Knee Gonarthrosis Of The 3rd Degree: Treatment, Rehabilitation After Surgery

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Grade 3 knee gonarthrosis: symptoms, treatment, rehabilitation after surgery

The content of the article:

1. The reasons
2. Symptoms

3. Treatment of gonarthrosis of the knee joint 3 degrees

   1. Drug therapy

      1. Non-steroidal anti-inflammatory drugs
      2. External means
      3. Corticosteroids
   2. Folk remedies for pain relief

4. Endoprosthetics

   1. Contraindications to total arthroplasty

   2. Rehabilitation after surgery

      1. Rehabilitation at home
      2. Precautions
5. Video

Grade 3 gonarthrosis of the knee joint is a degenerative-dystrophic disease in which the destruction of cartilage tissue occurs. Usually the disease affects older people (more often women), but sometimes the first manifestations occur at a young age. Third-degree gonarthrosis can be right-sided, left-sided, or bilateral.

Gonarthrosis is more commonly diagnosed in older people

As a result of malnutrition of the cartilage, its structure changes. If untreated, the disease progresses, leading to complete deformation of the joint. At the last stage of gonarthrosis, the joint capsule and its synovium are reborn. The joint fluid becomes viscous and thick, as a result of which the nutrition of the cartilage deteriorates.

The lack of nutrients leads to the fact that in some areas it simply disappears. In the future, the process of destruction is accelerated: friction between the articular surfaces increases, bones are deformed, and movements in the joint are limited. In this case, the clinical manifestations of the disease reach their maximum.

With the progression of the pathology, a complete deformation of the joint occurs.

If, during the examination, pathological fluid is detected inside the knee, it is necessary to periodically perform a puncture. In case of partial disability, the patient is assigned a 1 or 2 disability group.

The reasons

The reasons for the development of gonarthrosis include:

• autoimmune diseases (psoriatic or rheumatoid arthritis);
• knee dysplasia;
• trauma (fractures, dislocations, ligament injuries);
• diabetes;
• overweight;
• congenital shortening of the leg;
• hypothyroidism;
• frostbite;
• varus or hallux valgus;
• acromegaly;
• osteomyelitis;
• chondrocalcinosis.

The development of the disease is influenced by factors such as the patient's age (more often the disease occurs in the elderly), strong physical activity (especially intense squats and running).

Symptoms

1-2 tbsp. gonarthrosis in the patient there is a crunch in the joints, pain during exertion and stiffness. In the future, the disease progresses and its symptoms worsen.

Signs of grade 3 gonarthrosis:

Symptoms	Description
Pain	When the upper layer of cartilage is erased, the nerve endings located in it are exposed, resulting in pain. At the last stage of gonarthrosis, the pain syndrome is pronounced. Knee pain occurs not only during exertion, but also persists when a person is at rest
Decreased range of motion and stiffness	One of the reasons for the appearance of this symptom is a change in the amount and composition of the synovial fluid (an increase in its viscosity)
Joint enlargement and deformity	The enlargement of the joint is facilitated by the growth of osteophytes (thorn-like formations along the edges of the articular surfaces) and tissue edema. Gradually the destruction of the cartilage leads to the fact that the joint is deformed, its shape changes

Often, the destruction of cartilage is accompanied by an inflammatory process, as a result of which edema occurs, compressing the nerve fibers even more. In this case, excruciating pain appears, which can only be dealt with with the help of strong painkillers.

With gonarthrosis of grade 3, the knees practically do not extend completely, as a result of which lameness occurs.

Treatment of gonarthrosis of the knee joint 3 degrees

To alleviate the condition, you can use special knee pads or orthopedic insoles. It is recommended to use a cane, crutches, or walker to avoid injury and reduce stress.

It is recommended to use a walker, cane or crutches to reduce stress on the knees

Drug therapy

Treating arthrosis of the last stage with drugs is ineffective. It is almost impossible to slow down the degenerative process with hyaluronic acid or chondroprotectors at this stage of the disease, so they are usually not used.

Non-steroidal anti-inflammatory drugs

With severe pain syndrome, drugs from the group of non-steroidal anti-inflammatory drugs are prescribed - Diclofenac, Ibuprofen, Nimesulide, which can reduce pain and inflammation.

To relieve severe pain, non-steroidal anti-inflammatory drugs are used, such as Nimesulide

You need to take them after meals 1-3 times a day. Since drugs in this group can lead to severe side effects and significantly affect the state of the body, especially the gastrointestinal tract, the period of treatment is limited.

External means

In order to reduce pain, use ointments and gels based on diclofenac, ketorolac, nimesulide, bee or snake venom. They are applied to the affected area, according to the instructions. The use of such drugs may be longer.

Topical remedies reduce pain and swelling

As a pain reliever and anti-inflammatory agent at home, you can prepare a talker. To do this, mix 20 ml of Dimexide, 20 ml of Novocaine, 3 ml of Diclofenac, 2 ml of Dexamethasone. A piece of tissue is moistened in a solution and applied to the affected knee, covering it with a bandage on top. This compress is left overnight.

Corticosteroids

In order to reduce inflammation and improve the patient's condition, corticosteroids are used. In most cases, hormonal drugs are injected into the joint cavity, since the effect of their use in this case increases. Also, drugs can be administered intramuscularly.

Corticosteroids can be injected directly into the joint cavity

Hormone therapy cannot be continued for long because of the high risk of severe side effects.

