In most cases, it is not possible to identify any one cause of the pathology. Generally speaking, the occurrence of knee joint disease is caused by a combination of factors, including:

• Injuried. Approximately 20-30% of cases of knee arthropathy are related to a previous injury: tibial fractures (especially intra-articular fractures), meniscal injuries, torn or ruptured ligaments. Typically, knee arthrosis occurs 3-5 years after a traumatic injury, but it is also possible to present earlier disease - 2-3 months after the injury.
• Physical exercise. The manifestations of knee joint disease are usually related to excessive load on the joints. After the age of 40, many people understand that to maintain good physical condition, regular physical exercise is required. When starting to exercise, they do not take into account age-related changes and place unnecessary load on the joints, leading to the rapid development of degenerative changes and the appearance of symptoms of knee arthrosis. Running and strenuous, rapid squats are especially dangerous to the knees.
• excess weight. With excess weight, joint load increases, making microtrauma and major injuries (meniscal tears or ligament tears) more likely to occur. Arthropathy is particularly difficult in obese patients with severe varicose veins.

The risk of knee arthritis is also increased if you have had arthritis in the past (psoriatic arthritis, reactive arthritis, rheumatoid arthritis, gouty arthritis, or ankylosing spondylitis). Additionally, risk factors for the development of knee arthropathy include genetically determined weakness of the ligamentous machinery, metabolic disorders and impaired innervation in certain neurological disorders, traumatic brain injury, and spinal injuries.

onset

The knee joint is formed by the articular surfaces of two bones: the femur and the tibia. The front surface of the joint is the patella, which slides along the depression between the femoral condyles as it moves. The fibula does not participate in the formation of the knee joint. Its upper part is located on the side and just below the knee joint, and is connected to the tibia through low movable joints.The articular surfaces of the tibia and femur and the posterior surface of the patella are covered with smooth, very strong and elastic 5-6 mm thick dense elastic hyaline cartilage. Cartilage reduces friction during movement and provides shock absorption during impact loading.In the first stage of knee arthrosis, blood circulation in the small intraosseous vessels supplying the hyaline cartilage is disturbed. The surface of the cartilage becomes dry and gradually loses its smoothness. Cracks appear on its surface. Instead of sliding softly and unhindered, the cartilage "sticks" to each other. Due to continued microtrauma, cartilage tissue becomes thinner and loses its shock-absorbing properties.In the second stage of knee arthropathy, compensatory changes occur in the bone structure. The joint platform is flat and can accommodate increased loads. Thickening of the subchondral area (the part of the bone just below the cartilage). Bone growth occurs along the edges of the joint surfaces - osteophytes, which look similar to the spine on radiographs.During knee arthropathy, the synovium and joint capsule also degenerate and become "wrinkled. "The properties of synovial fluid change - it thickens and increases in viscosity, which leads to a deterioration of its lubricating and nutritional properties. Due to lack of nutrients, cartilage degeneration is accelerated. The cartilage becomes thinner and disappears completely in some areas. After the cartilage disappears, the friction between the joint surfaces increases sharply, and degenerative changes progress rapidly.In the third stage of knee joint disease, the bones are significantly deformed and appear to be pressing against each other, severely restricting joint movement. Cartilaginous tissue is virtually non-existent.

Classification

Considering the traumatological and orthopedic pathogenesis, knee arthropathy is divided into two types: primary (idiopathic) and secondary knee arthropathy. Primary knee arthritis occurs in older patients in the absence of previous trauma and is usually bilateral. Secondary knee arthropathy occurs in the context of pathological changes (disease, developmental disorders) or injury to the knee joint. It can occur at any age and is usually unilateral.Taking into account the severity of pathological changes, knee arthrosis is divided into three stages:

• The first stage– The first manifestations of knee arthropathy. It is characterized by periodic dull pain that usually occurs after a large load is placed on the joint. There may be slight swelling in the joint, but this will go away on its own. No deformation.
• second stage– Increased symptoms of knee joint disease. The pain becomes longer and more severe. A crunching sound is often heard. There is slight or moderate limitation of movement and slight deformation of joints.
• The third phase– Clinical manifestations of knee arthropathy reach their maximum. The pain is almost constant and gait is impaired. The ability to move is significantly limited and the joints are deformed significantly.

