Treatment of knee joint arthrosis, treatment of gonartrosis- To say gentle, not the easiest task.Therefore, before you start your hard fight with this disease, make sure you find a good doctor, examine it and make a treatment plan with it.
In no case do you try to make a diagnosis for yourself!
The fact is that union lesions, which resemble arthrosis, occur with many other diseases, and low -presented people are often mistaken in determining the diagnosis.It is best not to save time and money for medical consultation, because the mistake can cost you much more expensive in all aspects.
But that does not mean that you need to blindly trust a doctor and you should not throw away his recommendations, understanding the mechanism of the action of those medicines that you are prescribed.The patient must understand the meaning of medical prescriptions and represent why certain therapeutic procedures are performed.
So with the therapeutic treatment of gonartrosis, it is important to combine a number of therapeutic masses in such a way as to solve some problems immediately:
- eliminate pain;
- improve articular cartilage food and accelerate its restoration;
- activate blood circulation in the affected joint;
- Reduce the pressure on the damaged bone joints and increase the distance between them;
- strengthen the muscles surrounding the diseased joint;
- Increase joint movement.
Below we will consider how this or that method of treatment helps to achieve your goals:
1. Non -inflammatory drugs non -inflammatory:
Non -inflammatory drugs not -inflammatory -nsaids: diclofenac, pyroxycs, ketoprofen, indomethacin, butadion, meloxicam, healing, nimulides and their derivatives.
With arthrosis, non -hormonal, anti -inflammatory drugs are traditionally used to eliminate the pain and inflammation of the joint, as in the background of severe pain it is impossible to start normal treatment.Only by eliminating acute pain with anti-inflammatory drugs, you can then go, for example, to massage, gymnastics and those physiotherapeutic procedures that would be intolerable due to pain.
However, it is undesirable to use this group's medication for a long time, as they are able to "mask" the manifestations of the disease.
After all, when the pain decreases, a deceptive impression that a cure began.Meanwhile, arthrosis continues to progress: NSAIDs only eliminate individual symptoms of the disease, but do not treat it.
Moreover, in recent years, data has been obtained that indicate the harmful effects of prolonged use of non -steroidal anti -inflammatory drugs in proteinoglycan synthesis.Proteoglycan molecules are responsible for the flow of water in the cartilage, and a violation of their function leads to dehydration of cartilage tissue.As a result, the cartilage already affected by arthritis begins to collapse even faster.Thus, the pills the patient gets to reduce the pain in the joint can accelerate the destruction of this joint.
Moreover, using non -steroidal anti -inflammatory drugs, it should be remembered that all of them have serious contraindications and with prolonged use can give important side effects.
2. Condrroprotectors - glucosamine and chondroitinine sulfat:
Chondroprotectors - glucosamine and chondroitin sulfate - these are substances that feed the cartilage tissue and restore the structure of the damaged joint of the joints.
Chondroprotectors are the most useful group of medicines for the treatment of arthrosis.
Unlike non -inflammatory drugs non -inflammatory (NSAIDs), chondroprotectors not as much as eliminate the symptoms of arthrosis as the "basis" of the disease: the use of glucosamine and chondroitin sulfate helps restore hip joint surfaces, improve the production of "common flow" properties.
A similar complex effect of chondroprotectors on the joint makes them indispensable in the treatment of the initial stage of arthrosis.However, there is no need to exaggerate these medicines.
The chondroprotectors are a little effective in the third stage of arthrosis, when the cartilage is almost completely destroyed.After all, it is impossible to grow a new cartilage fabric or the return of the previous shape to deform the knee bones with glucosamine and chondroit sulfate.
And in the first or second stages of gonartrosis, the chondroprotectors act very slowly and improve the patient's condition immediately.To get a real result, you need to spend at least 2-3 and treatment with these medicines, which usually take from six months to one and a half years.
3. Ointments and therapeutic creams:
Ointments and therapeutic creams in no way can heal the arthrosis of the knee joints (even if their advertising approves otherwise).However, they can relieve the patient's condition and reduce pain in a sore knee.And in this sense, ointments are sometimes very useful.
So, with the arthrosis of the knee joint that occurs without a synovit without phenomena, I recommend heating ointments for my patients in order to improve blood circulation in the joint.
To do this, use the pepper fruit extract, etc.Listed ointments usually cause a feeling of heat and pleasant comfort to the patient.They rarely give any side effects.
Ointments based on non -steroidal anti -inflammatory substances are used in cases where the course of gonartrosis is exacerbated by synovitis.Unfortunately, they act not so effectively as we would like - because the skin passes no more than 5 - 7% of the active substance, and this is not clear enough to develop a complete anti -inflammatory effect.
