Gonarthrosis or osteoarthritis 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 prominent place among all osteoarthritis, and if at first only a small part of the joint is affected, 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 old, but in athletes it can also occur at a young age (after serious joint injuries).
Women are more susceptible to the process of joint deformation, but it often occurs in men and even young children.In order not to worsen the situation, it is necessary 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 the doctor always takes into account when prescribing treatment.But in terms of the nature of their manifestation, they are almost identical.
Thus, the types of acute osteoarthritis 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 knee joint gonarthrosis can develop for years without manifesting itself.But the earlier it is detected, the more favorable the prognosis will be for treatment.
- secondary gonarthrosisKnee pain is caused by 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 to avoid this disease.
There are types of osteoarthritis depending on its location:
- Gonarthrosis of the right side, 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.
- Gonarthrosis of the left sideinvolves the left knee in the pathological process.It occurs in people who practice sports professionally, as well as in patients diagnosed with obesity.
- Bilateral osteoarthritisIt has 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 older people, 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 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 by elastic glial cartilage, 5 to 6 mm thick.It helps reduce friction when a person performs physical activity, and in case of falls it performs a shock absorption function.
Pathological changes in the joints: gradual disorders.
At the first stage of the development of gonarthrosis of the knee joint, blood circulation is mainly affected.The small intraosseous vessels that supply blood to the hyaline joint are disturbed, 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 begins to develop gradually and the diseased cartilages, which move 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 form the cartilage, they gradually lose their shock absorption properties.
In the second phase of gonarthrosis progression, compensatory changes begin to occur in the bone area.Under the influence of increased loads, the articular platform begins to gradually flatten, this leads to compaction of the subchondral zone (the area of bone that is 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 thorns.
As the lubricating fluid in your joints becomes thicker, it loses much of its function.This leads to accelerated cartilage degeneration.For this reason, on an x-ray it looks like a thin thread or becomes completely invisible.
If this is noticed, it means that the disease progresses smoothly (or quickly, it all depends on the situation) into the third phase of development.
In the third stage of gonarthrosis of the knee joint, a noticeable deformation of the bones occurs.They appear to be squeezed together, which leads to decreased joint mobility.The cartilage tissue is almost exhausted.
Causes and predisposing factors.
The causes of osteoarthritis 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 (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 osteoarthritis of the knee joint is directly related to the person's age.Thus, it has been established that people over 40 years of age are the most susceptible to it, since during this period the flexibility of the cartilage begins to decrease and the joint lubricating fluid gradually “drys out.”
To delay this moment, patients are recommended to play sports, but physical activity should be moderate and not cause general discomfort.
Excess weight is also one of the factors that predispose to the development of gonarthrosis.The fact is that excess weight creates additional stress on bones and joints, which cannot but affect your health.
In this case, an important role is played by 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, constant pressure on the joints causes microtrauma and rupture of small blood vessels.Meniscus or ligament tears are also possible, which are considered a serious form of 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.
There is also a high risk of developing this pathology in people who:
- previously suffered from various types of arthritis;
- have unfavorable inheritance;
- have problems with the ligamentous apparatus;
- suffer from metabolic disorders;
- suffered traumatic brain injuries;
- injured in a traffic accident;
- He had spinal injuries.
Many of these factors are usually closely related to each other.An accurate determination of the cause helps to establish an accurate diagnosis and prescribe the patient the correct and effective treatment for osteoarthritis 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 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 descent and ascent of stairs.
In addition to pain, the patient feels a certain stiffness of movement, “tense” in the joint area.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 osteoarthritis of the knee joint become more intense and noticeable.The pain intensifies, causing significant difficulties and discomfort when walking.The pain syndrome disappears after a long rest, but with intense exercise it is felt again.
Inflammation of the joint causes swelling of the knee, which is noticeable even to the naked eye.When walking there is a loud, unpleasant creak.Movements become more difficult and restricted.
Stage three
The pain becomes very intense and the patient cannot do without pain relievers.It is difficult for a person to bend his 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.
