Osteoarthritis of the 2nd degree of the prospect of conservative treatment

Arthrosis is a common disease of the musculoskeletal system that causes joint deformation. The risk group includes the elderly and senile. The disease occurs in 60-70% of patients over 65 years old, with 80% being women. The affected joints are knee and hip joints. The appearance of pain causes physical inconvenience to the patient, limits functional ability, minimizes the possibility of movement and self-care, worsens the quality of life. In 60%, grade 2 arthrosis leads to disability, especially if pathology has occurred in elderly patients.

Causes of

They cause destruction of the articular cartilage and damage to the subchondral bone:

  • damage suffered (regardless of their statute of limitations);
  • autoimmune diseases, infectious origin;
  • metabolic problems, especially if laboratory deficiency of minerals in the body is confirmed;
  • age-related changes in the structure and condition of the musculoskeletal system.

A genetic predisposition to the development of arthrosis is another risk factor for this pathology. It has been proven that this form of joint damage affects individuals with a family history of cases of this disease.

Symptoms of the 2nd degree

It is difficult to detect 1,2 degree arthrosis – the signs of the disorder are blurred. The main manifestation of arthrosis is pain. Tension and excruciating discomfort increase as the destruction of the joint progresses. It becomes inactive, visually it is possible to determine the deformation. Typically, with arthrosis, pain in the joint increases after exercise, and rest can reduce the manifestation of an unpleasant sensation.

A specific crunch is heard in the affected area of ​​the musculoskeletal system. Less often – creaks or clicks, which in each case indicates a violation of the structure of the joint, its destruction.

Diagnostics

Only radiologically it is possible to prove that the pathology has reached 2 degrees – arthrosis is determined in the picture by characteristic signs. The size of the joint gap decreases, sclerotic changes of the subchondral bone are visible – its natural cells are replaced by connective tissue.

Laboratory methods for determining arthrosis are secondary, because radiation imaging methods already allow you to understand the clinical picture.

The specifics of the treatment of arthrosis 2 degrees

Quickly eliminate pain – the main goal of treatment. The doctor selects the optimal therapeutic approach, taking into account several factors: the severity of the disease, the area of ​​the prevalence (extent) of joint damage, the presence of concomitant pathologies of an acute form or chronic course, the patient’s age, family history (did any of the relatives suffer from arthrosis, which led to this )

Having answers to these questions (including by obtaining the results of the examination), the doctor prescribes an individual treatment regimen. Second degree arthrosis can be eliminated in several ways: conservative therapy, surgical intervention, physiotherapeutic methods. It is better not to consider the option of treatment with alternative methods, since in 99% of cases this approach is equivalent to a loss of time and does not promise recovery.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Medication

To stop arthrosis, drugs of the following pharmaceutical groups are prescribed:

  1. NSAIDs. Most often, drugs from the group of non-steroidal anti-inflammatory drugs are used to eliminate the pain syndrome. These include Ibuprofen, Diclofenac, Nimesulide (Nise), Meloxicam (Movalis). Especially actively apply the latter – Movalis. The drug has high anti-inflammatory, analgesic and chondroprotective properties. The medicine is well tolerated by patients of different ages. Meloxicam is prescribed in a dosage of 7,5 mg 2 times a day, for 10 days. The result is a decrease in pain, a decrease in the intensity of edema in the affected joint. But doctors often lose sight of the fact that non-steroidal drugs, with virtually no effect on blood pressure (BP) in patients with its initially normal values, cause an increase in the average level of blood pressure in patients suffering from hypertension.
  2. Chondroprotectors. They help to normalize the condition of the joints. The most widely used glucosamine and chondroitin sulfate.
  3. The introduction of hyaluronic acid improves the condition of the synovial fluid, makes the joints more flexible, which is important for patients suffering from arthrosis and impaired motor activity.
  4. Medications that improve blood circulation, provide expansion of blood vessels – Trental, Berlition.
  5. Vitamin Therapy. Prescribe drugs of group B, the introduction of ascorbic acid. This is necessary for general strengthening of the body, improving blood supply to tissues, normalizing metabolism.

Hormone therapy is also carried out – intra-articular injections of glucocorticosteroid drugs (Dexamethasone, Prednisolone, Metipred) are performed.