4. Funds for compresses:
Compresses have a slightly large therapeutic effect compared to ointments.
Of the local funds used in our time, in my opinion, three medicines deserve the most attention: Dimexide, Bishophytus and medical bile.
DUE- Chemical substances, liquid with colorless crystals, has a good anti -inflammatory and analgesic effect.At the same time, unlike many other external substances, Dimexid is really able to penetrate the skin barriers.That is to say, the doubles applied to the skin is truly immersed by the body and works inside it, reducing inflammation in the focus of the disease.Moreover, Dimexid has an absorbable property and improves metabolism in the field of application, which makes it more useful in the treatment of arthrosis, which occur with the presence of synovitis.
Bishop- Oil derivative, brine extracted while drilling oil wells.He gained his fame thanks to Drillers, who were the first to pay attention to his therapeutic effect with arthrosis.While working in oil wells from constant contact with an oil brine from the exercise, the arthrosis joints occurred in their hands.In the future, it turned out that bishophyte has a moderate anti -inflammatory and analgesic effect, and also acts warmly, causing a feeling of pleasant heat.
Medical bile- Natural bile mined by bile bile bile bile or pigs.Biliary has an absorbable and heater effect and is used in the same cases as bischophyte, but there are some contraindications: it cannot be used for pustular skin diseases, inflammatory diseases of the lymph nodes and canals, fever states with an increase in body temperature.
5. Intra -articular injections (injections in coupling):
Intra -articular injections are often used to provide urgent care for knee joint arthrosis.In many cases, intra -articular injection can relieve the patient's condition.But at the same time, injections in fusion with arthritis become much more often than it should.It's about this incorrect, in my opinion, the trends, I want to speak in detail.
Most often, corticosteroid hormone drugs are introduced into the joint: triamcinone, betamethasone, hydrocortisone.
Corticosteroids are good at that they quickly and effectively suppress pain and inflammation with synovitis (edema and swelling of the joint).The speed at which the therapeutic effect is achieved, which is the reason that corticosteroid injections have gained particular popularity among doctors.
But this led to the fact that intra -articular hormone injections began to be performed even without real need.For example, I have repeatedly faced the fact that hormones were introduced into the patient's joint for a preventive purpose to prevent further development of arthrosis.
However, the problem is that only arthritis itself corticosteroids are not treated and cannot be treated.So they cannot prevent arthrosis development!Corticosteroids do not improve the condition of the articular cartilage, do not strengthen bone tissue and do not restore normal blood circulation.
All that can reduce the inflammatory response of the body's response to one or another damage to the joint cavity.Therefore, it is useless to use intra -articular injections of hormonal drugs as an independent treatment method: they should only be used in complex arthrosis therapy.
For example, the patient detected phase II gonartrosis with a swelling of the joint due to the accumulation of fluid in it.The accumulation of fluid (synovitis) makes it difficult to perform medical procedures: manual therapy, gymnastics, physiotherapy.In such a situation, the doctor performs an intra -articular hormonal drug injection to eliminate the synovitis, and in a week begins in other active therapeutic measures - this is the right access.
Now imagine another situation.The patient also has phase II gonartrosis, but without accumulation of fluid edema and joint.Is it necessary to access corticosteroids in union in this case?Of course, no.There is no inflammation - no "exposure point" for corticosteroid hormones.
But even if intra -articular presentation of corticosteroids is really needed, a number of rules must be observed.First, it is undesirable to make such injections in the same joint more often than once every 2 weeks.The fact is that the medicine presented will "work" in full strength immediately and the doctor will be able to eventually assess the effect of the procedure immediately after 10 - 14 days.
You should also know that usually the first injection of corticosteroids brings more relief than later ones.And if the first intra -articular administration of the drug did not work, it is unlikely to give the second or third presentation of the same drug in the same place.In case of ineffectiveness of the first intra -articular injection, you need to change the medicine, or if the drug change has not helped, more precisely, choose the injection site.
If even after that, the introduction of a corticosteroid into the coupling did not give the desired result, it is best to abandon the idea of treating this joint with hormone medicines.Moreover, the hormone injection in the same joint is more than four to five times in general, is extremely undesirable in different ways, increased differently the possibility of side effects.
Unfortunately, in practice, you have to face excessive "determination" of doctors who, over and over, present corticosteroids in the same union, without at least the minimum effect with the first three injections.Two such cases hit me more than others.
One of the patients made "only" ten injections of one direction, while the procedure was performed daily, even without a rest of ten days necessary to evaluate the injection results.And the second patient was introduced into the hormones inside the knee joints, observing the interval (though only 3 to 5 days), but at the same time, the poor shock received twenty to twenty -five corticosteroid injections in a coupling course!
