Gonarthrosis, or arthrosis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes destruction of the structure of the cartilage 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 leading 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 receiving serious joint injuries).
Women are most susceptible to the process of joint deformation, but it often occurs in men and even small children.In order not to worsen the situation, you need to be able 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 developmental 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.
Thus, 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.Gonarthrosis of the knee joint of the primary type can develop for years without manifesting itself.But the sooner it is detected, the more favorable the prognosis for its treatment will be.
- Secondary gonarthrosisknee pain occurs due to previous injuries, but it 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 localization:
- Right-sided gonarthrosis, which develops in the articular 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 are professionally involved in sports, 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 severe, both in terms of symptoms and in terms of therapeutic approach.In most cases, this type of knee joint gonarthrosis develops in people of old age, that is, it is idiopathic in nature.
Anatomy and pathological changes
The knee joint is formed from the articular surfaces of the tibia and femur.In its anterior part there 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, which is 5-6 mm thick.It helps reduce friction when a person performs physical activity, and in case of falls it performs a shock-absorbing function.
Pathological changes in joints: gradual disorders
At the first stage of development of gonarthrosis of the knee joint, blood circulation is primarily affected.The small intraosseous vessels that supply blood to the hyaline joint are disrupted, which leads to gradual drying of its surface.It becomes less elastic, and cracks begin to form on its surface.
As a result, instead of sliding gently, these cartilages touch each other.Inflammation gradually begins to develop, and diseased cartilages, shifting slightly, prevent each other from performing their functions fully.Due to the formation of a large number of microcracks in the area of the tissues that make up the cartilage, they gradually lose their shock-absorbing properties.
In the second phase of progression of gonarthrosis, compensatory changes in the bone area begin to occur.Under the influence of increased loads, the articular platform begins to gradually flatten, this leads to compaction of the subchondral zone (the area of the bone that is located under the cartilage).
The joint surfaces along the edges begin to become overgrown 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 becomes completely invisible.
If this was noticed, this means that the disease smoothly (or rapidly - it all depends on the situation) flows into the 3rd phase of development.
At the third stage of gonarthrosis of the knee joint, noticeable deformation of the bones occurs.They seem to be squeezed into each other, which leads to decreased joint mobility.The cartilage 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 was intra-articular damage;
- violation of the integrity of the meniscal structure;
- tears or complete ruptures of ligaments;
- excessively intense stress on the knee joints.
Acute arthrosis of the knee joint is directly related to a person’s age.Thus, it has been established that people over 40 are most susceptible to it, since during this period the flexibility of cartilage begins to decrease, and the lubricating joint fluid gradually “dries out”.
To delay this moment, patients are recommended to play sports, but physical activity should be moderate and not lead to general discomfort.
Excess weight is also one of the factors predisposing to the development of gonarthrosis.The fact is that excess body weight creates additional stress on bones and joints, which cannot but affect their health.
In this case, an important role is played by the fact which leg bears more loads.For example, if your “support” is your left leg, then there is a high probability that you may develop left-sided gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels.Meniscus or ligament ruptures are also possible, which are considered a serious way of manifesting 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:
- previously suffered from various types of arthritis;
- have 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 interrelated.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
Symptoms of gonarthrosis do not manifest themselves 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
At the initial stage of development of the disease, patients complain of mild pain in the knee area, which intensifies with physical activity.They become especially intense during the descent and ascent of stairs.
In addition to pain, the patient feels a certain stiffness of movement, “tightening” in the joint area.It is felt in the popliteal part, and goes away when the knee muscles relax.
Another characteristic symptom is the so-called “starting 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 significant 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 of the knee, which is noticeable even to the naked eye.When walking, a strong, unpleasant crunching sound occurs.Movements become more difficult and constrained.
Stage three
The pain becomes very severe, and the patient cannot do without painkillers.It is difficult for a person to bend his knee, he feels stiffness in the movements of the joint.It becomes deformed and increases in size.In severe cases, the patient cannot move without additional support.
All these signs of arthrosis of the knee joint should not be ignored by the patient.The disease can put 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, you must consult an orthopedic traumatologist.If surgery is necessary, the help of a surgeon may be needed.
Diagnostic measures
To establish the cause of the illness, a comprehensive approach to examining the patient is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination by an orthopedist and medical history.The doctor determines whether the patient has symptoms of acute arthrosis of the knee joint, palpates the affected area of the leg, measures the bone and conducts angiometry - a test that can be used to evaluate the mobility of the joint from different angles.