Although the advantages of this method have been proven, there are contraindications to its implementation. The implementation of local hormone therapy by injection is prohibited if:

  1. The risk of introducing bacterial microflora into the joint.
  2. Severe process of destruction and apparent deformation of the joint.
  3. An increased degree of general activity.
  4. Detection of concomitant pathology of infectious origin.
  5. Weak tolerance to the drug or its rejection by the body.

Despite the versatile nature of conservative treatment, in certain clinical cases it turns out to be ineffective, then the option of surgical intervention and replacing a diseased joint with an implant is considered.

Surgery

Even the “neglected” ARTROZ can be cured at home! Just remember to smear it once a day.

The creation of a prosthesis that can replace a real hip, knee, ankle joints for a person has difficulties in biomechanics:

  • the functional status of the joint must be taken into account;
  • large variability of the geometry of the axis of motion;
  • the maximum load is carried out in the fixation areas (especially in the segment where the bone cement is in contact with the bone);
  • it is necessary to take into account the large amplitude of motion;
  • there is a threat of imminent instability of the endoprosthesis.

Of all types of endoprosthetics, it is most difficult to perform the operation under consideration on the ankle joint. The reason is the uniqueness of the anatomical, physiological and mechanical characteristics. The ligament balance during the intervention is not fully restored, the normal biomechanics of the symbiosis of the ankle and subtalar joints is not reproduced enough.

The best endoprostheses for replacing the ankle joint were determined by the clinical and experimental practices of orthopedists, surgeons, and traumatologists. Endoprosthetics are shown in the table.

Name of prosthesis, manufacturing countrydesign FeaturesThe advantages of the endoprosthesis of the brand in question
STAR by WALDEMAR LINK GmbH & Co. KG (Germany)The successful use of an endoprosthesis is predetermined by its following characteristics:
  1. It is made of cobalt-chromium alloy.
  2. The presence of a ram component with lateral planes.
  3. The technical capabilities of the implant are realized thanks to the porous deposition of surfaces in direct contact with the bone.
  4. Provides osteotropic properties to the metal of which it is made. For this, the prosthesis is coated with calcium phosphate.
  5. In the manufacturing process of the plastic meniscus implant between the tibial and talus component, ultrahigh-pressure polyethylene was used
  • Ensuring the protection of the articular cartilage of the ankles during the functioning of the endoprosthesis;
  • the possibility of using an endoprosthesis for implantation in patients with significant lesions of the lateral ankle joints (this often refers to the talus)
Mobility ™ (DePuy, England)The talus and tibial components of the endoprosthesis are implanted with a wrap, connected by crimping. In factories in Europe that manufacture medical equipment and individual devices, this technology is called “press-fit.” Its correct implementation requires considerable work and professionalism from the master. These requirements for the manufacturer of the product under consideration make it possible to judge the high quality of the endoprosthesisEndoprosthesis allows to achieve the following phenomena:
  • improve the physical condition and motor activity of the operated joint and limb;
  • significantly reduce or completely stop the pain syndrome;
  • minimize the number of possible postoperative complications

High-quality models include two-component implants of the brand TNK (Nara, Japan), AGILITY (DePuy, USA). The development of these types of prostheses increased the number of favorable outcomes of operations (from 65% to 90%). Satisfactory indicators of endoprosthetics can be achieved thanks to an in-depth study and understanding by designers of endoprostheses of the biomechanics of joints (especially physiologically large ones – hip, knee). Another advantage is the use of new, hypoallergenic materials.

The following factors can affect the negative outcome of an operation:

  • incorrect selection of patients for surgical intervention (endoprosthetics without clear indications for surgery);
  • when preventive measures are not taken regarding the possible instability of the joint, its deformation;
  • if arthrosis of adjacent joints is not taken into account.

If we take these factors into account, complications after arthroplasty are minimized – both early (occurring from a few hours to several days after surgery) and delayed (developing after discharge of the patient).

Consideration of risk factors depends on the doctor performing the surgery: this is one of the reasons why the choice of surgeon should be approached carefully, deliberately. Especially if the operation will be carried out in a planned rather than urgent manner.

A significant problem with ankle replacement is the complication of grade 2 arthrosis with avascular necrosis of the talus. Especially if the operation is to be performed by elderly patients suffering from deforming arthrosis of degenerative-dystrophic origin. Complication is almost always present in people of this age category. Necrotic changes in the talus are a direct contraindication for endoprosthetics, but nevertheless, the intervention is performed for objective reasons.