It seems that the doctor "went too far" a little - it's okay.Can there be damage from such treatment?It turns out, maybe!
First, with each injection, the knot, though slightly, is damaged by a needle.Second, with intra-articular injection, there is always a certain risk of fusion infection.Third, the frequent presentation of hormones provokes a violation of the structure of the joints and the surrounding muscles, causing relative "rot" joints.
And most importantly, frequent injections of corticosteroids exacerbate the condition of those patients in whom joint damage is combined with diabetes mellitus, high blood pressure, overweight, kidney failure, stomach or intestinal ulcer, tuberculosis, purulent infections and diseases.Even introduced exclusively in the joint cavity, corticosteroids affect the whole body and can aggravate the course of these diseases.
It is much more useful to administer hyaluronic acid medication in the knee joint affected by arthrosis (another name for hyaluronic acid - sodium hyaluronons).They appeared on sale about 15 years ago.
Hyaluronic acid preparations (sodium hyaluronate) are also called "liquid prosthesis" or "liquid implants", as they act on fusion as a healthy synovial fluid - that is, as a natural "common lubrication".
Hyaluronic acid preparations are very useful and effective medicines: sodium hyaluronate forms a protective film in the damaged cartilage, protecting the cartilage tissue from further destruction and improving the landslides.
Moreover, hyaluronic acid preparations penetrate the depth of the cartilage, improving its elasticity and elasticity.Thanks to Haaluronidase, "dried" and arthritis thinning, the cartilage restores its properties of shock.As a result of weakening mechanical overload, pain in the diseased knee joint decreases and its mobility increases.
At the same time, the joints administered correctly in the joint cavity, hyaluronic acid preparations practically do not give side effects.
Treatment with hyaluronic acid preparations is performed in courses: In total, 3-4 injections for the course of treatment in each injured knee are required, the interval between injections is usually from 7 to 14 days.If necessary, the course is repeated in six months or one year.
From my point of view, the main and only serious obstacle of hyaluronic acid drugs is their high price.So, in 2020, hyaluronic acid is represented in our market in the main import drugs.
But, returning to the issue of savings, I want to note that despite the relatively high cost of hyaluronic acid preparations, their use literally allowed many patients from those who previously, before these medicines, will definitely need to be operated.
And given the cost of surgery in the joints, it turns out that the timely use of hyaluronic acid (even for several years) in any case and in each sense costs the patient much cheaper than the surgery for the knee joint endoproshetics.Of course, provided that the physician who performs such injections possess the entry technique.
It is important to know: hyaluronic acid preparations are immediately destroyed in the union in which the pronounced inflammatory processes are developing.Therefore, it is practically useless to present them with those patients in whom gonartrosis continues against the active phase of arthritis.But it is useful to use them with constant forgiveness of arthritis to treat the phenomena of secondary gonartrosis.
With primary gonartrosis, you also need to pay attention to such moments.For example, if the patient's fusion "explodes" by the accumulation of excess, pathological fluid, it makes sense to first "extinguish" the phenomena of synovitis (inflammation) and remove excess pathological fluid with the help of an intra -inflammatory injection of hormones or anti -inflammatory drug intake.And only then to introduce hyaluronic acid into the joint, released from the inflammatory elements.
In addition to corticosteroid hormones and hyaluronic acid preparations, it tries to present different chondroprotectors in the joint.
But these medicines are many times inferior to the effectiveness of hyaluronic acid drugs.They help from a 50% strength for patients, and guess whether or not the effect of using them is impossible in advance.Moreover, the course of treatment requires 5 to 20 injections in the union, which, as we said, is fraught with possible damage to the joint and various complications.
6. Manual therapy and physiotherapy:
Manual therapy for Phase I and II gonartrosis often gives an excellent result.Sometimes some procedures are enough for the patient to feel important relief.Particularly manual therapy of the occasional joints helps, if you combine it with joint stretching, taking chondroprotectors and intraarticular injections of the point.
Such a combination of therapeutic procedures, from my point of view, is much more effective than the numerous physiotherapeutic measures proposed in each clinic.I will give an example from practice.
The case from the practice of the doctor.
A 47 -year -old woman with arthrosis of the right knot of Phase II knee came in waiting.At the time of our meeting, she had been sick for 5 years.Over the years, the Woman Managed to Experience All Possible Methods of Physiotherapy that can be proposed in our District Clinics: Laser, Magnetotherapy, Ultrasound, Phonophoresis, etc.Despite All the Efforts of Physiotherapists, the Patient's Condition of the Patient Continue to Deteriorate - and this is Natural, Since, Let's Say, Chondroprotectors were appointed to the Woman Only Oncece, A Woman Was APPOINTED TO A WOM.Short course.