- Clinical blood test to assess ESR.
- Biochemistry of blood.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common examination methods for arthrosis.However, in the initial stages, the image does not show any changes - they can only be noticed in the later stages of development.An x-ray reveals a 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, full examination results can be achieved if ultrasound is performed together with radiography.
- MRI allows you to thoroughly study all layers of articular, cartilage and bone tissues, and notice the first dystrophic changes in the early stages of arthrosis development.However, MRI has one big disadvantage - the procedure is quite expensive.But its high accuracy contributes to making a 99.9% accurate diagnosis.
Treatment
Treatment of acute arthrosis of the knee, as well as its diagnosis, requires an integrated approach.But, first of all, it is necessary to use drug therapy, because 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:
- Non-steroidal 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 of 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 drugs.They help relieve inflammation and get rid of swelling of the knee.Their use is advisable if synovitis occurs (an inflammatory process in the area of the synovial membrane).
- Treatment with chondroprotectors.
- Application of ointments, gels, creams.They improve blood circulation, warm up, relieve swelling and inflammation.
Method one
How to cure arthrosis of the knee joint using this method?The main elements of the treatment regimen are:
- use of medications (NSAIDs, chondroprotectors, painkillers, ointments, creams, gels);
- light physical therapy;
- manual therapy;
- physiotherapy;
- warm anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in arthrosis.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, treatment of arthrosis of the knee joint, as well as other articular pathologies, is carried out using this method.
The development of the famous doctor is based on the use of:
- medications;
- surgical intervention;
- following a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, visiting the sauna and going for a massage.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 knee joint gonarthrosis using this method completely eliminates dynamic loads, since they can significantly accelerate the process of deformation.Physical exercises should be slow, with low amplitude.
Example: sit on a chair “astride”, that is, facing the back.Spread your legs wide apart, but do not let them touch the floor.Lightly swing each leg in turn.Perform the exercise until you feel slightly tired.The number of approaches depends on the patient’s well-being.
Surgical intervention
How to treat advanced arthrosis 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 cartilage tissue and diseased joint (arthrodesis).This is done extremely rarely.
- Removal of damaged cartilage 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 lasts no longer than 3 years.
- Sawing and securing the diseased joint at a different angle.This method is called periarticular osteotomy.The technique is quite complex, but it makes it possible to forget about the pathology for 3-5 years.
Surgical intervention is resorted to infrequently, and only in the absence of a method that cures the disease, at least for 1-2 years.In the initial stages of the disease, surgery is almost never performed.
Endoprosthetics
Endoprosthesis replacement is considered the most common method of treating gonarthrosis.This 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.In addition, it can lead to quite serious consequences.
Instead of the “real” one, the patient is implanted with an artificial joint, which can last for 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 of 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 sore joint.
Exercises that are allowed:
- light shaking of the legs while kneeling on a blanket spread on the floor;
- careful movements on your 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.
Such exercises in combination with drug treatment and physiotherapy give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis that is in remission.Among the most effective methods it should be noted:
- electrophoresis with medicinal solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent a re-outbreak of the disease, physiotherapy courses must be taken at least 2 times a year.This will help prolong the remission phase.
Massage
Knee massage is performed to improve blood circulation.It is performed along the lymph flow in the direction from the peripheral area to the central zone.The popliteal fossa is not involved in this process.
Often, along with massage, manual therapy sessions are performed, aimed at gradually stretching the sore joint.Such procedures stabilize the patient’s condition, but can only be carried out by a specialist.
Is gonarthrosis completely curable?
Is it possible to cure osteoarthritis of the knee joint completely?Perhaps no one, even the most experienced traumatologist, can give an unambiguous answer to this question.It all depends on the severity of the disease.If you engage in therapy at the first stages of its development, you can stop further deformation of the joint.
However, if pathology is detected in the final stages, then even surgical intervention does not guarantee complete disappearance of unpleasant symptoms.The operation helps to cure only for a few years, after which the disease can make itself known again.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, raising and lowering legs);
- enrich the diet with foods containing many vitamins;
- limit the consumption of salt, hot spices, fried, smoked, sweets;
- maintaining normal physical shape;
- immediately consult a doctor if you receive the slightest knee injury;
- preventive use of chondroprotectors after reaching 35 years of age;
- drinking 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 from other diseases that can reduce your quality of life for a long time.