The patient should not ignore all these signs of osteoarthritis of the knee joint.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, it is necessary to consult an orthopedic traumatologist.If surgery is necessary, the help of a surgeon may be needed.
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 stages:
- 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 to determine the content of fibrinogen, urea and other substances.
- X-ray is one of the most common examination methods for osteoarthritis.However, in the initial stages, the image does not show any change;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, complete examination results can be achieved if an ultrasound is performed along with an x-ray.
- MRI allows you to thoroughly study all layers of joint, cartilaginous and bone tissue and notice the first dystrophic changes in the early stages of the development of osteoarthritis.However, MRI has one major disadvantage: the procedure is quite expensive.But its high precision contributes to making a diagnosis with an accuracy 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 medications and what medications to choose?Only a traumatologist will tell you about this.Often the treatment regimen includes drugs from the following groups:
- COX-1 or 2 non-steroidal anti-inflammatory drugs. The first group can seriously damage the gastrointestinal tract, so they cannot be used for a long time.The same cannot be said for the COX-2 group drugs, which are milder.They are administered intramuscularly or intravenously.
- Treatment of osteoarthritis of the knee joint also involves the use of hormonal drugs.They help relieve inflammation and eliminate swelling in the knee.Its 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, relieve swelling and inflammation.
Method one
How to cure osteoarthritis 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;
- warm anti-inflammatory compresses with medicinal solutions.
Furthermore, according to the famous rheumatologist, diet plays an important role in osteoarthritis.With a properly designed diet and the use of all of the above methods, you can achieve amazing results with therapy in the shortest possible time.
Method two
Often, the treatment of osteoarthritis 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:
- medications;
- surgical intervention;
- 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 by the third method.
Treatment of gonarthrosis of the knee joint with this method completely eliminates dynamic loads, since they can significantly accelerate the deformation process.Physical exercises should be slow and low amplitude.
Example: sitting on a chair “astride”, that is, facing backwards.Spread your legs wide, but do not let them touch the floor.Slightly swing each leg in turn.Do the exercise until you feel slightly 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 cartilage tissue and diseased joint (arthrodesis).This is done very rarely.
- Removal of damaged cartilage tissue without removing the joint.This procedure 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.
- Cut and secure 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 resorted to infrequently and only in the absence of a method that cures the disease, at least for 1 to 2 years.In the early stages of the disease, surgery is almost never performed.
endoprostheses
Stent replacement 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 diseased knee.But, despite its effectiveness, this technique requires long-term rehabilitation.Furthermore, it can have 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 it is made of.The procedure is not cheap, but it is quite effective, which is why it has gained particular popularity.
therapeutic exercise
A doctor prescribes a course of exercise therapy 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 loading on the sore joint.
Exercises that are allowed:
- slight shaking of legs when kneeling on a blanket spread on the floor;
- careful knee movements in the same position;
- In the same position, stretch your legs one by one, trying not to lift your heels off the ground, and then bend them again, avoiding sudden movements.
These exercises, in combination with pharmacological treatment and physiotherapy, give excellent results.
Physiotherapy
All physiotherapeutic procedures are prescribed for gonarthrosis in remission.Among the most effective methods it is worth highlighting:
- electrophoresis with medicinal solutions;
- magnetic therapy;
- Ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent a recurrence of the disease, physiotherapy courses should be carried out at least 2 times a year.This will help prolong the remission phase.
massage
A 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 does not participate in this process.
Often, along with massage, manual therapy sessions are carried out, aimed at gradually stretching the sore joint.These 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, 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 carry out 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 helps to cure only for a few years, after which the disease may manifest itself 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 and sweet foods;
- maintain normal physical shape;
- Consult a doctor immediately if you experience the slightest knee injury;
- preventive use of chondroprotectors after 35 years;
- drink the daily norm of water (2 l).
If you follow these simple recommendations, you will reliably protect yourself from osteoarthritis of the knee joint, as well as other diseases that can reduce your quality of life for a long time.