Gonarthrosis, or knee arthrosis, is a serious degenerative-dystrophic pathology of the knee joint, which causes the destruction of the joint cartilage tissue structure, which, in turn, leads to their deformation and loss of function.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 if there is no adequate treatment, when the disease reaches the final stage of development, the entire joint is involved in the pathological process.
Most often, this disease develops in people over the age of 40, but in athletes it can also occur at a young age (after receiving a serious joint injury).
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 early signs of this disease.
Varieties
The classification of gonarthrosis depends on its etiology and location.Each variety has its own developmental characteristics, which doctors always take into account when prescribing treatment.But in terms of the nature of their manifestation, they are almost the same.
Therefore, the types of acute arthrosis of the knee joint, depending on the etiology of the disease, are as follows:
- primary gonarthrosis.The disease develops without any preconditions.Risk groups include the elderly, women, and patients with obesity.Gonarthrosis of the knee joint of the primary type can develop for many years without manifesting itself.But the sooner it is detected, the better the prognosis for its treatment.
- Secondary gonarthrosisknee pain occurs as a result of previous injuries, but it can also be the result of various infectious pathologies.If the damaged joint is treated in time, the patient has every chance to avoid this disease.
There are types of osteoarthritis according to localization:
- right sided gonarthrosis, which develops in the articular tissue of the right knee.It often occurs in athletes, as well as in people whose work requires frequent physical activity.
- Gonarthrosis of the left sideinvolving the left knee in the pathological process.It occurs in people professionally involved in sports, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritishas a damaging effect on the knee joint tissue of both legs.This type of disease is considered the worst, both in terms of symptoms and in terms of therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in the elderly, that is, it is idiopathic.
Anatomy and pathological changes
The knee joint is formed from the articular surface of the tibia and femur.In its anterior part there is a patella, which during movement 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 does physical activity, and in the event of a fall it performs a shock absorbing function.
Pathological changes in the joints: gradual disorder
In the first stage of the development of gonarthrosis of the knee joint, blood circulation is mainly affected.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 come into contact with each other.Inflammation gradually begins to develop, and diseased cartilage, shifting slightly, prevents each other from performing their functions fully.Due to the formation of a large number of microcracks in the area of tissue that make up the cartilage, they gradually lose their shock-absorbing properties.
In the second phase of the development of gonarthrosis, compensatory changes in the bone area begin to occur.Under the influence of increased load, the articular platform begins to flatten gradually, this leads to the compaction of the subchondral zone (the bone area located under the cartilage).
The surface of the joint along the edge begins to be overgrown with bone processes, which on x-ray look like sharp spikes.
As the lubricating fluid in the joint 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 observed, it means that the disease smoothly (or quickly - it all depends on the situation) flows into the 3rd phase of development.
In the third stage of gonarthrosis of the knee joint, significant bone deformation occurs.They seem to be pressed against each other, which leads to a decrease in joint mobility.Cartilage tissue is almost gone.
Causes and predisposing factors
The causes of arthrosis of the knee joint are not isolated - often doctors determine several factors at once that lead to the development of the disease.
The most common and common reasons are:
- previous joint injury (moderate or severe severity);
- ankle fracture, especially if there is intra-articular damage;
- violation of the integrity of the meniscal structure;
- tear or complete rupture of the ligament;
- excessive pressure on the knee joint.
Acute arthrosis of the knee joint is directly related to a person's age.Therefore, it has been determined that people over the age of 40 are most susceptible to it, because during this period the flexibility of the cartilage begins to decrease, and the lubricating joint fluid gradually "dry".
To delay this time, patients are recommended to play sports, but physical activity should be moderate and not lead to general discomfort.
Being overweight is also one of the predisposing factors to the development of gonarthrosis.The fact is that excess body weight puts additional pressure on bones and joints, which inevitably affects their 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, then there is a high probability that you may have left-sided gonarthrosis.
In obesity, constant pressure on the joints leads to microtrauma and rupture of small blood vessels.A torn meniscus or ligament is also possible, which is considered a serious way to indicate a joint injury.
This disease is very difficult for patients with significant varicose vein symptoms.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;
- having an unfavorable lineage;
- have problems with the ligamentous apparatus;
- have metabolic disorders;
- suffered a traumatic brain injury;
- injured in a traffic accident;
- suffered a spinal injury.
Many of these factors are often closely related.Determining the exact cause helps to establish an accurate diagnosis and assign the patient the correct and effective treatment for arthrosis of the knee joint.
Clinical manifestations
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 step by step.
First stage
In the early stages of the disease, the patient complains of mild pain in the knee area, which increases with physical activity.They become very intense when going down and up stairs.
In addition to pain, the patient feels stiffness of certain movements, "tightening" in the joint area.It is felt in the popliteal region, and disappears 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 knee gets 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 increases, 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 with the naked eye.When walking, a loud and unpleasant crunching sound occurs.Movement becomes more difficult and restricted.
Level three
The pain becomes very severe, and the patient cannot do without painkillers.It is difficult for a person to bend his knees, he feels stiffness in the movement 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.This 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 steps
To determine the cause of the disease, a comprehensive approach to examining the patient is very important.
