Gonarthrosis, or arthrosis of the knee, is a serious degenerative-dystrophic pathology of the knee joint, which causes destruction of the structure of the cartilaginous tissues 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 progresses to a late stage of development, all of it is involved in the pathological process.
Most often the disease develops in people over 40 years old, but in athletes it can occur at a young age (after receiving serious joint injuries).
Women are most susceptible to joint deformation, but often it occurs in men and even in young children. In order not to aggravate 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 localization. Each of the varieties has its own developmental characteristics, which are always taken into account by the doctor when prescribing treatment. But by the nature of the manifestation, they are practically the same.
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 obese patients. Gonarthrosis of the knee joint of the primary type can develop over the years without manifesting itself in any way. But the sooner it is discovered, the more favorable the prognosis of its treatment will be.
- Secondary gonarthrosisof the knee occurs due to trauma, but it can also be the result of various infectious pathologies. If the damaged joints are healed in a timely manner, the patient has every chance of avoiding this disease.
There are types of osteoarthritis by 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 exertion.
- Left-sided gonarthrosisinvolves the left knee in the pathological process. 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 from the standpoint of a therapeutic approach. In most cases, this type of gonarthrosis of the knee joint develops in people in old age, that is, it is idiopathic.
Anatomy and pathological changes
The knee joint is formed from the articular surfaces of the tibia and femur. In its front part there is a patella, which, during movement, glides smoothly along the depression located between the condyles of the femoral joint.
The femur and tibia together with the knee pad are covered with elastic clay cartilage, which is 5-6 mm thick. It helps to reduce friction during physical activity by a person, and in case of falls, it performs a shock-absorbing function.
Pathological changes in the joints: phased disorders
At the first stage of development of gonarthrosis of the knee joint, blood circulation is affected first of all. Small intraosseous vessels that supply blood to the hyaline joint are disturbed, which leads to a gradual drying of its surface. It becomes less elastic, and cracks begin to form on its surface.
As a result, instead of smoothly sliding, these cartilages touch each other. Inflammation gradually begins to develop, and the diseased cartilages, shifting slightly, interfere with each other to fully perform 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 cushioning properties.
In the second phase of gonarthrosis progression, compensatory changes in the bone area begin to occur. Under the influence of increased loads, the articular platform gradually begins to flatten, this leads to a compaction of the subchondral zone (the part of the bone that is located under the cartilage).
The articular surfaces along the edges begin to overgrow with bony processes, which on an X-ray image look like sharp spines.
As the lubricating fluid thickens in the joints, it loses most of its function. This leads to accelerated cartilage degeneration. For this reason, it looks like a thin thread on the X-ray, or becomes completely invisible.
If something like this was noticed, it 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, there is a noticeable deformation of the bones. They seem to be squeezed into each other, which leads to a decrease in joint mobility. The cartilage tissue almost completely dries up.
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 (moderate or high severity);
- leg fractures, especially if there was intra-articular damage;
- violation of the integrity of the meniscus structure;
- tears or complete tears of the ligaments;
- excessive stress on the knee joints.
Acute arthrosis of the knee joint is directly related to a person's age. So, it was found that people over 40 are most susceptible to it, since during this period the flexibility of the cartilage begins to decrease, and the lubricating joint fluid gradually "dries up".
To delay this moment, sports are recommended for patients, 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 an additional load on bones and joints, which cannot but affect their health.
In this case, an important role is played by the fact which leg has more loads. For example, if your "support" is the 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. Ruptures of the menisci or ligaments, which are considered a severe way of manifesting joint injuries, are also possible.
This disease is extremely difficult for patients with pronounced symptoms of varicose veins. In this case, the patient is shown a phlebologist's consultation.
A high risk of developing this pathology also exists in people who:
- have previously suffered from different types of arthritis;
- have unfavorable heredity;
- have problems with the ligamentous apparatus;
- suffer from metabolic disorders;
- have suffered traumatic brain injury;
- were injured in an accident;
- had spinal injuries.
Many of these factors are often closely interrelated. Accurate determination of the cause helps to establish an accurate diagnosis and prescribe the correct and effective treatment for arthrosis of the knee joint to the patient.
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 the development of the disease, patients complain of mild pain in the knee area, which increases with physical exertion. They become especially intense during the descent and ascent of the stairs.
In addition to pain, the patient feels a certain stiffness of movements, "constriction" in the joint area. It is felt in the popliteal region, and passes when the muscles of the knee are relaxed.
Another characteristic feature is the so-called "starting pain syndrome". It develops at the first steps of the patient. 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 exertion it again makes itself felt.
The inflammation of the joint causes swelling of the knee that is visible even to the naked eye. There is a strong, unpleasant crunch when walking. The movements become heavier and more constrained.
Stage Three
The pain becomes very severe and the patient cannot do without pain medication. It is difficult for a person to bend the knee, he feels the stiffness of the joint movements. It becomes deformed and increases in size. In severe cases, the patient cannot move without additional support.
All these signs of knee arthrosis 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 knee gonarthrosis?
For the diagnosis and treatment of knee gonarthrosis, it is necessary to consult an orthopedic traumatologist. If surgery is necessary, you may need the help of a surgeon.
Diagnostic measures
In order to establish the cause of the ailment, an integrated approach to patient examination is extremely important.
The diagnostic scheme consists of several stages:
- Visual examination of the orthopedist and taking anamnesis. 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 an angle measurement - a test that can be used to assess the mobility of the joint at different angles.
