Gonarthrosis, or arthrosis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes destruction of the structure of the cartilaginous tissue of the joints, which, in turn, leads to their deformation and loss of their functions.Pathology often leads to human disability.
Deforming gonarthrosis of the knee occupies a prominent place among all arthrosis, and if at first only a small part of the joint is affected, then, in the absence of adequate treatment, when the disease reaches a late stage of development, the entire joint is involved in the pathological process.
Most often, the disease develops in people over 40 years of age, but in athletes it can also occur at a young age (after severe joint injuries).
Women are more susceptible to the process of joint deformation, but it frequently occurs in men and even young children.To avoid worsening the situation, you need to know how to recognize the first signs of this disease.
Varieties
The classification of gonarthrosis depends on its etiology and location.Each of the varieties has its own development characteristics, which are always taken into account by the doctor when prescribing treatment.But in terms of the nature of their manifestation, they are almost identical.
So, the types of acute arthrosis of the knee joint, depending on the etiology of the disease, are as follows:
- Primary gonarthrosis.This disease develops without any prerequisites.The risk group includes the elderly, women and patients suffering from obesity.Primary type gonarthrosis of the knee joint can develop for years without manifesting itself.But the sooner it is detected, the more favorable the prognosis for treatment.
- Secondary gonarthrosisKnee pain occurs due to previous injuries, but can also be a consequence of various infectious pathologies.If damaged joints are treated in a timely manner, the patient has every chance of avoiding this disease.
There are types of osteoarthritis according to location:
- Right-sided gonarthrosis, which develops in the joint tissues of the right knee.It often occurs in athletes, as well as in people whose work requires frequent physical activity.
- Left-sided gonarthrosisinvolves the left knee in the pathological process.It occurs in people who play sports professionally, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a destructive effect on the joint tissues of the knees of both legs.This type of disease is considered the most serious, both in terms of symptoms and therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in elderly people, that is, it is idiopathic in nature.
Anatomy and pathological changes
The knee joint is formed by the articular surfaces of the tibia and femur.In its anterior part is the patella, which during movements slides smoothly along the depression located between the condyles of the femoral joint.
The femur and tibia, together with the kneecap, are covered with elastic glialine cartilage, 5 to 6 mm thick.It helps reduce friction when a person performs physical activity and, in the event of falls, performs a shock-absorbing function.
Pathological changes in joints: gradual disturbances
In the first stage of development of knee joint gonarthrosis, blood circulation is mainly affected.The small intraosseous vessels that supply blood to the hyaline joint are ruptured, which leads to gradual drying out of its surface.It becomes less elastic and cracks begin to form on its surface.
As a result, instead of sliding smoothly, these cartilages touch each other.Inflammation begins to develop gradually, and diseased cartilages, changing slightly, prevent each other from fully performing their functions.Due to the formation of a large number of microcracks in the region of the tissues that make up the cartilage, they gradually lose their shock-absorbing properties.
In the second phase of gonarthrosis progression, compensatory changes begin to occur in the bone area.Under the influence of increased loads, the joint platform begins to gradually flatten, which leads to compaction of the subchondral zone (the area of the bone located under the cartilage).
The articular surfaces along the edges begin to become covered with bone processes, which on an x-ray look like sharp spikes.
As the lubricating fluid in the joints becomes thicker, it loses much of its function.This leads to accelerated cartilage degeneration.For this reason, it looks like a thin thread on an x-ray or is completely invisible.
If this was noticed, it means that the disease flows smoothly (or quickly - it all depends on the situation) into the 3rd phase of development.
In the third stage of gonarthrosis of the knee joint, a noticeable deformation of the bones occurs.They seem to be squeezed together, which leads to decreased joint mobility.Cartilaginous tissue is almost completely depleted.
Causes and predisposing factors
The causes of arthrosis of the knee joint are not isolated - often the doctor determines several factors at once that led to the development of the disease.
The most common and common reasons are:
- previous joint injuries (of moderate or severe severity);
- ankle fractures, especially if there is intra-articular damage;
- violation of the integrity of the meniscal structure;
- ruptures or complete ruptures of ligaments;
- excessively intense stress on the knee joints.
Acute osteoarthritis of the knee joint is directly related to the person's age.Thus, it has been established that people over 40 are more susceptible to it, as during this period the flexibility of the cartilage begins to decrease and the lubricating fluid in the joints gradually “dries up”.
To delay this moment, patients are advised to practice sports, but physical activity must be moderate and not cause general discomfort.
Excess weight is also one of the predisposing factors for the development of gonarthrosis.The fact is that excess body weight creates additional stress on bones and joints, which cannot but affect your health.