The diagnostic scheme consists of several stages:
- Visual examination by an orthopedic specialist and medical history.Doctors determine whether the patient has symptoms of acute arthrosis of the knee joint, palpate the affected area of the leg, measure the bones and conduct angiometry - a test that can be used to assess joint mobility from different angles.
- Clinical blood tests to assess ESR.
- Blood biochemistry.
- Urine and blood studies for the content of fibrinogen, urea and other substances.
- Radiography is one of the most common examination methods for arthrosis.However, at an early stage, the image does not show any changes - it is only visible at a later stage 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, a full examination result can be achieved if ultrasound is performed together with radiography.
- MRI allows you to carefully study all layers of articular tissue, cartilage and bone, and notice the first dystrophic changes in the early stages of the development of arthrosis.However, MRI has one big drawback - 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 diseased joints can become inflamed at any time.
Drug treatment
How to treat gonarthrosis of the knee joint with the help of pharmaceutical drugs, and which drug should be chosen?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 should not be used for a long time.This cannot be said about COX-2 group drugs, which are milder.They are given intramuscularly or intravenously.
- Treatment of arthrosis of the knee joint also involves the use of hormonal drugs.They help relieve inflammation and relieve knee swelling.Its use is advised if synovitis occurs (inflammatory process in the area of the synovial membrane).
- Treatment with chondroprotectors.
- Use of ointments, gels, creams.They improve blood circulation, warm the body, 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:
- the use of drugs (NSAIDs, chondroprotectors, painkillers, ointments, creams, gels);
- mild physical therapy;
- manual therapy;
- physiotherapy;
- warm anti-inflammatory compresses with medicinal solutions.
In addition, according to a well-known rheumatologist, diet plays an important role in arthrosis.Through a properly designed diet and the use of all the above methods, you can achieve amazing results from therapy in the shortest possible time.
The second method
Often, the treatment of arthrosis of the knee joint, as well as other articular pathologies, is carried out using this method.
The development of famous doctors is based on the use of:
- medicines;
- surgical intervention;
- follow a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
Doctors also recommend 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 neglected and untreated for a long time.
Treatment uses the third method
Treatment of gonarthrosis of the knee joint using this method completely eliminates the dynamic load, as it can significantly accelerate the deformation process.Physical exercise should be slow, with low amplitude.
Example: sitting on a "stride" chair, i.e. facing backwards.Spread your legs wide, but do not let them touch the floor.Slowly swing each leg in turn.Do exercise until you feel a little tired.The number of approaches depends on the well-being of the patient.
Surgical intervention
How to treat advanced arthrosis of the knee joint?In this case, there is only one way out - surgery.There are several types of surgery performed for osteoarthritis of the knee joint:
- Removal of defective cartilage tissue and diseased joints (arthrodesis).This is done very 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 the effect is no more than 3 years.
- Sawing and securing diseased joints at different angles.This method is called periarticular osteotomy.This technique is quite complex, but it makes it possible to forget the pathology for 3-5 years.
Surgical intervention is rarely performed, and only if there is no method that cures the disease, at least for 1-2 years.In the early stages of the disease, surgery is almost never performed.
Endoprosthetics
Endoprosthesis replacement is considered the most common method of treating gonarthrosis.This is the type of surgery that allows you to fully preserve the mobility of the diseased knee.But, despite its effectiveness, this technique requires long-term recovery.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 is made.This procedure is not cheap, but quite effective, which is why it has gained certain popularity.
Therapeutic exercise
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease.However, the principle of performing exercises is the same for all cases:
- avoid intense pressure on the knee joint;
- sudden and forced movements are prohibited;
- do not do exercises that require full load on the painful joint.
Allowed exercises:
- light shaking of legs while kneeling on a blanket spread on the floor;
- careful movement of your knees in the same position;
- in the same position, straighten your legs one by one, try not to lift your heels off the floor, and then bend them again, avoiding sudden movements.
Such training in combination with drug treatment and physiotherapy gives excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis that is in remission.Among the most effective methods should be noted:
- electrophoresis with medical solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- bathing with radon or hydrogen sulfide;
- mud treatment.
To prevent the recurrence of the disease, a course of physiotherapy must be taken 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 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 the massage, manual therapy sessions are performed, aimed at gradually stretching the painful joints.Such a procedure stabilizes the patient's condition, but can only be carried out by a specialist.
Can gonarthrosis be completely cured?
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 stage of its development, you can stop further joint deformation.
However, if the pathology is detected at a late stage, then even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms.Surgery provides a cure only for a few years, after which the disease can be recognized again.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- always do physical exercises (squats, running, raising and lowering legs);
- enrich the diet with foods that contain many vitamins;
- limit the use of salt, hot spices, fried, smoked, sweets;
- maintain a normal physical form;
- see a doctor immediately if you receive a minor knee injury;
- preventive use of chondroprotectors after reaching the age of 35;
- drink the daily norm of water (2 l).
By following these simple recommendations, you will definitely 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.