- Clinical blood test for ESR assessment.
- Blood biochemistry.
- 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, at the initial stages, the snapshot does not show any changes - they can be noticed only at the later stages of development. The radiograph shows a narrowing of the joint gap, sclerotic changes in the cartilage area, damage to bone tissue and salt deposits.
- Ultrasound is the most informative diagnostic procedure. However, full-fledged examination results can be achieved if ultrasound is performed along with radiography.
- MRI allows you to thoroughly examine all layers of articular, cartilaginous and bone tissues, and notice the first dystrophic changes in the early stages of arthrosis. However, MRI has one big drawback - the procedure is quite expensive. But its high accuracy contributes to 99. 9% accurate diagnosis.
Treatment
Treatment of acute arthrosis of the knee, like its diagnosis, requires an integrated approach. But, first of all, it is necessary to apply drug therapy, because the diseased joint can become inflamed at any time.
Medication
How to treat gonarthrosis of the knee joint with pharmacy drugs, and which drugs to choose? Only a traumatologist will say about this. Often, drugs of the following groups are included in the therapy regimen:
- 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. The same cannot be said about the drugs of the COX-2 group, which are more gentle. They are administered intramuscularly or intravenously.
- Treatment of knee arthrosis also involves the use of hormonal drugs. They help relieve inflammation and swelling in the knee. Their use is advisable if there is synovitis (inflammation in 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 technique? The main elements of the therapy scheme are:
- use of medications (NSAIDs, chondroprotectors, pain relievers, ointments, creams, gels);
- light physiotherapy exercises;
- manual therapy;
- physiotherapy;
- warming anti-inflammatory compresses with medicinal solutions.
In addition, according to the famous rheumatologist, diet plays an important role in arthrosis. Due to a properly developed diet and the use of all of the above techniques, you can achieve amazing results from therapy in the shortest possible time.
Method two
Often the treatment of arthrosis of the knee joint, like other articular pathologies, is carried out using this method.
The development of a famous doctor is based on the application:
- medications;
- surgical intervention;
- adherence to a diet that removes excess fluid from the body;
- kinesitherapy;
- physiotherapy.
The doctor also recommends swimming more in the pool, going to the sauna and going for a massage. This will help improve the patient's health, especially if the disease has been ignored for a long time and has not been treated.
Treatment by the third method
Treatment of gonarthrosis of the knee joint using this technique completely eliminates dynamic loads, since they can significantly accelerate the deformation process. Exercise should be slow, low amplitude.
Example: sit on a chair "on top", that is, facing the back. Spread your legs wide, but do not let them touch the floor. Gently wave each leg in turn. Do the exercise until you feel a little tired. The number of approaches depends on the patient's well-being.
Surgery
How to treat advanced arthrosis of the knee joints? In this case, there is only one way out - operation. There are several types of surgery for osteoarthritis of the knee joints:
- Removal of deformed cartilage and diseased joint (arthrodesis). It is extremely rare.
- 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 is called a periarticular osteotomy. The technique is rather complicated, but it makes it possible to forget about the pathology for 3-5 years.
Surgical intervention is rarely resorted to, 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, the operation is almost never performed.
Endoprosthetics
Endoprosthetics is considered the most common treatment for gonarthrosis. This is a type of surgery that allows you to fully maintain the mobility of the affected knee. But, despite its effectiveness, this technique requires long-term rehabilitation. Moreover, it can lead to rather serious consequences.
The place of the "real" patient is implanted with an artificial joint, which can serve 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.
Physiotherapy exercises
The course of exercise therapy is prescribed by the doctor depending on the stage of the disease. However, the principles of doing the exercises are the same for all cases:
- avoiding intense stress on the knee joint;
- abrupt and forced movements are prohibited;
- do not perform exercises that require full load on the sore joint.
Exercises Permitted:
- light shaking of the legs while kneeling on a blanket spread on the floor;
- neat kneeling movements in the same position;
- in the same position, alternately straighten the legs, trying not to lift the heels off the floor, and then bend them again, avoiding sudden movements.
These exercises, combined with medication and physical therapy, give excellent results.
Physiotherapy
All physiotherapy procedures are prescribed for gonarthrosis in remission. Among the most effective techniques, it should be noted:
- electrophoresis with medicinal solutions;
- magnetotherapy;
- ultrasound therapy;
- microwave treatment;
- paraffin therapy;
- baths with radon or hydrogen sulfide;
- mud treatment.
To prevent a recurrent outbreak 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 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 carried out, aimed at gradually stretching the diseased joint. Such procedures stabilize the patient's condition, but can only be carried out by a specialist.
Is gonarthrosis completely cured?
Is it possible to completely cure osteoarthritis of the knee joint? 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 in the early stages of its development, you can stop further joint deformation.
However, if a pathology is found in the last stages, then even surgical intervention does not guarantee the complete disappearance of unpleasant symptoms. The operation helps to heal only for a few years, after which the disease can again remind of itself.
Prevention
To prevent gonarthrosis it is necessary:
- avoid knee injuries;
- constantly exercise (squatting, running, raising and lowering legs);
- enrich the diet with foods containing many vitamins;
- limit the use of salt, hot spices, fried, smoked, sweet;
- maintaining normal physical shape;
- immediate medical attention if you receive the slightest knee injury;
- prophylactic use of chondroprotectors after reaching 35 years of age;
- consumption of daily water intake (2 liters).
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.