Gonarthrosis or arthrosis of the knee is a serious degenerative-dystrophic pathology of the knee joint, which causes destruction of the cartilage tissue structure 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 initially 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 appear 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 in young children.In order not to worsen the situation, you must be able to recognize the first signs of this disease.
Varieties
The classification of gonarthrosis depends on its etiology and localization.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.
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 preconditions.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 showing 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 the damaged joints are treated promptly, the patient has every chance to avoid this disease.
There are types of osteoarthritis according to localization:
- Right-sided gonarthrosis, which develops in the joint tissues of the right knee.It is often found 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 the therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in elderly people, that is, it has an idiopathic character.
Anatomy and pathological changes
The knee joint is formed by the articular surfaces of the tibia and femur.In its front part is the patella, which during movements smoothly slides along the recess located between the condyles of the femoral joint.
The femur and tibia together with the knee cap are covered with elastic glialine cartilage 5-6 mm thick.It helps to reduce friction when a person performs physical activity, and when falling, it performs a shock absorbing function.
Pathological changes in the joints: gradual disorders
In the first stage of development of gonarthrosis of the knee joint, blood circulation is mainly 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 smoothly, these cartilages touch each other.Inflammation gradually begins to develop, and diseased cartilages, slightly displaced, 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 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 that is located under the cartilage).
The articular surfaces along the edges begin to grow with bony 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 is noticed, it means that the disease smoothly (or quickly - it all depends on the situation) passes into the 3rd phase of development.
At the third stage of gonarthrosis of the knee joint, a noticeable deformation of the bones appears.They seem to be pressed into each other, which leads to reduced mobility of the joints.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 causes are:
- previous joint injuries (of moderate or severe severity);
- ankle fractures, especially if there is intra-articular damage;
- violation of the integrity of the meniscus structure;
- ruptures 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 was found that people over 40 are most susceptible to it, because during this period the flexibility of the cartilage begins to decrease and the lubricating joint fluid gradually "dries up".
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 carries more loads.For example, if your "support" is your left leg, then there is a high probability that you will develop left-sided gonarthrosis.
In obesity, the constant pressure on the joints leads to microtraumas and rupture of small blood vessels.Tears of menisci or ligaments are also possible, which are considered a serious way to manifest joint injuries.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins.In this case, the patient is recommended 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;
- there are problems with the ligament 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.The exact determination of the cause helps to establish an accurate diagnosis and to prescribe the patient the correct and effective treatment of 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 should be considered in stages.
First stage
In the initial stage of the disease, patients complain of mild pain in the knee area, which is aggravated by physical exertion.They become especially intense when going down and up stairs.
In addition to pain, the patient feels some stiffness of movement, "tightness" in the joint area.It is felt behind the knee 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 significant difficulty and discomfort when walking.The pain syndrome disappears after a long rest, but during intense exercise it is felt again.
Inflammation of the joint causes swelling of the knee, which is noticeable even with the naked eye.A loud, unpleasant crunch is heard when walking.Movements become more difficult and restricted.
Third stage
The pain becomes very strong and the patient cannot do without painkillers.A person has difficulty bending his knee, feels stiffness in the movements of the joint.It deforms 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 to the point of disability.
Which doctor treats gonarthrosis of the knee joint?
To diagnose and treat gonarthrosis of the knee, you should consult an orthopedic traumatologist.If surgery is necessary, the help of a surgeon may be required.
Diagnostic measures
In order to establish the cause of the disease, a comprehensive approach to the examination of 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 study that can be used to assess the mobility of the joint from different angles.
- Clinical blood test to evaluate ESR.
- Blood biochemistry.
- Examination of urine and blood for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common methods for studying arthrosis.However, in the initial stages, the image does not show any changes - they can be noticed only in the later stages of development.X-rays reveal 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 results of the study can be achieved if ultrasound is performed together with radiography.
- MRI allows you to thoroughly examine all layers of joint, cartilage and bone tissue and notice the first dystrophic changes in the early stages of the development of arthrosis.However, MRI has one major drawback – the procedure is quite expensive.But its high accuracy contributes to making a 99.9% accurate diagnosis.
Treatment
The treatment of acute arthrosis of the knee joint, as well as its diagnosis, require an integrated approach.But, first of all, it is necessary to use drug therapy, since the diseased joint can become inflamed at any time.
Drug treatment
How to treat gonarthrosis of the knee joint using 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 damage the gastrointestinal tract, so they cannot be used for a long time.This cannot be said about the drugs of the COX-2 group, which are more gentle.They are administered intramuscularly or intravenously.
- Treatment of arthrosis of the knee joint also includes the use of hormonal drugs.They help relieve inflammation and eliminate knee swelling.Their use is recommended when synovitis occurs (inflammatory process in the area 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 treat arthrosis of the knee joint with this method?The main elements of the treatment regimen are:
- use of drugs (NSAIDs, chondroprotectors, pain relievers, ointments, creams, gels);
- light physical therapy;
- manual therapy;
- physical therapy;
- warm anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in arthrosis.Through a properly developed diet and the use of all the above methods, you can achieve incredible results of the 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;
- following a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
In addition, the doctor 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 according to 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: sit in a chair "reclining", that is, facing the back.Spread your feet wide, but don't let them touch the floor.Gently rotate 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 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 cartilaginous 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 performed using a special device - an arthroscope.The procedure is simple, but its effect lasts no more than 3 years.
- Excision and fixation of the diseased joint at a different angle.This method is called periarticular osteotomy.The technique is quite complicated, but it allows to forget about the pathology for 3-5 years.
Surgical intervention is rarely resorted to and only in the absence of a method to cure the disease, at least for 1-2 years.In the initial stage of the disease, surgery is almost never performed.
Endoprosthetics
Endoprosthesis is considered the most common method of treating gonarthrosis.This is a type of surgery that allows you to completely preserve the mobility of the affected 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 that can last 20 years.Although, of course, it all depends on the material from which it is made.The procedure is not cheap, but quite effective, which is why it has gained particular popularity.
Physical therapy
The 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 inflamed joint.
Exercises that are allowed:
- slight trembling of the legs while 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, then bend them again, avoiding sudden movements.
Such exercises in combination with drug treatment and physical therapy give excellent results.
Physiotherapy
All physiotherapy procedures are prescribed for gonarthrosis that is in remission.Among the most effective methods should be noted:
- electrophoresis with medicinal solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave processing;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment
In order to prevent a recurrence of the disease, physiotherapy courses should be held at least 2 times a year.This will help prolong the remission phase.
massage
Knee massage is done to improve blood circulation.It is carried out along the course of the lymph flow in the direction from the peripheral zone to the central zone.The popliteal fossa is not involved in this process.
Often, along with the massage, manual therapy sessions are conducted, aimed at gradually stretching the inflamed 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 arthrosis of the knee joint?Perhaps no one, not even the most experienced traumatologist, can give an unequivocal answer to this question.It all depends on the severity of the disease.If you engage in therapy in the first stages of its development, you can stop further deformation of the joint.
However, if the pathology is detected in the final stages, then even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms.The operation provides a cure for only a few years, after which the disease may recur.
Prevention
To prevent gonarthrosis, it is necessary:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, lifting and lowering the legs);
- enrich the diet with foods containing many vitamins;
- limiting the consumption of salt, hot spices, fried, smoked, sweets;
- maintaining a normal physical shape;
- consult a doctor immediately if you get the slightest injury to the knee;
- preventive use of chondroprotectors after the age of 35;
- 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.