Folk remedies for pain relief

You can relieve pain with deforming arthrosis with the help of folk remedies:

• recipe number 1: 50 g of larkspur root is crushed and filled with 100 ml of 96% alcohol. The tool is insisted in a dark place for 10 days, then filtered and used to rub the knees. The tincture is rubbed 2-3 times a day;
• recipe number 2: the cabbage leaf is slightly cut with a knife and heated for a couple. A thin layer of honey is applied to its surface. The sheet is applied to the damaged joint and covered with a bandage. Such a compress is done before bedtime;
• recipe number 3: a glass of lilac flowers is poured into 0.5 liters of vodka and insisted in a dark place for a week. The tool is used for compresses and lotions. You can also prepare an ointment based on lilac flowers, for which they are crushed and mixed with petroleum jelly. Apply the remedy 2-3 times a day.

Endoprosthetics

The functions of the affected joint can be fully restored only with the help of surgical intervention.

At the last stage of gonarthrosis, the function of the damaged joint can be restored by endoprosthetics

Indications for the operation:

• severe pain syndrome;
• ineffectiveness of conservative treatment;
• lack of support for limbs;
• complete motor blockade of the articular block;
• significant curvature of the bones that form the knee.

Joint replacement surgery is technically difficult and traumatic, so it requires at least two surgeons. Endoprosthetics is performed under general or epidural anesthesia.

An incision is made on the front of the knee, after which the damaged joint is removed. The leg of the prosthesis is immersed in the depression of the tibia. Also, several filings are made on the thigh bone.

In the next step, the surgeon installs the prosthesis. Fixation is carried out using a special substance or by hammering. The site is washed with saline, drainage is placed and the wound is sutured. The injured limb is immobilized using orthopedic devices. Until the sutures are removed, the patient remains in the hospital.

Contraindications to total arthroplasty

Surgical treatment is indicated for patients over 50 years of age. At a younger age, total knee arthroplasty is performed only if there are additional indications, including the polyarticular form of rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, and other rheumatological diseases involving several large joints.

Endoprosthetics in young patients is performed only if there are additional indications

Contraindications for endoprosthetics:

• active infectious process or the presence of non-sanitized foci of chronic infection of any localization;
• purulent arthritis over the past 6 months;
• osteomyelitis of the tibial or femur condyles;
• lack of active extension in the knee, associated with the failure of the extensor apparatus (due to damage to the ligaments of the patella or its non-fused fracture, rupture of the tendon of the quadriceps femoris muscle) or severe muscle dysfunction;
• extensive rough scars welded to the underlying bone in the knee joint;
• exacerbation of thrombophlebitis;
• mental and general somatic diseases in the stage of decompensation.

Rehabilitation after surgery

Within 24 hours after the operation, the patient should lie on his back, while the operated leg is straightened. Do not use pillows under your knee. On the second day, in the absence of pain, you can turn on your side. You can sleep on your side from the third day.

After the operation, the patient needs rehabilitation under the guidance of a physiotherapist

Getting out of bed should be done from the side of the healthy leg. It is allowed to roll over on the stomach 12-14 days after surgery (depending on the condition of the wound).

Already in the first days after the operation, under the supervision of a physiotherapist, the patient needs to exercise in walking.

If a person initially begins to limp, it will be very difficult to relearn. A useful exercise is the stork gait, in which the operated leg is raised slightly higher while walking. You can completely get rid of crutches 4–6 weeks after endoprosthetics.

Rehabilitation at home

The patient can stay in the hospital for up to 10 days, in the future, rehabilitation is carried out at home. You can return home in the car, sitting next to the driver, while the seat must be pushed back, and its back must be tilted back a little.

During rehabilitation, sudden movements should be avoided.

Some sports (Nordic walking, swimming, cycling) can be resumed two months after the surgery, going to the bathhouse or sauna - after 3 weeks.

In the postoperative period, the following recommendations should be followed:

• choose shoes with a durable, stable and non-slip soles, high-heeled shoes or a large platform should be discarded;
• avoid deep squats, sudden changes in body position or jumping during the rehabilitation process;
• use aids (canes, crutches, ice shoes), if necessary, move on a slippery or uneven surface;
• periodically lie on your stomach, which helps to restore the motor activity of the joint;
• avoid positions during work in which there is an additional load on the knee joint;
• do not lift weights weighing more than 15 kg;
• strictly monitor weight, since excess weight increases the load on the joint and contributes to its wear and tear.

Precautions

It must be remembered that the metal detector reacts to the material from which the prosthesis is made, therefore, in order to avoid misunderstandings, you must carry a copy of the X-ray with you.

You should consult a doctor in the following cases:

• the appearance of severe swelling or pain in the area of the operated joint;
• a sudden increase in body temperature in the absence of other symptoms of any disease;
• long-term preservation of subfebrile body temperature;
• decreased mobility of the operated joint.

Grade 3 knee gonarthrosis is a pathology with an unfavorable prognosis. Gradually, the joint loses its functions, and it cannot be restored.

In order to prevent the development of gonarthrosis, it is necessary:

• eat properly;
• exercise, strengthen the periarticular muscles;
• monitor body weight.

When unpleasant symptoms appear in the form of knee pain, stiffness and crunching, it is necessary to start treatment, as this will make it possible to slow down the development of pathology.

Video

We offer for viewing a video on the topic of the article.

Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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