Completely desperate, the woman decided on extreme measures - she underwent a course of cigarette treatment of wormworms according to oriental methodology.As a result, the knee was covered with burns wound, but did not move better.Yes, and it is unlikely that I can, despite all my respect for Eastern medicine, I understand that the wormwood cauterization cannot eliminate bone deformities and increase the distance between the articulated bones in the knee.
After the woman did not help numerous physiotherapeutic procedures and even cauterization in worm wood cigarettes, she practically agreed on surgical treatment.But then she still changed my mind and decided to try the complex method I proposed.
The first treatment session passed, as they say, "with a wrinkle" - we managed to "promote" just joining with the help of manual mobilization slightly.Therefore, we planned the next session after preliminary preparation: Within 3 weeks, the woman took the chondroprotectors, made herself -massage and compresses Dimexide.After 3 weeks, I again started mobilizing the joint, and then I did a repositioning ("landing" of the joint using manual manipulation. There was a click and suddenly the knot began to move much easier and cheaper. The woman felt clear relief.
In the next two sessions using mobilization, we adjusted the improvement achieved, after which we have regulated the success of two intra -articular injections of the point.And after a month and a half from the beginning of our not very intense treatment (after all, we only needed six meetings), the woman was finally able to throw the stick she had bored with her and started moving very freely.
Two years have passed since then.Twice a year, the patient gets chondroprotectors in a short course, and occasionally comes to my control technique, where I am happy to note that the knee condition is only better from year to year.And now, even the first phase of arthritis would be very difficult to assume - the patient's knee joint was almost completely restored.
Thus, only six treatment sessions (manual therapy plus intra -surveillance injections of Orenil) in combination with the flow of chondroprotectors were more effective than five years of physiotherapy.
From this story (and in no way the only one like it) it becomes clear why I consider physiotherapy as important, but only an additional part of the medical program for gonartrosis.In this sense, I like laser therapy, thermal treatment (ozokerite, paraffin therapy, therapeutic mud) and especially cryotherapy (local cold treatment).
7. Diet:
Diet with arthritis is also very important.
8. Using the cane:
Based on the stick when walking, patients with arthritis of the knee joints seriously help their treatment, as the stick receives 30 - 40% of the load intended for the union.
It is important to choose a stick according to your height.To do this, stand straight, lower your hands and measure the distance from the wrist (but not from the fingertips!) On the floor.It is such a length that there should be a cane.When buying a stick, pay attention to its end - it should be fitted with a rubber orifice.Such a stick is depreciated and does not slip when resting on it.
Remember that if your left foot hurts, then the stick should be held in your right hand, and vice versa.By making a step by the patient with one foot, transfer part of the body weight to a stick.
9. Therapeutic gymnastics:
The most important treatment for knee joint arthrosis is special therapeutic gymnastics.Almost no person who has a gonartrosis can achieve a real improvement in the state without therapeutic gymnastics.
After all, it is impossible to strengthen the muscles, "pump" blood vessels and activate blood flow as much as it can be achieved using special exercises.
At the same time, the doctor's gymnastics is almost the only method of treatment that does not require financial costs for purchasing equipment or medication.All the patient needs is two square meters of free space in the room and a carpet or blanket laid on the floor.
There is nothing more to consult a gymnastics specialist and the patient's desire to do this gymnastics.True, only with such a desire, most patients do not burn.Almost every patient, in whom I detect arthritis, should literally persuade physiotherapy exercises.And it is more often possible to convince a person only when it comes to the inevitability of surgical intervention.
The second "gymnastics" problem is that even those patients who are configured for physiotherapy exercises often cannot find the necessary groups of exercises.Of course, there are brochures for patients with arthritis for sale, but the competence of a number of authors is suspicious - after all, some do not have a medical education.
So such "teachers" do not always understand the meaning of individual exercises and the mechanism of their action on the injured joints.Often, gymnastics complexes simply without thinking corresponds from one brochure to another.At the same time, there are such recommendations in them that it is right to grab your head!
For example, many brochures describe the patient with arthritis of the knee joints "to perform at least 100 meetings a day and walk as much as possible."
Often, patients follow such tips, without first consulting a doctor, and then honestly confused why they worsened.Well, I will try to explain why the condition of the nodes diseased by such exercises, as a rule, only deteriorates.
Let's imagine the union as a bearings.Damaged by arthritis, the injured knot has already lost its ideal shape.The surface of the "bearings" (or cartilage) ceased to be quiet.Moreover, cracks, pits and "burrs" appeared in it.Plus, lubrication inside the sphere thickens and dried, it was not enough.