Symptoms of knee joint disease

The disease begins gradually and gradually. In the first stage of knee joint disease, patients may experience mild pain when moving, especially going up and down stairs. The joints may feel stiff and the popliteal area may feel "tight". A typical symptom of knee joint disease is "initial pain" - pain that occurs on the first step after rising from a sitting position. When patients with knee joint disease "diverge, " the pain decreases or disappears, only to return after significant stress.Externally, the knee remains unchanged. Sometimes people with knee arthritis will notice slight swelling in the affected area. In some cases, during the first stage of knee arthropathy, fluid accumulates in the joints - synovitis occurs, which is characterized by an increase in joint volume (swelling, globular shape), a feeling of heaviness and restriction of movement.In the second stage of knee arthrosis, the pain becomes more severe, occurs even with light loads, and worsens with strenuous or prolonged walking. Typically, the pain is localized on the front inner surface of the joint. The pain usually goes away after a long period of rest and reappears with movement.As knee arthrosis progresses, the joint's range of motion gradually decreases, and severe pain occurs when trying to bend the leg as far as possible. It may make a rough crunching sound when moved. The shape of the joint changes, as if it is expanding. Synovitis is more common than the first stage of knee arthrosis and is characterized by a more protracted course and greater fluid accumulation.In the third stage of knee joint disease, the pain is almost constant and bothers the patient not only when walking, but also when resting. At night, patients spend a long time trying to find a comfortable sleeping position. Pain often occurs even at night.Flexion of the joint is significantly limited. In some cases, not only flexion but also extension is restricted, which is why people with knee arthritis are unable to fully straighten their legs. The joints enlarge and deform. Some patients develop bunions or varus deformities—the legs become X- or O-shaped. The gait becomes unstable and wobbly due to limited movement and deformation of the legs. In severe cases, people with knee joint disease can only move with the support of a cane or crutch.

diagnosis

The diagnosis of knee arthrosis is made based on the patient's chief complaint, objective examination data and X-ray examination. When examining patients with stage 1 knee arthropathy, external changes are often not detectable. In the second and third stages of knee arthropathy, coarsening of the skeletal contours, joint deformations, restricted movement, and curvature of the limb axis can be detected. A crunching sound can be heard as the patella moves laterally. Palpation reveals an area of pain medially from the patella, at the level of the joint space, and above and below it.In synovitis, the joints increase in size and smooth out their contours. A bulge was detected along the anterolateral surface of the joint and over the patella. By palpation, determine the fluctuations.Knee X-ray is a classic technique that allows you to confirm the diagnosis, determine the severity of knee pathologies and monitor the dynamics of the process, taking repeated pictures after a period of time. Due to its availability and low cost, it remains to date the main method for diagnosing knee arthropathy. Furthermore, this research method allowed us to exclude other pathological processes of the tibia and femur (e. g. tumors).In the initial stages of knee arthrosis, there may be no changes on X-rays. Subsequently, narrowing of the joint space and compression of the subchondral area are identified. The articular ends of the femur and especially the tibia expand, and the edges of the condyles become pointed.When studying radiographs, it should be taken into account that more or less pronounced changes characteristic of knee arthropathy are observed in most elderly people and are not always accompanied by pathological symptoms. The diagnosis of knee arthropathy can only be made by combining radiological and clinical symptoms of the disease.Currently, in addition to traditional radiography, modern techniques such as computed tomography of the knee (which allows detailed study of pathological changes in the bone structure) and magnetic resonance imaging of the knee (which is used to identify changes in soft tissues) are also used to diagnose the knee jointsick.

Treatment of knee joint disease

conservative activities

Treatment is performed by traumatologists and orthopedic surgeons. Treatment of knee joint disease should begin as early as possible. During exacerbations, patients with knee joint disease are advised to rest in order to minimize the load on the joints. Patients receive therapeutic exercises, massage, physical therapy (ultra-high frequency, novocaine electrophoresis, hydrocortisone phonophoresis, high-power current, magnet and laser therapy) and mud therapy.Medical treatment of knee joint disease includes chondroprotectants (drugs that improve metabolic processes in the joint) and drugs that replace synovial fluid. In some cases, for arthropathy, intra-articular administration of steroid hormones is required. The patient may then be referred to a nursing home for treatment.People with knee joint disease may be advised to walk with crutches to reduce the load on their joints. Sometimes special orthotics or custom insoles are used. In order to slow down the degenerative process of the arthritic knee joints, it is very important to follow certain rules: exercise, avoid unnecessary stress on the joints, choose comfortable shoes, monitor your weight, correctly organize your daily life (alternate loads and rest, perform exercises) Specialpractise).

Surgery

Due to marked destructive changes (third stage of knee arthrosis), conservative treatment was ineffective. When severe pain, joint dysfunction, and limited work ability occur, especially in young adult patients with knee arthropathy, they resort to surgery (knee replacement). Subsequently, rehabilitation measures will be taken. The time for full recovery after joint replacement surgery for knee arthritis ranges from 3 months to 6 months.