In this case, an important role is played by the fact which leg bears more load.For example, if your “support” is your left leg, there is a high probability that you will develop left-sided gonarthrosis.
In obesity, constant pressure on joints leads to microtrauma and rupture of small blood vessels.Ruptures of menisci or ligaments are also possible, considered a serious manifestation of joint injuries.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins.In this case, the patient is advised to consult a phlebologist.
A high risk of developing this pathology also exists in people who:
- has suffered from several types of arthritis;
- has unfavorable heredity;
- have problems with the ligamentous apparatus;
- suffer from metabolic disorders;
- suffered traumatic brain injuries;
- injured in a traffic accident;
- had spinal injuries.
Many of these factors are often closely related.An accurate determination of the cause helps to establish an accurate diagnosis and prescribe the patient the correct and effective treatment for arthrosis of the knee joint.
Clinical manifestations
The symptoms of gonarthrosis do not appear immediately - they begin to appear gradually, depending on the stage of the disease.For this reason, the clinical picture must be considered in stages.
First stage
In the initial stage of development of the disease, patients complain of mild pain in the knee region, which intensifies with physical activity.They become especially intense when going down and up stairs.
In addition to pain, the patient feels a certain stiffness of movement, “tightening” in the joint region.It is felt in the popliteal part and disappears when the knee muscles relax.
Another characteristic symptom is the so-called “initial pain syndrome”.It develops during the patient's first steps.When the knees get used to the load, this anomaly disappears without a trace.
Second stage
At this time, the symptoms of arthrosis of the knee joint become more intense and noticeable.The pain intensifies, causing great difficulty and discomfort when walking.The pain syndrome disappears after a long rest, but with intense exercise it makes itself felt again.
Inflammation of the joint causes swelling in the knee, which is noticeable even to the naked eye.When walking, a strong and unpleasant crunching sound occurs.Movements become more difficult and restricted.
Stage three
The pain becomes very intense and the patient cannot do without painkillers.It is difficult for a person to bend their knee, they feel stiffness in the movements of the joint.It becomes deformed and increases in size.In severe cases, the patient is unable to move without additional support.
All these signs of arthrosis of the knee joint should not be ignored by the patient.The disease can leave a person in a hospital bed for a long time and sometimes lead to disability.
Which doctor treats gonarthrosis of the knee joint?
To diagnose and treat knee gonarthrosis, it is necessary to consult an orthopedic traumatologist.If surgery is necessary, the help of a surgeon may be required.
Diagnostic measures
To establish the cause of the disease, a comprehensive approach to examining the patient is extremely important.
The diagnostic scheme consists of several steps:
- Visual examination by an orthopedist and medical history.The doctor determines whether the patient has symptoms of acute osteoarthritis of the knee joint, palpates the affected area of the leg, measures the bone and performs angiometry - a test that can be used to assess the mobility of the joint at different angles.
- Clinical blood test to evaluate ESR.
- Blood biochemistry.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common examination methods for osteoarthritis.However, at the initial stages, the image does not show changes - they can only be noticed at later stages of development.An x-ray reveals narrowing of the joint space, sclerotic changes in the cartilage area, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure.However, complete examination results can be achieved if ultrasound is performed together with radiography.
- Magnetic resonance imaging allows you to thoroughly study all layers of articular, cartilaginous and bone tissues and observe the first dystrophic changes in the initial stages of the development of arthrosis.However, MRI has one major disadvantage: the procedure is quite expensive.But its high precision contributes to a diagnosis with 99.9% accuracy.
Treatment
The treatment of acute knee osteoarthritis, as well as its diagnosis, requires an integrated approach.But, first of all, it is necessary to use drug therapy, as the diseased joint can become inflamed at any time.
Drug treatment
How to treat gonarthrosis of the knee joint with the help of pharmaceutical drugs and which drugs to choose?Only a traumatologist will tell you about this.Often the treatment regimen includes drugs from the following groups:
- Nonsteroidal anti-inflammatory drugs COX-1 or 2. The first group can seriously harm the gastrointestinal tract, so they cannot be used for a long time.This cannot be said about drugs from the COX-2 group, which are more gentle.They are administered intramuscularly or intravenously.
- Treatment of arthrosis of the knee joint also involves the use of hormonal medications.They help relieve inflammation and eliminate knee swelling.Its use is advisable if synovitis occurs (inflammatory process in the region of the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams.They improve blood circulation, warm, relieve swelling and inflammation.
