Gonarthrosis, or arthrosis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes the 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 leading place among all arthrosis, and if at first only a small part of the joint is affected, in the absence of adequate treatment, when the disease reaches an advanced 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 manifest itself even at a young age (after suffering serious joint injuries).
Women are more susceptible to the process of joint deformation, but this often occurs in men and even in young children.In order not to make the situation worse, you must be able to recognize the first signs of this disease.
Variety
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 the nature of their manifestation they are almost identical.
Therefore, 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 elderly people, women and patients suffering from obesity.Gonarthrosis of the knee joint of the primary type can develop for years without manifesting itself.But the earlier it is identified, the more favorable the prognosis for its treatment will be.
- Secondary gonarthrosisKnee pain occurs due to previous injuries, but can also be a consequence of various infectious pathologies.If damaged joints are treated timely, the patient has every chance to avoid this disease.
There are types of arthrosis depending on the location:
- Gonarthrosis of the right side, which develops in the joint tissues of the right knee.It often occurs in athletes, as well as people whose work requires frequent physical activity.
- Gonarthrosis of the left sideinvolves the left knee in the pathological process.It occurs in people who play sports professionally, as well as in patients diagnosed with obesity.
- Bilateral arthritishas 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 in terms of therapeutic approach.In most cases, this type of gonarthrosis of the knee joint develops in older 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 patella, are covered with elastic glial cartilage, 5-6 mm thick.It helps reduce friction when a person carries out physical activity, and in the event of falls it has a shock-absorbing function.
Pathological changes in the joints: gradual disorders
In the first stage of development of gonarthrosis of the knee joint, mainly blood circulation is affected.The small intraosseous vessels supplying 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 the diseased cartilages, shifting slightly, prevent each other from fully performing their functions.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 stage of the progression of gonarthrosis, compensatory changes begin to occur in the bone area.Under the influence of increased loads, the joint platform begins to gradually flatten, this leads to compaction of the subchondral zone (the area of the bone located under the cartilage).
The joint surfaces along the edges begin to be covered with bony processes, which on X-rays look like sharp tips.
As the lubricating fluid in the joints becomes thicker, it loses much of its function.This leads to accelerated degeneration of the cartilage.For this reason, on x-ray, it appears as a thin thread, or becomes completely invisible.
If this was noticed, it means that the disease flows smoothly (or quickly, it all depends on the situation) in the 3rd stage of development.
At the third stage of gonarthrosis of the knee joint, noticeable deformation of the bones occurs.They seem squeezed into each other, which leads to reduced 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 simultaneously determines several factors 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 tears of ligaments;
- excessively intense stress on the knee joints.
Acute arthrosis of the knee joint is directly related to a person's age.Therefore, it has been established that people over 40 are more susceptible to it, since during this period the flexibility of the cartilage begins to decrease and the lubricating fluid of the joints gradually “dries out”.
To delay this moment, patients are advised to play sports, but physical activity should be moderate and not lead to general discomfort.
Excess weight is also one of the factors that predispose 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, the fact that the leg supports more loads plays an important role.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 microtraumas and rupture of small blood vessels.Meniscus or ligament tears are also possible and are considered a serious way of experiencing 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 an unfavorable inheritance;
- have problems with the ligament system;
- suffer from metabolic disorders;
- suffered traumatic brain injury;
- injured in a road accident;
- he had spinal injuries.
Many of these factors are often closely related.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 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 phases.
First phase
In the initial stage of development of the disease, patients complain of mild pain in the knee area, which intensifies with physical activity.They become particularly intense when going down and up stairs.
In addition to pain, the patient feels a certain stiffness of movements, a "stiffening" in the joint area.It is felt in the popliteal area 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 phase
At this time, the symptoms of arthrosis of the knee joint become more intense and noticeable.The pain intensifies, causing considerable difficulty and discomfort in 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 loud and unpleasant creaking sound occurs.Movements become more difficult and limited.
Phase three
The pain becomes very strong and the patient cannot do without painkillers.It is difficult for a person to bend the knee, he 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 lead to disability.
Which doctor treats gonarthrosis of the knee joint?