To minimize the likelihood of postoperative complications, special models of endoprostheses are created for elderly patients. Such implants are attached to the calcaneus after resection of the talus (Berdyev’s prosthesis). Negative reviews about them are explained by a high risk (80% of cases) of shortening of the operated limb. The endoprosthesis of such a model is more massive when compared with analogues, and therefore the attachment of its elements is not always stable.

Despite the difficulties of endoprosthetics, orthopedists have high hopes for the quality of modern implants. Three-component prostheses appeared with different axes of rotation, degree of freedom. Actively use metal components with a coating that guarantees biological fixation. Modern implants significantly reduce the area of ​​bone resection, which is prepared for the intervention.

Physiotherapeutic treatment

The following types of physiotherapeutic effects have a beneficial effect on the condition of the joints:

  1. Ultrasound therapy. Ultrasonic vibrations improve blood flow to the affected membranes of the joints, reduce the manifestation of inflammation. The number of contraindications is minimal.
  2. Magnetotherapy. It has an analgesic, anti-inflammatory effect. Improves metabolic processes at the local level.
  3. Phonophoresis. For phonophoresis, it is best to use Lyoton® gel. This is a topical anticoagulant of direct action, belongs to a number of medium-molecular heparins. The main component is heparin of multimodal action (helps to normalize the regulation of vascular tone, provides microcirculation). The second most important component of the gel is nitrogen monoxide (guarantees a beneficial effect on articular tissue, bioavailability). The drug penetrates deep into the tissue thanks to the molecules of ketoprofen, which have the smallest size and polarization, and a special gel-based therapeutic agent. It provides maximum penetration. Lyoton is advisable to use for phonophoresis and improve the condition of the joints. According to evidence-based medicine, topical ketoprofen among all anti-inflammatory drugs has a strong anti-inflammatory and analgesic effect.

Anton Epifanov on the effectiveness of physiotherapy:

The peculiarity of the tool and its advantage is a safe effect on articular cartilage.

ethnoscience

Experts do not approve of the methods of traditional medicine as a treatment for arthrosis, since patients place unjustified hopes on the action of decoctions, infusions and warming. The disease is still progressing, and the patient is waiting for disability.

If the specialist does not find potential harm to the patient in the methods of traditional medicine, the following recipes are acceptable:

  • to strengthen the immune properties, you can brew in a thermos (1 liter) for 1 teaspoon of dry weight of chamomile, St. John’s wort, marigolds (calendula). Pour 1 liter of boiling water, wait 15-20 minutes, and then you can drink it like regular tea. The drink will provide increased immunity, which has a beneficial effect on the condition of the body. To normalize the condition of the joints, marsh saber is used, brewing it like tea;
  • take a bath with the addition of medicinal plants. Avoid excessively high water temperatures, and it is useful to use thyme, chamomile, coltsfoot, and elderberry from herbs;
  • the skin over the diseased joint is rubbed with herbal tincture. A dandelion is poured into the bottle (up to half the capacity). The remaining volume is filled with 70% alcohol or triple cologne. Then the bottle needs to be tightly closed, left in a dark place for insisting (at least 30 days). The temperature in the room should not be high. After 1 month, the treatment solution can be used as a means for applying compresses or rubbing with a cotton swab. According to patient reviews, for joints, tincture of dandelions is enough to use 2 months.

The listed recipes do not apply to the methods of official medicine, and therefore they can be implemented only after the approval of the attending physician.

Conclusion

Osteoarthritis of the 2nd degree can be cured only with timely access to medical care. To stop the pain, relieve inflammation, appoint Meloxicam. It interacts with other medications, including cytostatic, diuretics, cardiac glycosides, adrenergic blocking agents, which is important when overseeing disorders in patients with aggravating pathologies.

Contrary to popular belief, even moderate destruction is an indication for surgery. The pathology of this stage is accompanied by intense pain, which completely destabilizes the patient’s motor activity. Injecting non-steroidal drugs and analgesics is incorrect, because it is proved that the listed drugs negatively affect the condition of the stomach and intestines, disrupt the functioning of the heart. Even after surgery, you need to periodically (1 time in 6 years) visit a doctor – for a follow-up examination and taking a picture. An X-ray examination will make sure that the endoprosthesis is complete and that there are no inflammatory processes in the hidden course.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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