Method one
How to cure arthrosis of the knee joint with this method?The main elements of the treatment regimen are:
- use of medications (NSAIDs, chondroprotectors, analgesics, ointments, creams, gels);
- light physiotherapy;
- manual therapy;
- physiotherapy;
- hot anti-inflammatory compresses with medicinal solutions.
Furthermore, according to the famous rheumatologist, diet plays an important role in osteoarthritis.Through a properly designed diet and the use of all of the above methods, you can achieve amazing results from therapy in the shortest possible time.
Method two
Often, the treatment of arthrosis of the knee joint, as well as other joint pathologies, is carried out using this method.
The development of the famous doctor is based on the use of:
- medicines;
- surgical intervention;
- follow a diet that removes excess fluid from the body;
- kinesiotherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, going to the sauna and getting massages.This will help improve the patient's health, especially if the disease has been ignored and untreated for a long time.
Treatment using the third method
Treatment of gonarthrosis of the knee joint with this method completely eliminates dynamic loads, as they can significantly accelerate the deformation process.Physical exercises should be slow, with low amplitude.
Example: sitting on a chair “astride”, that is, facing backwards.Spread your legs wide apart, but don't let them touch the floor.Lightly swing each leg in turn.Do the exercise until you feel a little tired.The number of approaches depends on the patient's well-being.
Surgical intervention
How to treat advanced osteoarthritis of the knee joints?In this case, there is only one way out: surgery.There are several types of surgery performed for osteoarthritis of the knee joints:
- Removal of deformed cartilaginous tissue and diseased joint (arthrodesis).This is done extremely rarely.
- Removal of damaged cartilaginous tissue without removing the joint.This intervention is called arthroscopic debridement.It is carried out using a special device - an arthroscope.The procedure is simple, but its effect does not last more than 3 years.
- Saw and fix the diseased joint at a different angle.This method is called periarticular osteotomy.The technique is quite complex, but it allows you to forget about the pathology for 3 to 5 years.
Surgical intervention is rarely used and only in the absence of a method that can cure the disease for at least 1-2 years.In the early stages of the disease, surgery is almost never performed.
Endoprostheses
Endoprosthesis replacement is considered the most common method of treating gonarthrosis.It is a type of surgery that allows you to fully preserve the mobility of the diseased knee.But despite its effectiveness, this technique requires long-term rehabilitation.Furthermore, it can lead to quite serious consequences.
Instead of the “real” one, the patient receives an artificial joint, which can last 20 years.Although, of course, it all depends on the material from which it was made.The procedure is not cheap, but quite effective, which is why it has gained particular popularity.
Therapeutic exercise
A course of exercise therapy is prescribed by a doctor depending on the stage of the disease.However, the principles for performing the exercises are the same for all cases:
- avoiding intense stress on the knee joint;
- sudden and forced movements are prohibited;
- do not perform exercises that require full load on the painful joint.
Allowed exercises:
- slight tremor in the legs when kneeling on a blanket spread on the floor;
- careful movements of knees in the same position;
- In the same position, straighten your legs one by one, trying not to lift your heels off the floor, and then bend them again, avoiding sudden movements.
These exercises, combined with drug treatment and physiotherapy, provide excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission.Among the most effective methods, the following should be highlighted:
- electrophoresis with medicinal solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent the disease from reappearing, physiotherapy courses should be carried out at least 2 times a year.This will help prolong the remission phase.
Massage
Knee massage is performed to improve blood circulation.It is carried out along the lymphatic flow in the direction of the peripheral area to the central area.The popliteal fossa is not involved in this process.
Often, along with massage, manual therapy sessions are carried out, with the aim of gradually stretching the painful joint.Such procedures stabilize the patient's condition, but can only be performed by a specialist.
Is gonarthrosis completely curable?
Is it possible to completely cure osteoarthritis of the knee joint?Perhaps no one, even the most experienced traumatologist, can give an unequivocal answer to this question.It all depends on the severity of the disease.If you get therapy in the early stages of its development, you can prevent further deformation of the joint.
However, if the pathology is detected in the final stages, even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms.The operation provides cure only for a few years, after which the disease may manifest itself again.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- perform physical exercises constantly (squats, running, raising and lowering your legs);
- enrich the diet with foods that contain many vitamins;
- limit the consumption of salt, spicy seasonings, fried foods, smoked foods, sweets;
- maintain normal physical shape;
- consult a doctor immediately if you suffer the slightest knee injury;
- preventive use of chondroprotectors from the age of 35;
- drink the daily norm of water (2 l).
By following these simple recommendations, you will reliably protect yourself from arthrosis of the knee joint, as well as other diseases that can reduce your quality of life for a long time.