To diagnose and treat gonarthrosis of the knee it is necessary to consult an orthopedic traumatologist.If surgery is necessary, you may need the help of a surgeon.
Diagnostic measures
To establish the cause of the disease, a comprehensive approach to patient examination is extremely important.
The diagnostic scheme is composed of several phases:
- 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 evaluate the mobility of the joint from different angles.
- Clinical blood test to evaluate ESR.
- Blood biochemistry.
- Study of urine and blood for the content of fibrinogen, urea and other substances.
- X-ray is one of the most common examination methods for osteoarthritis.However, in the early stages, the picture does not show any changes, which can only be noticed in the 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 obtained if ultrasound is performed together with x-ray.
- Magnetic resonance imaging allows you to thoroughly study all layers of joint, cartilaginous and bone tissues and notice the first dystrophic changes in the early stages of the development of arthrosis.However, MRI has one big disadvantage: the procedure is quite expensive.But its high accuracy helps to make an accurate diagnosis of 99.9%.
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, because the diseased joint can become inflamed at any time.
Pharmacological treatment
How to treat gonarthrosis of the knee joint with the help of drugs and which drugs to choose?Only a traumatologist will tell you.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 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 drugs.They help relieve inflammation and eliminate swelling in the knee.Their use is advisable in case of synovitis (an 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 cure arthrosis of the knee joint using this method?The main elements of the treatment regimen are:
- use of drugs (NSAIDs, chondroprotectors, painkillers, ointments, creams, gels);
- light physical therapy;
- manual therapy;
- physiotherapy;
- anti-inflammatory warm compresses with medicinal solutions.
Also, according to the famous rheumatologist, diet plays an important role in osteoarthritis.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.
Method two
Often this method is used to treat arthrosis of the knee joint, as well as other joint pathologies.
The development of the famous doctor is based on the use of:
- drugs;
- surgery;
- follow a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, visiting the sauna and getting 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 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 on a chair "straddling", i.e. facing your back.Spread your legs, but don't let them touch the floor.Slightly swing each leg in turn.Perform the exercise until you feel slightly tired.The number of approaches depends on the well-being of the patient.
Surgery
How to treat advanced arthrosis of the knee joints?In this case there is only one way out: surgical intervention.There are several types of surgical interventions performed for arthrosis 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 surgery 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.
- 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 3-5 years.
Surgical intervention is rarely used 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.
Endoprosthesis
Endoprosthesis replacement is considered the most common method for treating gonarthrosis.This is a type of surgery that allows you to fully preserve the mobility of the affected knee.But, despite its effectiveness, this technique requires long-term rehabilitation.Moreover, it can lead to quite serious consequences.
Instead of the "real" one, the patient is implanted with an artificial joint, which can last 20 years.Although, of course, it all depends on the material with 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 physical 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:
- avoid 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 trembling of the legs while kneeling on a blanket spread on the floor;
- careful movements on the 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 physiotherapy give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission.Among the most effective methods should be noted:
- electrophoresis with medicinal solutions;
- magnetotherapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulphide;
- sludge treatment.
To prevent a recurrence of the disease, physiotherapy courses should 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 lymphatic flow in the direction from the peripheral zone to the central zone.The popliteal fossa is not involved in this process.
Often, together with massage, manual therapy sessions are performed, aimed at 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 arthrosis of the knee joint?Perhaps no one, not even the most experienced traumatologist, can give a clear answer to this question.It all depends on the severity of the disease.If you undertake therapy in the early stages of its development, you can stop 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 a cure for only a few years, after which the disease can manifest itself again.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- constantly perform physical exercises (squats, running, lifting and lowering the legs);
- enrich your diet with foods containing many vitamins;
- limit the consumption of salt, hot spices, fried, smoked, sweet foods;
- maintain normal physical shape;
- consult a doctor immediately if you receive the slightest knee injury;
- preventive use of chondroprotectors after 35 years of age;
- drink the daily norm of water (2 l).
By following these simple recommendations, you will reliably protect yourself from arthrosis of the knee joint and other diseases that can reduce the quality of life for a long time.